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|Quick reference medical handouts used
by Pediatric offices
Three Myths about Childhood Head Injuries
media are partially responsible for some of the myths surrounding head
injuries. We see the hapless movie victim fall backwards, striking her
head on the brick fireplace, and within seconds, the character dies from
the injury. Or after a head injury, a dazed, nearly unconscious teen
gets rushed to the ER, while his friends frantically yell at him to stay
the reality is far different from the media portrayal of an injured
head, so let us separate the myths from the facts.
MYTH #1: Never let
a head injured child fall asleep.
Consider this common scenario: Your 2-year-old twin boys
are racing through the house just before bedtime, when one of them falls
and strikes his forehead against the doorjamb. He cries immediately
(screaming might be more accurate), develops an impressive goose egg,
but within minutes, he is active and happy. Bedtime approaches, but you
diligently keep him awake using whatever means are necessary. After all,
if he falls asleep, he may never wake up. By the time you bring him to
the ER, your toddler is extremely cranky from being kept up several
hours past his bedtime, and you are exhausted from your efforts.
Furthermore, from an ER doctor's point of view, trying to evaluate the
mental status of an over-tired and irritable 2-yearold is the ultimate
Let the poor kid sleep. Sleeping is not the issue. What I want to know
is whether or not the child can be awakened. In other words, is he just
sleeping, or is he unconscious?
a person gets bonked on the head, the fragile brain can bruise and swell
after bouncing against the much harder skull. Head trauma can cause
brief unconsciousness, followed by a headache, nausea, or
lightheadedness. We refer to this cluster of symptoms as a concussion,
and the injury usually resolves over the course of a few days.
do we do for simple concussions? Not much. Rest, watchful care, and try
to avoid any new injuries while the brain heals. (I always feel silly
telling parents to keep their 2-year old from playing in any way that
would risk a fall or further injury, as if such a thing is humanly
child's goose egg is also not a major source of worry. The scalp and
forehead have thick skin, packed with tiny blood vessels. A contusion to
this tissue breaks these vessels and they bleed beneath the skin. A
goose egg can be impressive in size, but rarely causes any lasting
we worry about much more than a concussion or a goose egg is bleeding
inside the head, between the skull and the brain, or inside the brain
itself. This expanding pool of blood, called a hematoma can compress the brain, causing lethargy or unconsciousness. Surgery
on this very dangerous injury can be life-saving.
#2: X-rays are needed to properly diagnose head injuries.
of all, while X-rays can show if the skull has a fracture, they do not answer
the far more important question: How is the brain doing? Secondly, skull
fractures usually are benign and rarely require any treatment at all. The only
way to properly assess for bleeding inside the skull or brain is with a CT-scan
or an MRI, not plain X-rays.
MYTH #3: Head
injuries are not serious if a person who's been knocked-out wakes up within a
This is a dangerous myth.
injuries can cause slow and subtle bleeding between the brain and the skull, and
the signs of such bleeding might not be apparent for several hours. Any child
who has been knocked out should be evaluated by a physician, even if the child
looks and acts fine. As for the head-injured child who wasn't knocked out-if he
or she has a headache, is irritable or vomiting, or "just not acting
right" to you-get the child checked out by a physician, too. And certainly
if a child continues to scream or cry, he should be checked by a doctor. Take
this to mean that prolonged fussiness and crying are red flags for you as a
please, while you are driving to the doctor, let your fussy child sleep if she
wants to. Doctors have wonderfully
annoying ways of waking up patients in the emergency room.
by Steven Sainsbury, M.D., and reprinted from the January/February 2006 issue of
Twins Magazine and posted 01-02-06 on kidsgrowth.com
As a reminder, this information should not be relied on as
medical advice and is not intended to replace the advice of your childs pediatrician.
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