Pediatric head injury

Pediatric head trauma is common and can range from minor to severe. Management is directed toward detecting and treating possible brain injury and is based on the extent of the head injury. Most pediatric head injuries are minor. Despite advances in the care of the child who has experienced TBI, the treatment varies greatly. Pediatricians often are the first responders to the head-injured child and must assess and triage the children quickly. Early decisions include whether to refer to an emergency department and whether neuroimaging is needed. The ideal imaging modality for assessing head injury is noncontrast CT, which can detect both intracranial injury and skull fracture reliably. However, pediatricians should be aware of the long-term risks associated with radiation exposure from CT. The child who has normal neurologic findings after isolated head trauma and a negative CT scan is at very low risk for developing intracranial abnormalities later and may be discharged from the hospital with close observation. Children who have suffered mild-to-moderate concussions should not return to contact sports until they are completely symptom-free, both at rest and on exertion, for 1 week. Any child who has experienced head injury with symptoms lasting for longer than 1 week should be referred for neurocognitive evaluation.