Childhood emergencies

May 2010

FocusChildhood emergencies

Minor head injuries in children

An approach to management

Volume 39, No.5, May 2010 Pages 284-287

Carl Luckoff

Mike Starr

Background

Traumatic head injury is a common occurrence in the paediatric population, with the majority of patients sustaining only mild head injury.

Objective/s

This article outlines the management of mild head injuries in children.

Discussion

A careful history including time of injury, the mechanism of injury, and any loss of consciousness or seizure activity; a thorough examination including a Glascow Coma Scale (GCS) score; and observation should be appropriate for most patients. Only a small number of injuries require further examination/imaging with computerised tomography. Indicators for transfer to hospital include GCS equal to or less than 12, focal neurological deficit, clinical evidence of skull fracture, loss of consciousness for more than 30 seconds, ataxia, amnesia, abnormal drowsiness, persistent headache, seizure following initial normal behaviour or recurrent vomiting. Postconcussive symptoms frequently occur after minor head injuries and parents and other family members should be aware of what symptoms to expect, and possible duration. Regular follow up until all symptoms have resolved is mandatory, with clear guidelines for stepwise resumption of physical activity.

Although head injury (HI) is common within the paediatric population, no accurate data exist for the true incidence of HIs within this population subset in Australia. For the management of HIs, all those aged 16 years or less are considered to be part of the paediatric population.

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Correspondence afp@racgp.org.au

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