All Children Bump their Heads, Not all Children Should Get a CT Scan if they Do

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All Children Bump their Heads, 
Not all Children Should Get a CT Scan if they Do


Whenever a child bumps their head, we have to ask- "Are they OK?"


This is a very fair question.


The main reason they might not be, is that when you bump your head,
you bump your brain.  So when you bump your head, we want to be 
sure the brain is OK.


Now and then, stories of seemingly minor head injuries end with 
tragic loss of brain function.


This is a real problem, because every child will bump their head, 
and far, far more than 99% will experience no injury to their brain at all.


The key is to know when to worry, and recently, an article was published
in The Lancet (Sept. 15, 2009) that helps.  In this study, about 42,000
children, ages 18 and younger, had an accident with a bike, car, or 
serious fall.  About 15,000 had a CT scan done, and only 780 or
5% of them had anything wrong with their CT scan.


The real value of the article is that they were able to list 6 items, 
that if your child does not have one, the CT scan was normal.


For kids 2 and older the six signs were:

• Loss of consciousness (can't be awakened at all)
• Altered mental state (can't stay awake or act normally)
• Signs of a skull fracture
• Vomiting
• Headaches
• A high speed impact (like a car accident)

For kids under 2 years old the six signs were:

• Loss of consciousness (can't be awakened at all)
• Altered mental state (can't stay awake or act normally)
• Signs of a skull fracture
• Scalp swelling (beyond just a goosegg)
• Unusual behavior
• A high speed impact (like a car accident)

It is estimated by just not getting a CT scan after a head injury, about 

20-25% of all CT scans for head injury could be avoided, while not missing

any problem with the brain.

BOTTOM LINE

• Every child will hit his or her head during childhood
• The main concern is brain safety after a bump
• Hitting your head while on the ground, while standing, without any change in behavior, alertness, vomiting, severe pain, or unusual swelling almost never results in any injury to the brain that can be seen on a CT scan.
• The situation to worry about is mainly when something increases the impact, such as:
• Falling from a height
• Two fast runners colliding
• Skating rapidly on ice
• HIt in or by a car, bicycle,  other vehicle
• Again, a slow bump with no symptoms means the brain should be fine.

Feel free to call if you ever are unsure.

Dr. Arthur Lavin

A couple of point

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