Kids Love Dr. Barton

Ouch, That Head "Bonk" Hurts!

by Dr. Douglas Barton, M.D., Pediatrician 03/30/2009


What parent hasn’t seen it?  Your son (or daughter) is running along, trips and hits his head on the (you fill in the blank).  Now, there’s a huge “goose-egg” on his forehead.  If the bump protrudes out then it’s ok, right?  Isn’t it better than having a dent in his head?  Both perceptions are common, but wrong.  With the recent death of actress Natasha Richardson, head injuries are back in the news and scarier than ever.

The first thing to know is that this happens all the time, with over 1.5 million reported head injuries in the United States annually and 300,000 pediatric hospital admissions.  The vast majority of these result in no long-term problems. However, as in Richardson’s case, results can be catastrophic.  So how do you decide which kind of head injury your child has?

There are two bad outcomes from head injuries: concussion and intracranial bleeding.  A concussion is ANY change in mental status following a head injury.  That means even a small amount of confusion, dizziness or disorientation following a head injury is considered a concussion.  Most of the time, these symptoms are trivial.  On occasion, however, these symptoms can persist a very long time.  They may even progress to chronic headaches, chronic mood changes, and chronic trouble concentrating.  Many of these symptoms are not treatable, as scientists do not really understand why they happen.  Most importantly, if a child has ANY residual symptoms of a concussion and then has another head injury, it can lead to severe consequences, including death.  This so-called “second impact syndrome” is the reason I do not allow any athlete to compete in any sport with the potential for head injury until ALL symptoms of the first concussion are resolved.

Intracranial bleeding is the complication that killed Richardson.  There are two kinds of bleeding in the head. The first, subdural, is inside the skin that surrounds the brain, called the dura.  These bleeds are relatively common and usually lead to progressive headache with some vomiting. They usually show up on the first CT scan done in the emergency room. They also tend to not cause sudden catastrophic outcomes.  The second type of bleeding, epidural, is outside the skin around the brain. These bleeds often cause an initial bad headache, followed by a period of hours to a day or so, where the patient feels totally fine.  Then all of a sudden, the patient will develop a severe headache and mental status changes that appear to have no cause, except the injury from the day before.  These bleeds are absolute emergencies and can cause death very quickly.  It is unclear from press reports what caused Richardson’s death, but I suspect this latter type of bleeding was the cause of her demise.

Needless to say, any head injury that causes symptoms should prompt at least a phone call to your physician.  The vast majority of these are harmless, but any persistence or worsening of symptoms can be very concerning and should be managed in concert with your physician.

 

 

 

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