Study purpose

1. HEAD INJURIES IN
CHILDREN
Presented by: Maqsooda sttar
Lecturer, snc
RN, RM, Post RN BSN
Dip in paediatric health nursing

2. OBJECTIVES:
At the end of session the learners will be able to,
Define HEAD INJURY
Indicate etiology
Discuss pathophysiology
Explain types of head injuries
 Describe complications
 Enumerate management

3. HEAD INJURY
• A head injury is a broad term that describes a vast
array of injuries that occur to the scalp, skull, brain,
and underlying tissue and blood vessels in the head.
Head injuries are also commonly referred to as
brain injury, or traumatic brain injury (TBI),
depending on the extent of the head trauma.

4. HEAD INJURY
• Is a pathologic process involving the
scalp,skull,meninges or brain as a result of
mechanical force.
• is a morbid state, resulting from gross or
subtle structural changes in the scalp, skull,
and/or the contents of the skull, produced by
mechanical forces.

5. ETIOLGY
The three major causes of brain damaging childhood ,in order of
importance are :
1. falls
2. Motor vehicle injuries.
3. Bicycle injuries
Neurologic injuries accounts for the highest mortality rate,
with boys usually affected twice as often as girls. Incomplete
motor development contributes to falls at young ages and the
natural curiosity and exuberance of children increase their risk
for injury. Infants are often left unattended on beds, in high
chairs and in other places from which they can fall.

6. PATHOPHYSIOLOGY
The AVPU scale (Alert, Voice, Pain, Unresponsive) is a system, which is
taught to healthcare professionals and first aiders on how to measure and
record the patient's level of consciousness.

7. CLINICAL MANIFESTATION
• Raised, swollen area from a bump or a bruise.
• Small, shallow cut in the scalp.
• Headache.
• Sensitivity to noise and light.
• Irritability or abnormal behavior.
• Confusion.
• Lightheadedness or dizziness.
• Problems with balance.

8. TYPES OF HEAD INJURIES
• Concussion.
• Contusion.
• Laceration.
• fractures.

9. CONCUSSION
• Is the most common head injury , an alteration in
mental status with or without loss of
consciousness, which occurs immediately after
head injury.
• The hallmark of concussion are confusion and
amnesia.
• Pathogenesis is still unclear but it may be a result
of shearing forces that causes stretching ,
compressions and tearing of nerve fibres,
particularly in the area of the brain stem.

11. CONTUSSION
• Represents petechial hemorrhages or localized
burusing along the superficial aspects of the brain at
the site of impact or a lesion remote from the site of
direct trauma.
• The major areas of the brain susceptible to
contussion are occipital,frontal and temporal lobes.
• It may cause focal disturbances in strength ,
sensations or visual awareness in children.

13. LACERATION
• A laceration is a wound that is produced by the
tearing of soft body tissue. This type of wound is
often irregular and jagged. A laceration wound is
often contaminated with bacteria and debris from
whatever object caused the cut.
• Also describes & as actual bruising and tearing of
cerebral tissue.
• Is associated with penetrating or depressed skull
fractures.

15. FRACTURES
• Skull fractures results from a direct blow or injury
to the skull and are often associated with intra-
cranial injury.
The types of skull fractures are
1. linear
2.comminuted.
3. depressed.
4. open
5. basilar
6. growing fractures

16. DESCRIPTION
• Linear : This is the most common simple
type. It is typically in the temporal or
parietal area.
• Depressed : This is usually caused by a
direct blow to the head and requires a
neurosurgical opinion. A depressed skull
fracture can sometimes be referred to as a
ping-pong fracture.
• Open : An open fracture carries a high risk
of infection.

17. Conti….
• Basal : Basal fractures involve any of the bones of the
base of the skull. Basal fractures are more
complicated due to underlying structures such as
cranial nerves and sinuses which can lead to hearing
loss, facial paralysis, or decreased sense of smell.
They also can pose a risk for meningitis.

18. Conti…
• Growing : A growing fracture describes herniation of
the brain through the broken dura following a skull
fracture (often diastatic). It usually presents later and
grows as the brain herniates through the gap, as a
persistent swelling or pulsatile mass. It is uncommon

19. COMPLICATIONS
• Seizures.
• Venous sinus thrombosis.
• Intra-cerebral bleed.
• Meningitis (if there is an open fracture).
• Growing skull fracture.
• Hemorrhage .
• Infection.
• Edema.
• Herniation.

20. DIFFERENTIAL DIAGNOSIS
• Brain laceration
• Epidural hematoma
• Frontal Lobe Syndromes
• Generalized Tonic-Clonic Seizures
• Hydrocephalus
• Open and depressed fracture
• Subdural Empyema
• Subgaleal hematoma

21. ASSESSMENT
Rapidly assess the child's mental state using
the AVPU scale.
A Alert
V Responds to voice
P Responds to pain
Purposefully
Non-purposefully: Withdrawal/flexor response or
extensor response
U Unresponsive
Assess pupil size, equality and reactivity.

22. CONT..
• History
• Time and mechanism of injury.
• Circumstances of injury, e.g. accident, unexplained fall (consider
syncope).
• Loss or impairment of consciousness and duration.
• Nausea and vomiting.
• Clinical course prior to consultation - stable, deteriorating,
improving.
• Other injuries sustained.
• Past history of bleeding tendency.
• Presence of amnesia.
• Post injury seizure.
• Presence of headache.

23. MEDICAL MANAGEMENT
• Asymptomatic patients may be discharged home to the care of
reliable parents or guardians.
• If after initial evaluation there is headache or repeated vomiting, or
there is a history of loss of consciousness at the time of trauma, a
period of clinical observation, with reassessment, is indicated.
• In the child younger than two years of age, and particularly in
children younger than 12 months of age, greater caution is advised.
• All patients with moderate head trauma should undergo imaging by
CT scan.
• Once the patient with a severe head injury has been stabilized,
including intubation, a cranial CT scan should be performed.
• Patients with severe head trauma require referral to a trauma
centre with neurosurgical and paediatric critical care services.

24. NURSING MANAGEMENT
• Continuous monitoring of vital signs and, if possible,
end-tidal CO2
• Mechanical ventilation to maintain normal
oxygenation and ventilation
• Maintenance of a normal core temperature
• Providing sedation and analgesia, particularly during
procedures and transport
• Fluid administration as required to maintain
normovolemia and avoid hypotension.

25. PREVENTION
• Health care practitioners have numerous opportunities to
provide age-appropriate anticipatory guidance around risk
factors for head trauma in children. The CPS advocates for
public policy and legislation to ensure, for example, helmet
use in sporting activities, child restraint use in vehicles and
the ban on baby walkers in Canada. Such measures have
proven successful in reducing both the incidence and severity
of head trauma in paediatric patients. Clinicians treating
infants, children and youth should include injury prevention
when counselling families.

26. REFERENCE
 Hockenberry, m and wilson, d. (2015) wong's nursing care of
infants and children. 10th edition.
 Basis of pediatrics
 Manual of neonatal care,7th ed, john p. Cloherty. Md,eric
Eichenwald, md,anne r. Hansen, md, mph,ann r stark, md
 Basic of peadiatric 7th edition (pervez akber khan)