Head Injuries in Infants: What Parents Need to Know

Bruise

Hello: On June 18th, I took my baby to the hospital for an outpatient visit.
During an X-ray, the nursing staff accidentally allowed him to fall from a bed about one meter high.
When discovered, he was face down but conscious.
An X-ray was performed at that time, and there were no fractures.
We were instructed to go home and monitor him.
How long should we observe him at a minimum? Until when should we follow up to feel reassured? My baby is currently over eight months old, born at 35 weeks and 3 days, with a corrected age of over seven months.
He has been suffering from bronchiolitis and has been on medication for nearly half a month without improvement.
We just arrived at Zhongshan, and I didn't expect this to happen.
Is it certain that falling and hitting his head will lead to long-term effects? How can we determine if there is internal bleeding? Please help a mother who feels guilty.
Thank you.

Yin Yin, 0~9 year old female. Ask Date: 2005/06/17

Dr. Cai Zhengxian reply Pediatrics

Dear Mother,
I understand that such an incident can indeed be concerning.
You may be wondering if there will be any long-term effects from the head injury.
Generally speaking, infants have softer skulls, and their fontanelles have not fully closed yet.
When a head injury occurs, the primary concern is to observe for signs of a concussion.
The signs to monitor for a concussion are consciousness changes, such as excessive drowsiness or agitation, loss of tone in one arm or one leg, and any non-feeding related repeated vomiting within the first 48 hours after the injury.
It seems that it has been almost 48 hours since the incident (I apologize for only seeing your message today).
If none of the aforementioned symptoms are present, you should feel more at ease.
Conversely, if any of these symptoms are observed, please ensure to take your baby to the hospital for neuroimaging, such as a cranial ultrasound or a CT scan of the brain (which is the best tool to check for intracranial bleeding).
If there are no signs of a concussion, a CT scan is generally not necessary due to the significant radiation exposure it poses to an infant's brain.
Wishing you and your baby safety and good health!
Sincerely,
Dr.
Tsai Cheng-Hsien
Department of Pediatrics
Tainan City Hospital

Reply Date: 2005/06/17

More Info

When it comes to head injuries in infants, especially those who are as young as eight months old, it is crucial for parents to be vigilant and informed about the potential risks and necessary precautions. In your case, the incident of your baby falling from a height of approximately one meter is understandably concerning, and it is important to follow appropriate guidelines for observation and care.

Observation Period
After a head injury, the recommended observation period typically lasts for at least 24 to 48 hours, but in the case of infants, it is often advised to monitor them for up to a week. During this time, parents should be alert for any signs of complications, such as:
1. Changes in Consciousness: If your baby becomes increasingly lethargic, difficult to wake, or unresponsive, this could indicate a serious issue.

2. Vomiting: Repeated vomiting, especially if it is forceful or "projectile," can be a sign of increased intracranial pressure or other complications.

3. Seizures: Any seizure activity following a head injury should prompt immediate medical evaluation.

4. Behavioral Changes: Look for unusual irritability, decreased appetite, or changes in normal activity levels.

5. Physical Symptoms: Monitor for any swelling, bruising, or abnormal movements.

Long-term Monitoring
While many infants recover from minor head injuries without any lasting effects, it is essential to remain cautious. If your baby shows no concerning symptoms during the initial observation period, you may feel more reassured. However, it is wise to continue monitoring for any delayed symptoms for at least a week or two. If any new symptoms arise, do not hesitate to seek medical advice.

Risk of Complications
Regarding your concern about potential long-term effects or complications such as intracranial bleeding, it is important to understand that not all head injuries result in significant damage. The absence of fractures on the X-ray is a positive sign, but it does not completely rule out the possibility of internal bleeding or other injuries. If your baby exhibits any of the warning signs mentioned above, a follow-up with a healthcare provider is necessary. In some cases, a CT scan may be warranted to rule out any internal injuries.

Assessing for Internal Bleeding
Determining whether there is internal bleeding can be challenging, especially in infants who cannot communicate their symptoms. Parents should be particularly attentive to the following signs:
- Unusual crying or irritability: This may indicate discomfort or pain.

- Changes in feeding habits: Refusal to eat or drink can be a sign of distress.

- Physical signs: Look for any swelling or unusual bruising on the head or body.

Conclusion
As a parent, it is natural to feel anxious after such an incident, especially when your child is still recovering from a respiratory illness like bronchiolitis. It is essential to trust your instincts; if you feel that something is not right, do not hesitate to consult a healthcare professional. Regular check-ups and open communication with your pediatrician can provide reassurance and guidance as your baby continues to grow and develop. Remember, while head injuries can be serious, many infants recover fully without any long-term effects. Your vigilance and care are crucial in ensuring your child's health and safety.

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