Post-Head Injury Swelling in Children: What to Know

Q: Post-Head Injury Swelling in Children: What to Know

Hello： We recommend that you take her to our neurosurgery outpatient clinic for better assistance. <br>Sincerely, Dr. <br>Ding Hsien-Wei, Neurosurgery.

Swelling after a head injury?

My daughter (7 years old) bumped the back of her head while playing two weeks ago.
That day, it was red, swollen, and painful.
Three days later, since she felt a slight bulge at the injury site and it was still painful when pressed lightly, I took her to China Medical University for an examination to check for a concussion or any internal brain injury.
The doctor said the critical period of three days had passed, and as long as the child did not experience drowsiness, vomiting, or any discomfort, there should be no major issues.
He advised applying ice for 1-2 days, followed by heat for 3 days, and that she should recover.
After returning home, we applied ice once that day.
Since the child showed no abnormal symptoms and was in good spirits, we did not continue with the ice or heat treatments.

Until the day before yesterday, when I was tying her hair, I suddenly noticed a significant protrusion at the injury site (which had not been there before; it was just a normal swelling).
I asked my daughter if it hurt when I pressed there, and she said it did not.
Later, she mentioned it hurt a little bit, but it did not hurt when lying flat to sleep.
We took her back to China Medical University to see the same doctor, who said that based on visual inspection and palpation, it appeared to be a bone tumor.
He indicated that it was generally not serious.
I asked the doctor if it could be related to the earlier bump, and he said the two were unrelated.
However, I suspect this timing is coincidental.
The doctor later mentioned another possibility: that there could be a fracture in the bone causing the meninges to be pushed out.
If this were the case, immediate surgery would be necessary, but the likelihood of this situation is low.
We are currently waiting for an MRI, which is scheduled for September 1.
The doctor also mentioned that bone tumors typically do not require surgery unless they grow larger and affect daily life.
If surgery is needed, it would be better to wait until the child is in her teens.
Could this appear to be a bone tumor? Or is there a greater chance of it being another condition (the meninges protruding), or could there be other possibilities? (The protrusion feels hard but has a slightly soft component; it is not completely hard.)

tc, 30~39 year old female. Ask Date: 2006/08/16

Dr. Ding Xianwei reply Neurosurgery

Hello: We recommend that you take her to our neurosurgery outpatient clinic for better assistance.
Sincerely, Dr.
Ding Hsien-Wei, Neurosurgery.

Reply Date: 2006/08/16

More Info

When a child experiences a head injury, especially in the case of a fall or a significant impact, it is crucial to monitor for any signs of complications. In your daughter's case, she sustained a bump on the back of her head two weeks ago, and while initial assessments indicated no severe issues, the subsequent development of a noticeable bump raises valid concerns.

Understanding the Bump
1. Possible Causes: The bump you described could be due to several factors:
- Hematoma: After a head injury, blood can accumulate under the skin, leading to a localized swelling known as a hematoma. This can feel firm and may be tender to the touch. Over time, hematomas can resolve on their own, but they can also change in appearance as they heal.

- Bone Callus Formation: If there was a minor fracture that went unnoticed, the body might form a callus around the healing bone, which can feel like a bump. This is a natural part of the healing process.

- Osteoma: This is a benign bone tumor that can develop in children. Osteomas are usually asymptomatic unless they grow large enough to cause discomfort or pressure on surrounding tissues.

- Meningocele: In rare cases, if there is a fracture, the protective membranes covering the brain (meninges) could bulge out, leading to a condition known as meningocele. This would typically require surgical intervention.

2. Symptoms to Monitor: It is essential to keep an eye on any changes in your daughter's condition. Symptoms that warrant immediate medical attention include:
- Increased pain or tenderness at the site of the bump.

- Changes in behavior, such as increased irritability or lethargy.

- New symptoms such as headaches, dizziness, or nausea.

- Any signs of neurological changes, such as difficulty walking or speaking.

Diagnostic Approach
Given the complexity of head injuries and the potential for delayed complications, the MRI you are awaiting is a crucial step. It will provide detailed images of the brain and surrounding structures, helping to rule out any serious conditions such as fractures or abnormalities in the brain tissue.

Treatment Considerations
- Observation: If the bump is indeed a hematoma or a benign osteoma, the typical approach is to monitor it over time. Most of these conditions resolve without intervention.

- Surgical Intervention: If the MRI indicates a meningocele or a significant fracture, surgical intervention may be necessary. The decision for surgery would depend on the size of the bulge, its impact on surrounding structures, and any associated symptoms.

Conclusion
While the physician's initial assessment suggests that the bump is likely benign, the development of a hard yet slightly soft protrusion after a head injury should not be taken lightly. It is prudent to await the MRI results for a definitive diagnosis. In the meantime, continue to monitor your daughter for any new symptoms and maintain open communication with her healthcare provider regarding any concerns you may have. If the bump grows or if she experiences any discomfort, do not hesitate to seek further medical evaluation.

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