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When a bump on the noggin should be cause for concern

July 27, 2010

It’s summertime, the most active season of the year, especially for kids out of school. And that can mean more slips and spills. Hitting your head after slipping on the wet pool deck. Getting beamed on the noggin by a baseball bat.

For children and adolescents, head injuries are a common occurrence, yet most are mild and not associated with traumatic brain injury. But for some kids a bump to the head can be more than just a sensitive memory of the fall they took out of a tree in 3rd grade. And that raises the question, “When is it appropriate for a child to visit the Emergency Department after suffering a head injury?”

Any child who's not acting like themselves after hitting their head should see a doctor,” said Dr. Joeli Hettler, attending physician in the Pediatric Emergency Department at Baystate Medical Center. She said parents should seek immediate medical attention for their child if they notice behavior changes such as irritability or drowsiness, if the child develops a severe headache, or has recurrent vomiting.

Furthermore, the American Academy of Pediatrics recommends that parents contact their child’s healthcare provider for advice on any injury that is “more than a light bump on the head.”

For a child who resumes playing or running immediately following a bump on the head, life-threatening injury is unlikely.  Dr. Hettler noted symptoms of a serious head injury usually appear immediately, but can develop within the first few hours. For example, actress Natasha Richardson died of a traumatic brain injury last year following a blunt impact to the head, but did not have any symptoms until an hour after the accident. If a child appears sleepy or confused after a head injury it is important to have a physician determine if he or she has sustained a simple concussion, or a more serious injury. 

If the neurological exam is abnormal, or if symptoms are not improving, a CT scan (computed tomography) of the brain is often necessary to evaluate for bleeding or swelling of the brain.

Most kids with head injury can be treated safely without having a CT scan. It is important to keep in mind, however, that the more serious the injury, the greater the possibility a CT scan will be necessary.

Studies have shown that all too often youngsters with mild head trauma are unnecessarily exposed to radiation from a CT scan. Research has also shown that exposure to ionizing radiation increases the likelihood that a patient will develop cancer in the future, although the risk is low for a single scan, especially if there is appropriate attention to dose reduction.

According to Dr. Stephen C. O’Connor, director of the Radiology Residency Program at Baystate, the hospital takes precautions to protect children and adults from over exposure to radiation from CT scans and other forms of imaging technology.

“The most important first step is to document that a CT scan is required, and there are clinical practice guidelines that we carefully follow to determine which patients will benefit from the information to be derived from an imaging study. The second step is to minimize exposure to the extent possible,” said Dr. O’Connor.

He noted while radiation exposure factors can be significantly decreased in children compared with adults for chest, abdomen and pelvic CT scans, there is less room for dose reduction in head imaging because of the difficulty presented in the detection of subtle traumatic brain injury.

“Nevertheless, our standard pediatric head CT protocol includes age-based selection of exposure parameters,” he added.

Under the guidance of Dr. Stanley Polansky, chief, Pediatric Radiology, the Department of Radiology is a member of the Image Gently Campaign, a national collaborative effort to change practice by increasing awareness of the opportunity to lower radiation dose in the imaging of children.

For more information on Baystate Children’s Hospital, visit