Assessment and management of minor head injuries in toddlers and adolescents

Abstract

Every parent will, at one time, encounter a scenario during which one of their children suffers a serious-appearing head strike. Therefore, the odds suggest that every pediatrician will be faced with the scenario of a scared parent calling to ask for advice on what to do after a frightening head strike. General statistics are very reassuring: most children who present with mild head trauma have little or no neurologic sequelae. However, a very small number of children may have an underlying traumatic brain injury—and it is the difficult task of primary care physicians, in the office, on call over the phone, or in the emergency departments, to identify those children who have experienced a head strike who may need further evaluation. These injuries will often require an emergency room evaluation, commonly an imaging study, less commonly intensive care unit monitoring, and rarely neurosurgical intervention. This chapter will provide clinicians with a brief overview of mild head injury in the pediatric patient and discusses decision-making rules regarding imaging, assessment, and prevention.