Table of contents:
- Emergency in children: head injury
- How does a severe head injury manifest itself?
- How can I provide first aid?
- What else can I do?
- Things to know about head injuries in children
Emergency in children: head injury
Head injuries can occur in different ways: from a fall, an impact, a blow to the head, a traffic accident etc. The possible consequences range from lacerations to bruised skulls to concussions. If bony structures and brain tissue are injured, one speaks of a traumatic brain injury. Even if only a few signs of injury are visible on the outside, bleeding can occur inside the skull. These then lead to pressure on the brain tissue and can be life-threatening.
The extent of the injury is not always immediately recognizable; in some cases the symptoms only appear after a few hours. In the case of severe head injuries or if an injury to brain tissue is suspected, rapid first aid and medical treatment are important.
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Children have a relatively large head in relation to their height. The bony structures of the head are more elastic than in adults, which means that injuries can be better compensated for and do not always have serious consequences. Harmless falls are relatively common, especially in small children (e.g. while learning to walk) and only rarely dangerous.
Danger! In children under six months old, a fall on the head should always be assessed by a doctor.
The cause of the injury or the course of the accident are usually decisive. For example, falls from a height of one meter can be problematic, as can falls onto a pointed object (e.g. the edge of a table, corner of a shelf). A blow to the head or a traffic accident also usually results in serious injuries. Regardless of the type of accident, it is important to keep a close eye on the child; medical help should be sought if there is any sign of serious injury or involvement of the brain.
How does a severe head injury manifest itself?
The following signs can indicate a serious head injury:
- vomiting several times immediately after the event or up to six hours afterwards,
- persistent crying and whimpering in toddlers,
- Indication of severe headaches in older children,
- Sudden sleepiness, difficult to wake up, slurred speech, sudden change in nature (e.g. no curiosity or interest in the surroundings, introverted),
- Unwillingness to drink, lack of utterance no (e.g. no "babbling") in babies,
- any external signs of injury, such as a bruise (bump), heavy bleeding,
- Blood or clear fluid (cerebrospinal fluid) leaks from your ears, nose, or mouth
Remember: Even if there are no or only slight signs of injury externally, the brain can still be injured. If you have the feeling that your child is suspicious or that something is wrong, go to the nearest hospital or call 144.
How can I provide first aid?
Rapid first aid and medical treatment are important after serious accidents or if a serious head injury is suspected. Since a cervical spine injury can occur especially if you fall on your head, you should be particularly careful. For now, do not pick up the child and do the following:
Do an emergency check-up to check your consciousness and breathing:
Speak to the child out loud, for example, “Wake up!” And touch the child lightly (for example on the inside of the upper arm).
- If the child is responsive, lay them flat with the upper body slightly elevated.
- Dial the emergency number 144.
- Do not leave the injured child alone and monitor their breathing.
- Keep the child warm (cover up).
Carefully overextend the child's head, then hear, see, feel for a maximum of ten seconds. In the case of infants, the head is not overstretched, but only in the "sniffing position" (head only a little backwards, the nose should point slightly upwards)
If breathing is normal: Lay the child on their side in a stable position. Dial the emergency number 144. Check the child's breathing regularly until the emergency services are on site. Don't leave it alone. Cover it up to avoid hypothermia
If breathing is not normal: Start resuscitation immediately. Lay the child flat on their back, carefully stretch their head back and ventilate them 5 times. If the child remains motionless, start with chest compressions: press 30 times at a frequency of 100 to 120 times per minute. After a minute of resuscitation, dial 144. Continue until the emergency services arrive
More on the topic: 1x1 first aid for children
What else can I do?
For minor head injuries that do not necessarily require medical attention, the following measures can be helpful:
- Let the child rest for a while, either by lying down and possibly having a short nap, or by playing something quiet and not frolicking.
- Give the child something to drink.
- If there is a wound: Stop the bleeding or cleanse and treat the wound.
- If there is swelling, apply cool packs or cool compresses (never apply ice directly to the skin!).
- The most important thing: watch your child. If the symptoms (e.g. headache) do not improve, get worse, or if other symptoms appear, then go to a hospital.
Things to know about head injuries in children
The most common diagnoses for head injuries are:
Concussion (commotio cerebri)
Concussion is an acute, temporary disorder of the brain. It manifests itself through an unconsciousness. The loss of consciousness can last from a few minutes to a maximum of an hour. Although nerve cells are also destroyed in a concussion, the extent is so limited that normally there is no permanent damage. Nausea, vomiting, headache and dizziness are other typical complaints. In addition, it can lead to a memory impairment. This is known as either retrograde amnesia, if the child has no memory of what happened before the accident, or anterograde amnesia, if the memory gap persists for the period after the accident.
Danger! Symptoms such as visual disturbances or paralysis are atypical for a concussion, they can be an indication of severe brain damage!
Any loss of consciousness MUST be clarified in the hospital. Even if it was short-lived.
Brain contusion (contusio cerebri)
In contrast to a concussion, a cerebral contusion is a serious injury to the brain tissue. The extent and localization of the damage depend on the intensity of the force acting. A prolonged loss of consciousness (over an hour) and other neurological symptoms such as cramps, paralysis, visual disturbances are noticeable. The brain damage is visible on computed tomography (CT). In the case of a concussion, however, the CT is normal.
Cerebral haemorrhage can also occur as a result of a contusion in the brain. Cerebral hemorrhages are particularly dangerous because the skull cannot expand due to the bony limitation. Persistent bleeding therefore leads to an increase in pressure in the skull with possibly life-threatening effects. Signs of a cerebral haemorrhage include severe headaches, nausea, vomiting and increasing loss of consciousness.
Depending on whether arteries or veins are injured, the situation is more or less acute: if an artery bleeds, a large amount of blood will leak out in a short time, and a life-threatening condition can quickly develop. Bleeding from injured veins, on the other hand, tends to progress slowly (oozing bleeding), the symptoms appear later and are usually less pronounced.
Depending on the location of the hemorrhage, a distinction is made between epidural hemorrhage (between the cranial bones and hard meninges), subdural hemorrhages (between hard and middle meninges) and subarachnoid hemorrhages (between middle and soft meninges).