Fitness and healthy lifestyle 

A two-month-old child hit his head on a sharp object. What to do if the child hit his forehead hard and he had a bump, after how long does the hematoma pass

The nervous system of children develops gradually. At first, the child learns to hold the head, roll over, then begins to better manage with sweeping hand movements. At six months, the baby begins to sit down, crawls, and a little later, hesitantly rises to his feet.

Of course, this is a joyful moment for parents when their beloved baby masters his first steps. These steps most often end with a “squat” on the ass, and the baby does not want to take the initiative for a few more days, since the first fall caused him fear. When this moment is forgotten, the baby tries again, and everything works out great for him.

But the joy of parents is quickly replaced by fear for their child. After all, the steps are very uncertain, the baby strives to fall on the side, sit down or transfers his center of gravity so forward that it seems that he is about to fall and hit his forehead or nose.

Children feel especially insecure when standing on a soft surface. Therefore, often seeking medical help occurs after falling off the couch. In addition, from the moment you take the first steps, you will find out that there are corners in your house, of which there are a huge number. They are very dangerous, as they are at the level of your child's head, and more often than not, children hit their temples on the corner of one of the pieces of furniture.

Even small children pull on themselves all the things that they cannot see well, but which their palm reached out to. And they are not always soft plush toys. Toddlers pull together vases, laptops, lamps, stacks of books and directly “catch” them with their head, on which bumps and bruises form afterwards.

Due to the poorly developed orientation in space, the unimportant interaction of parts of their body and surrounding objects, children constantly stumble, cling to surrounding objects, their legs are “braided”, which undoubtedly causes falls to the floor.

The baby may fall off the changing table when it learns to roll over onto its tummy.

NEVER leave your baby unattended lying on the changing table, do not turn away from him even “for a second”, because it is at this moment that the child will roll over on his tummy and fall from a height of a little more than one meter. Given that the heaviest part of the baby is the head, it is with her that he hits first!

Features of the structure of the skull and brain of a child

  • in the first years of life in infants, the size of the head increases rapidly. This expresses the disproportion of growth;
  • any slight injury to the skin can cause serious damage, because the stratum corneum is poorly developed in the child;
  • a feature of the blood supply to the head is a richly developed venous network with many fistulas. About 18 - 20% of the blood output from the heart goes directly to the baby's head. These two factors are the risk of massive bleeding from scalp wounds;
  • due to the fragile attachment of a thin aponeurosis to the periosteum, extensive cephalohematomas may appear. In children older than 6 months, the risk is less;
  • the brain part of the skull in a child is smaller than the front. In adolescents and adults, on the contrary, a more extensive facial;
  • fontanelles are a feature of babies. They increase the "reserve space" with an increase in brain volume for various pathologies, especially if the child hit his temple. It contributes to a longer “light gap” with hemorrhages in a baby.

    A sharp bulge or / and tension in the fontanel is a formidable sign! It is urgent to go to the clinic!;

  • the bones that make up the skull of the baby are thin, contain few mineral elements, but are rich in water. Due to this feature, linear or depressed fractures are observed, and not multi-comminuted, as in adults;
  • diploic veins, devoid of valves, can contribute to the rapid spread of infection from the wound into the cranial cavity;
  • the brain grows rapidly until the age of six, then growth slows down;
  • the baby's brain is better supplied with arterial blood, but venous outflow is difficult due to underdevelopment of the veins after the fontanelles close;
  • Nerve fibers are unevenly covered with myelin. At first, motor (the child hones skills in walking, coordination of movements, manipulation of hands with objects), only then sensitive. Therefore, the pain is not felt so strongly;
  • The blood-brain barrier is an obstacle between the brain and infectious agents in the environment. In children, it is more permeable, so there is a high probability of exposure to toxic and infectious agents on the nervous system;
  • at an early age, in response to an injury, swelling and edema of the brain often occurs, which are dangerous with serious consequences and need to be supervised by a doctor.

What to do if the child fell and hit his forehead?

  1. Raise the baby, examine the frontal area for open wounds, changes in the shape of the skull.
  2. Hitting a sharp object, the baby can get gaping wounds in the forehead and profuse bleeding. In this case, it is worth calling emergency medical care and at the same time apply a pressure bandage or bandage the head with sterile bandages.
  3. Before the arrival of medical help, calm down and do not panic. Record changes in the child's behavior, the approximate amount of blood loss, tell the doctor if there was vomiting.

    No pills should be given on their own.

  4. The child hit his forehead on the corner of the tabletop, and a “huge” bump came out? Most often, the name "bump" refers to a subcutaneous hematoma, which could appear when the baby hit his forehead hard and the vessel was damaged, but the skin remained intact. Under the skin, venous blood most often comes out and accumulates. Depending on the size of the hematoma and the well-being of the child, first aid will differ.

With a small hematoma and the general condition of the child is not disturbed, cold can be applied.

It can be meat or dumplings that are taken out of the freezer and applied to the baby's skin ONLY through a clean towel or thick cloth for a short time.

Usually about two to three minutes followed by a break of five minutes.

A cold object can cause excessive cooling of the skin, and the child will get frostbite in addition to a hematoma!

You should immediately seek medical attention, if:

  • the hematoma is large, causes anxiety and crying of the child, the baby does not allow touching the damaged area;
  • the child, after a short crying and the appearance of a bump, quickly fell asleep, does not wake up when trying to wake him up.

Do not perform independent manipulations with the injured area, do not apply ointments and do not pierce, do not give painkillers and solutions.

In the first few hours after the child hit his forehead, he may be disturbed by dizziness, doubling of objects. Younger children will rub their eyes, try not to turn their heads.

Try not to disturb the baby during this period. It is advisable to do without games on the tablet and watching cartoons. It is necessary to ensure visual peace and make a cool compress on the child's forehead.

How to help if your child hit his nose?

  1. If the nose bleeds after the blow, do not tilt the child's head back. Why? Because it is necessary to know how much blood the baby lost if the bleeding did not stop for a long time in order to provide adequate medical care and avoid adverse consequences.
  2. Lay on a flat surface. So that the baby is not afraid of the sight of blood, you can shallowly insert a sterile gauze into the external nasal passage.

    No need to try to put the gauze pad as deep as possible, so that later, without additional trauma to the mucosa, remove it. It is advisable not to use cotton wool or cotton pads, since you will have to “tear off” a cotton pad soaked in blood from the nasal wall, and cotton villi can impair the regeneration (recovery) of the mucosa. If the child has a blood clotting disease, it is necessary to contact a medical institution. There medication will help stop the bleeding.

  3. After the blood has stopped flowing and the child is ready for new exploits, do not let the baby overstrain, monitor the body temperature. There is no need to blow blood clots or rinse your nose, give the vessels time to recover. In the first two to three days after the child hit, thermal procedures are undesirable - a bathroom, a sauna, a bath.

What should parents do if the child hits the back of the head?

If the child hits the back of the head, do not panic.

The well-known pediatrician Komarosky E. O. draws attention to the fact that when a child falls and hits his head, parents suffer the most, because many falls are not as serious as they might seem at first. Especially if the baby quickly stopped crying, began to play and even smiles at you, there is no bump at the site of impact, the shape of the skull has not changed, the child has not vomited, and there was no blackout.

  1. Assess the child's condition. If, after hitting the back of the head, the baby lost consciousness, cannot calm down for a long time, his nose bleeds, he stops responding to you, to rattles, or after a short time his body temperature rises, you need to seek medical help.
  2. Urgently call an ambulance if you notice that a clear liquid flows from the nasal passages or ears, since this is most likely cerebrospinal fluid (cerebrospinal fluid).
  3. Parents should provide first aid to their baby. For example, after falling from the couch, the child could get off with a slight fright and bruises, without bruises.

First of all, apply a cold compress, which is pre-wrapped in a cloth or cotton towel.

With small bleeding wounds, you should not smear them with a solution of iodine or "brilliant green", and you should not treat the wound itself with alcohol tinctures or vodka. Using non-traditional methods, you can cause a chemical burn, and the wound will take longer to heal with scarring.

It is worth treating the wound with hydrogen peroxide, and around (in the presence of skin contamination) wipe with a swab dipped in an aqueous solution of Chlorhexidine.

If vomiting starts, lay the baby on its side. So the vomit will not get into the bronchi, and the child will not choke. Call an ambulance immediately!

If a couple of days after your baby hit his head, moaning and shuddering appeared in a dream, the chin or hands are shaking before falling asleep and immediately after, it is worth seeing a pediatric neurologist and undergoing an examination.

Rule out spinal injury!

If the child hit his head when falling from the sofa, you should not sharply lift him off the floor, since not only the head, but also the spinal table, especially in the cervical region, could be damaged during the impact. Pay attention to the movements in the arms and legs. With a holistic spinal column, without damage to the spinal cord, the baby makes active movements with arms and legs, shows where it hurts, the fingers on the hands actively shrink and unclench.

If, after a fall, the child’s arms or legs do not move, when he tries to move them, he cries more, it is necessary to seek medical help to rule out fractures.

What should parents do if your child hits his temple?

  1. After the baby has hit his temple, it is necessary to assess whether he hears normally. Pay attention to whether he reacts to sharp sounds, whether he hears rattles or whispered speech.
  2. If you notice oddities in the child's behavior after the impact, expressed in a sharp emotional response to any irritation (for example, with a sharp sound or bright light, the baby begins to cry, run to another room or hide; a previously sociable child does not understand well the speech addressed to him, requests or performs actions only after a visual image) it is necessary to consult an ENT doctor with the delivery of an audiogram.
  3. If the child hit his head in the temple area on the corner and lost consciousness, immediately seek medical help. You will probably need neurosonoscopy if your baby is still infancy. Or an MRI of the brain, if the child is of primary preschool age. It is necessary to exclude fractures of the temporal bone, hemorrhages in the temporal region.

The temporal lobe is involved in the processing of information coming from the organs of hearing and vision, and is also responsible for understanding speech and emotional reactions.

What will happen if the dysfunction of the brain after traumatization is not treated?

  1. Lag in the development of the child.
  2. Speech difficulties.
  3. Frequent headaches.
  4. Vertigo.
  5. Sleep disturbance.
  6. epileptic seizures.
  7. Hyperactive behavior at school.
  8. Difficulty remembering new information.

Movement disorders (paresis or paralysis, if there was a hemorrhage after an injury)

The consequences of head injuries are quite different, and, unlike adults, children do not always have a deep injury worse than a superficial one. The consequences will depend on the area in which the injury is, whether it is combined with other injuries, how old the baby is, how quickly the parents sought medical help and whether they followed the doctor's instructions, on the state of the child's body at the time of injury or impact.

You know that all children are different, and injuries are also different. Therefore, after hitting your head, you should not give painkillers to children, and also give them valerian or motherwort for a sound sleep. This can change the picture of a serious illness and complicate the care of a child.

Children are inquisitive and restless, and therefore no one succeeds in completely avoiding injuries, falls and bruises. In the process of learning about the world, babies fall quite often. But if a fall on the ass or back does not cause panic attacks in parents, then the situation changes dramatically if the child hits his head. An authoritative pediatrician, author of numerous books and articles on children's health, Yevgeny Komarovsky, tells why such falls are dangerous and when to start worrying.


Features of child physiology

The head of a small child is designed in such a way that it is relatively large compared to the rest of the body, so babies most often, losing balance, fall on their head. But there is also a positive: the child's brain is quite reliably protected from injuries when falling. If a small child fell from the sofa upside down, then his parents, and not himself, received the greatest injury (psychological properties). The bones of the baby's skull are very soft, and the "fontanelle" and dynamic "seams" between the bones of the skull provide them with mobility. The larger the fontanel, says Yevgeny Komarovsky, the less likely it is to get injured when falling upside down. In addition, nature has come up with another shock-absorbing mechanism - a large amount of cerebrospinal fluid.


If a child at 6-7 months, when he becomes more mobile, rolled over unsuccessfully and fell off the sofa or changing table, you should not immediately panic. The kid, of course, will scream heart-rendingly. But parents should understand that he is crying not from terrible pain, but more from fright caused by a sharp movement in space. If after half an hour the baby smiles, walks and leads his usual way of life, nothing has changed in his behavior, then there are no reasons for alarm, examination by doctors, says Komarovsky.

Most often, children under one year old begin to beat their heads when they master the first steps. This usually happens after 8-9 months. That is why it is important that the baby first learn to crawl, and only then stand and walk.


Of course, a child who hit his head requires more careful attention from the parents. It is advisable to provide the baby with peace, do not let him run a lot, play outdoor active games, shout loudly. The first day will show if the baby has an injury . For this, parents need to be aware of the symptoms of head injuries.

Traumatic brain injury

It does not matter the age and gender of the child, the height from which he fell head down, the size of the bruise or bump on his forehead, and the presence or absence of abrasions and blood. All mothers and fathers should know that in all situations associated with the presence of a head injury, the child needs qualified medical care.

The presence of an injury can be suspected if the child has clouding of consciousness, loss of consciousness of any duration and frequency. Observation is very important, as parents who know the peculiarities of their child's behavior will be able to notice changes in his behavior in time. Any inadequate changes may indicate a possible head injury.


If the child stops falling asleep normally, or, conversely, sleeps unusually long, he has a headache, and it does not go away even an hour and a half after the fall, you should seek qualified medical help.

A characteristic symptom of a head injury is vomiting, especially if it is repeated. The child may become shaky and unsure gait, dizziness, convulsions, there may be noticeable incoordination, weakness of the arms, legs, inability to move one or two paired limbs at once. In all these cases, it is imperative to call an "ambulance".

Discharge from the nose and ears, whether they are bloody, bloody, or clear and colorless, is a definite reason to assume an injury.

Also, symptoms of injuries can be various disorders of the functioning of the sense organs.(hearing loss, visual impairment, complete, or perhaps partial lack of response to tactile contact). The child may begin to complain that he is cold or hot. Yevgeny Komarovsky advises paying attention to each of these symptoms.

concussion

This is a fairly simple traumatic brain injury in which the child may lose consciousness, but such a loss will be short-term (no more than 5 minutes), nausea, dizziness are possible. The brain is not damaged, but a concussion temporarily disrupts some brain cell functions. Dr. Komarovsky claims that this is the easiest consequence of a fall on the head, because after a couple of days the brain functions normalize and the child's condition returns to normal.


brain contusion

This is an injury in which the membranes of the brain are directly damaged, as well as its deeper structures with the formation of a hematoma and the occurrence of edema. How long the state of unconsciousness lasts affects the degree of injury, it can be mild, moderate or severe. In the first degree, the symptoms are similar to a concussion, only the unconscious state in a child can last more than 5 minutes. The average severity of the injury is characterized by the duration of fainting from 10-15 minutes to an hour or a little more. In severe form, consciousness may be absent for several hours or several weeks.


Brain compression

This is an extremely dangerous condition when, as a result of a head injury, compression occurs inside the skull. With such a pathology, vomiting occurs, which has a protracted and repeated character. Periods of loss of consciousness are replaced by the so-called "light" periods, when the child behaves normally, without showing any signs of a brain disorder. Such periods can last up to 48 hours.

First aid

If the child fell, hit his head and there was a cut in the skin or hair, while the child did not lose consciousness. and a day later there is no sign of injury, there is no need to take him to the doctor, says Yevgeny Komarovsky. It is enough to treat the wound with an antiseptic, apply ice to the site of the external injury. With an extensive wound (more than 7 mm), you should go to the emergency room, the child will have several sutures, and this treatment can be considered complete.


If the wound is open (with an open craniocerebral injury), in no case should you put pressure on it to stop the bleeding. Mom should put ice around the edges of the wound before the doctor arrives.

If the child fell, hit the back of the head or forehead on the floor, and the parents immediately or several hours later found signs of injury in the child, the child should be laid down and the hospital should be called. To establish the type of injury, its nature and severity is the task of doctors.


If the head injury is severe, the child is unconscious, he is not breathing, the child needs to be resuscitated before the arrival of the ambulance. The child should be put on his back, fix his head, carry out cardiopulmonary resuscitation, after the baby comes to his senses, he should not be allowed to move, drink and talk until the doctors arrive.

Effects

With craniocerebral injuries, vital centers and parts of the brain suffer. If the child is not provided with timely medical care, the changes that are caused by bruising or compression may be irreversible. Severe injury can result in death.

If a child hits his head while away from his parents, for example, in a health summer camp or boarding school, parents, for objective reasons, cannot observe the behavior and condition of the child for 24 hours after the impact. In this situation, one should be sympathetic to the fact that doctors and educators of a children's institution "reinsure themselves" and immediately send your child to the hospital. According to Komarovsky, in 99% of cases, such hospitalization is required not in order to treat the child, but in order to have someone to observe him.

If some time after a blow to the head or on the head, the child, having cried, calmed down and fell asleep, Komarovsky does not advise him to interfere - let him sleep.

However, it is very important for a mother to remember that the child must be awakened every three hours and assess his condition, for example, by asking a simple question (how many fingers does he see, what is his name, etc.). This will help to understand whether there are changes in the mind of the child.

If it is not possible to wake up or the answers are unintelligible, you should immediately call a doctor.


There is no specific prevention of head injuries. However, the task of parents, as best as possible, is to think through all dangerous situations and, to the extent possible, do everything to protect the baby.

Starting from 8 months, the child should not be left alone in the room while he is awake, unless he is in the playpen. He can fall and hit at any moment.

Older children should definitely give a special helmet for a gift in the form of a bicycle, and a helmet and shields for arms and legs for roller skates. In the bathroom, be sure to put non-slip mats on the floor and on the bottom of the tub.

For information on when a fall is really dangerous and how to provide emergency care, see Dr. Komarovsky's program.

Every child can fall and hit the back of the head. This happens at different ages, be it a month, a year, 2 years old, and under any circumstances, but such a fall often causes shock in any mother. Any head injury can lead to the most serious consequences, but if your child fell and hit the back of the head, the main thing is not to panic, but to provide first aid correctly. Today we will talk about what to do in such situations and what consequences such strikes can cause.

What to expect

Small children are restless, therefore, only having learned to walk, they begin to attract various injuries to themselves. Usually these are minor abrasions, bruises, cuts, bumps, but the situation can be much more serious. For example, if a child, by an absurd accident, hits the back of his head on some surface: asphalt, floor, corner, etc.

The baby's body is not yet so strong, so children face frequent fractures. Children's brain tissue is also very fragile, and it will not be difficult to damage them. Therefore, a strong blow to this area can lead to traumatic brain injury (TBI). This type of damage happens:

  • open (with violation of the integrity of bones and tissues);
  • closed (no visible damage).

In turn, closed TBI is divided into the following types:

  • bruising of brain tissue;
  • concussion;
  • brain compression.

If the child hit the forehead or the back of the head, the bruise will be the easiest injury. The brain itself is not affected. However, if we are talking about concussion, or even more so, compression, then everything is much worse. But how to determine the nature of the damage in the baby? There are several characteristic features of each injury. For example, concussion symptoms may include:

  1. Loss of consciousness.
  2. Vomit.
  3. Increased sweating.
  4. Pale skin color.
  5. Lack of appetite.

If the child fell and hit the back of the head, earning a bruise, you may notice an interruption in breathing and a violation of the heartbeat. With a fracture of the skull and compression of the brain, the appearance of cerebrospinal fluid is noted - a light-colored liquid, and the tissues around the eyes can turn blue.

As a rule, symptoms appear after a while, so be extremely vigilant. It is better not to go far at all in the first few hours. If the child cries for a quarter of an hour and calms down, then most likely everything is fine and you will not need an ambulance. If you still doubt and are afraid that you did not notice the absence of damage, it is better to contact a specialist who will examine your baby and tell you what to do next. It is better to once again be vigilant and examine the child than to deal with the consequences of a fracture.

An arriving specialist can examine the baby and send him to neurosonography. This procedure can be carried out for children up to one and a half years old, who have not yet overgrown the fontanel. The method is absolutely safe and includes a study using an ultrasound machine. Neurosonography reveals an increase in intracranial pressure, which can lead to unpleasant consequences.

We found out the possible troubles and their symptoms that may occur in a child after a fall or blow to the back of the head. Next, let's talk about how to give the baby first aid for certain injuries.

We provide first aid

First aid in such a situation will depend on the nature of the injuries received by the child as a result of the blow. If a bump jumped up on the back of the head, the first thing to do is to apply something cold (best of all - ice). If your house has magnesia, you can use it, experts (including Komarovsky) recommend making lotions with it 2 times a day.

Did the baby bleed? You should definitely have gauze pads at home for this case. In this case, if the bleeding continues for more than a quarter of an hour, call the specialists. It is important not to let the baby sleep in the first hours after the impact. Try to watch him, talk. By his reaction, you can easily determine the presence of brain damage. At night, experts advise waking up the baby and checking the coordination of his movements. If, nevertheless, the fact of injury is recorded, any visual load is contraindicated for a week.

If the baby has lost consciousness or the bleeding does not stop for a long time, you need to urgently call an ambulance. If the child loses consciousness, it is necessary to turn on its side, this will not allow him to swallow his tongue and choke when vomiting occurs. When falling from a height onto the back, injuries of the spine can also be noted, in such cases, changing the position of the baby should be as careful as possible.

There are a number of symptoms in which an ambulance must be called immediately. We present them below:

  1. Feeling unwell.
  2. The appearance of dizziness, severe drowsiness.
  3. Twitching of limbs, convulsions, paralysis.
  4. Paleness of the skin.
  5. Vomit, feces, urine with blood impurities.
  6. Pupil dilation without any reaction to external stimuli.

As you know, any trouble is better to prevent, so pay special attention to the prevention of such situations. Small children should not be left alone on the changing table, and if you need to leave, it is better to put the child on the floor (of course, not naked). Changing tables are generally very unreliable, a small area often leads to a fall of a baby who has already learned to roll over. Therefore, swaddling is best done on a soft surface.

The appearance of a child in the family requires constant attention and care from adults. And although, as a rule, all family members are well aware of this and are completely absorbed by the child, nevertheless, there are cases when children of the first year of life, left unattended even for a short time, fall from a height (from a changing table, from a crib, a stroller). , from the hands of parents, etc.) and get a head injury (traumatic brain injury).

Typical cases of traumatic brain injury in infants

  • The baby lies on the changing table or on the couch, the mother turns away for a few moments, and the baby falls to the floor.
  • The baby is left unattended in a high chair. He kicks off the table with his feet and, together with the chair, falls on his back.
  • The baby is trying to get up in the crib. Something on the floor interested him, and he is hung over the side and falls.
  • The baby was left to sit in the stroller, not assuming that he would try to get up in it and, not finding support, would fall down.

What is a traumatic brain injury

Traumatic brain injury (TBI) is a mechanical damage to the skull and intracranial structures (brain, blood vessels, nerves, meninges). The manifestation of traumatic brain injury in children differs significantly from the symptoms characteristic of adults, and they are due to the characteristics of the child's body, namely:

  • the process of ossification of the baby's skull has not yet been completed, the bones of the skull are plastic, flexible, their connection to each other is loose;
  • the brain tissue is immature, saturated with water, the differentiation of the structures of the nerve centers and the circulatory system of the brain is not completed.

Thus, on the one hand, the brain tissue has great compensatory capabilities and the so-called margin of safety (soft bones of the skull and more fluid in the brain than in adults can absorb shock). On the other hand, since it is the immature brain tissue that is subjected to trauma, this can lead to a disruption in the development of its structures and provoke further limitation of mental development, emotional disorders, etc.

Classification of traumatic brain injury

Traumatic brain injuries are of several types:

  1. Open TBI - injuries to the head, in which the integrity of the soft tissues, bones of the skull is broken. If at the same time the dura mater is also damaged, then the wound is called penetrating. In other words, the traumatic agent penetrates not only into the cranial cavity, but also reaches the brain. There is a threat of infection, which dramatically aggravates the healing of the injury.
  2. Closed TBI - injuries to the head, in which the integrity of soft tissues is not violated (or there are only minor abrasions, scratches) and skull bones. Most often, when falling from a height, children of the first year of life get closed TBI. In turn, closed injuries are divided into:
  • concussion (without division into severity);
  • mild, moderate and severe brain contusion;
  • brain compression.

concussion- A mild form of traumatic brain injury. Damage to the brain occurs at the molecular level (molecules are shaken), while its functions are disturbed, but there are no pronounced changes in the structure of the substance of the brain.

Brain contusion (contusio)- damage to the brain, characterized by the occurrence of a focus / foci of destruction of the medulla of varying severity. Foci can be single, multiple, different in depth and location. In this case, the patient develops neurological disorders (for example, the inability to make a certain hand movement, etc.) and / or psychological changes.

Brain compression (compressio)- severe damage to the substance of the brain, which, as a rule, occurs against the background of a brain contusion and extremely rarely without it. The causes of brain compression are the accumulation of blood inside the skull as a result of a ruptured vessel, or the brain can be compressed by fragments of the skull in the so-called depressed fracture.

External manifestations of head injuries

Since the relative weight of the baby's head is much greater than the weight of the body, when he falls, he first of all hits the head and more often the parietal region. Very rarely, the frontal and occipital regions of the head are injured. After a fall, the child develops redness in the impact zone, the baby feels pain. If within a few minutes a pronounced rapidly growing edema does not appear in this place, but only a slight swelling is noted, then, as a rule, this indicates a bruise of the soft tissues of the head (which does not apply to TBI). Something cold must be applied to the sore spot (an ice pack, a towel moistened with cold water - do not forget to re-wet it periodically - etc.). A cold compress is applied for at least 5-15 minutes (or at least for as long as the baby allows it - often such a procedure causes active protest), and most importantly - stay calm and try to calm the child. External signs of concussion in children of the first year of life are rather meager. For infants, loss of consciousness on the background of a concussion is a rarity, unlike children of preschool and school age and adults. Nor can they complain of a headache. They just immediately begin to cry loudly, there is motor anxiety. After screaming, they can fall asleep. Waking up, they are capricious, refuse food. Then there is vomiting (usually single) or frequent regurgitation. On the first night after an injury, children do not sleep well. The more pronounced these violations in the behavior of the child and the longer they last, the more likely the brain suffering. Another reaction to trauma is also possible: after sleep, the child's outward signs of trauma disappear and a false idea of ​​recovery is created. This is a dangerous delusion: the baby's condition can deteriorate dramatically. If after the fall there was a long period of time (from one to several minutes) between the fall itself and the cry of the baby from the blow, most likely there was a loss of consciousness. The presence of such a symptom often indicates a brain injury. But sometimes in such a situation, parents lose track of time, it is difficult for them to orient themselves, a lot of time has passed since the child's fall or a little, there was a loss of consciousness or not. Even if the child just started screaming from the blow, but before that it was quiet for some time, parents should be alerted by this situation and should be attributed to a more severe pathology. This will allow, without wasting time, to seek medical help and find out the severity of the injury. A contusion of the brain is accompanied by a violation of its blood flow of varying severity (from a decrease to a complete cessation), swelling of the brain substance, hemorrhages in the brain, and the development of paresis and paralysis is possible. Other signs of pathology are the same as with a concussion, but only more pronounced: repeated vomiting, prolonged anxiety, etc. With severe bruising of the brain, a coma develops. If, during a brain injury, a hemorrhage occurred in its substance, then this leads to compression of the brain, in which damage to the vital centers of respiration and cardiac activity is possible, which disrupts their functioning up to the complete cessation of the body's vital activity. As a rule, depression of consciousness is noted in children with intracranial hemorrhages. The degree of impaired consciousness may vary depending on the degree of brain damage - from severe drowsiness to coma. When falling from a height, children may have fractures of the bones of the skull (open TBI), which can also compress the brain. Fractures of the skull bones in infants are most often identified by fissures and linear fractures. According to their localization, length, width, one can judge the severity of the injury. Thus, the divergence of the edges of a bone fracture may indicate that there is a rupture of the dura mater, and this is an indication for surgery. Depressed fractures (dents) are more rare. In this case, the bone is concave inside the skull, bone fragments compress the brain. These fractures also require surgery. A rapidly growing edema appears in the fracture zone, which may be the result of accumulation of blood in soft tissues (hematoma) due to damage to them by bone fragments. Often, it is the presence of such a swelling (bump) on the head of a child that makes parents see a doctor, while the very moment of injury or its consequences go unnoticed.

What to do first if the child falls

We strongly advise parents whose children have suffered a head injury: even if, in your opinion, the baby is not bothered by anything, he fell from an insignificant height, stopped crying, etc., immediately seek help from the following doctors: a pediatric neuropathologist, a traumatologist, a neurosurgeon. To do this, you need to call an ambulance team at home, and you and your child will be taken to a specialized hospital, or contact the indicated specialists yourself. If they do not confirm the pathology, it will be possible to safely return home. Failure to see a doctor is dangerous due to the late diagnosis of an injury, the aggravation of the course of its healing, and the possibility of coma. All this requires treatment in intensive care, in some cases - surgery. Seeing a doctor late increases the risk of death, prolongs the recovery period and worsens its outcome, to the point that the child may become disabled.

Where is traumatic brain injury treated?

According to existing rules (standards), all children with traumatic brain injury must be hospitalized. Children with a concussion (a mild traumatic brain injury) can be treated in the neurological and neurosurgical departments. Patients with more severe forms of trauma should be treated in the neurosurgical department (if there is one in a particular region). To conduct reasonable targeted treatment, it requires a comprehensive examination of the child, which is possible only in a hospital. This examination includes thorough examinations of the nervous system, vestibular apparatus, organs of vision, hearing, and other studies. In the admission department, the child is examined, signs are identified that indicate damage to the bones of the skull or brain injury, parents are asked about the condition of the child after a fall, etc.

Methods for diagnosing traumatic brain injuries

An important examination for head trauma in infants is neurosonography - a study of the structure of the brain using an ultrasound machine through the large fontanel of the child (such a study is possible until the large fontanel has closed - up to 1-1.5 years). This method is easy to use, does not have a negative effect on the body, provides enough information to determine the tactics of treating the patient. With its help, you can, first of all, exclude or determine the presence of intracranial hemorrhages (the most life-threatening). The only limitation of its use may be the lack of an ultrasound machine in the hospital or a specialist who can work on it (for example, not all hospitals in the country with ultrasound machines can perform emergency neurosonography at night, since the specialist works during the day, etc. ).

If intracranial hemorrhage is suspected (especially if neurosonography is not possible for various reasons), a lumbar puncture is performed - a therapeutic and diagnostic manipulation, in which a hollow needle connected to a syringe is punctured in the region of the second - fourth lumbar vertebrae of one of the spaces of the spinal cord (subarachnoid space) and taking a portion of cerebrospinal fluid for examination under a microscope. By the presence of blood cells in the cerebrospinal fluid, the presence of intracranial hemorrhage is judged. In addition, there are more sophisticated methods for examining a child's head: computed tomography (CT) and magnetic resonance imaging (MRI).

Computed tomography (CT) (from Greek tomos - segment, layer + Greek Grapho - write, depict) is a research method in which images of a certain layer (slice) of the human body (for example, the head) are obtained using X-rays. With CT, the rays fall on a special device that transmits information to a computer that processes the received data on the absorption of x-rays by the human body and displays the image on the monitor screen. Thus, the smallest changes in the absorption of rays are recorded, which, in turn, allows you to see what is not visible on a conventional x-ray. It should be noted that the radiation exposure with CT is much lower than with conventional X-ray examination.

Magnetic resonance imaging (MRI) is a diagnostic method (not associated with X-ray radiation) that allows you to get a layered image of organs in different planes, to build a three-dimensional reconstruction of the area under study. It is based on the ability of some atomic nuclei, when placed in a magnetic field, to absorb energy in the radio frequency range and radiate it after the cessation of exposure to the radio frequency pulse. For MRI, various pulse sequences have been developed to image the structures under study in order to obtain the optimal contrast between normal and altered tissues. This is one of the most informative and harmless diagnostic methods. But the widespread use of CT and MRI in early childhood is difficult due to the need to conduct this examination in children in a state of immobility (under anesthesia), since a necessary condition for the successful implementation of the technique is the immobility of the patient, which cannot be achieved from an infant.

Tactics of treatment of craniocerebral injuries

After the examination and clarification of the diagnosis, the tactics of treatment are determined. Children with mild traumatic brain injury are prescribed medication (therapy aimed at eliminating cerebral edema, lowering intracranial pressure, correcting brain metabolism, etc.). Surgical treatment is used (and necessary) primarily to eliminate compression of the brain. It is prescribed for children with depressed skull fractures and intracranial hemorrhages. Parents need to realize that only a comprehensive, adequate examination of the child allows him to correctly and timely treat a brain injury, achieve recovery and avoid his disability.

Sequelae of traumatic brain injury

Research on the problem of traumatic brain injury shows that even a minor injury can cause undesirable consequences. Under the influence of trauma (the moment of mechanical damage to the substance of the brain) and its consequences, the functions of various parts of the brain are disrupted, and, consequently, the work of their subordinate organs and systems (endocrine, digestive systems, etc.). Blood flow may be disturbed, including the outflow of venous blood from the cranial cavity. The regulation of vascular tone suffers - they can narrow inadequately, leading to an increase in blood pressure. All this impairs the course of metabolic processes in the brain, as a result of which brain cells can be replaced by cystic cavities, that is, holes filled with fluid form in their place, and in the place where these cysts exist, certain brain functions fall out. For example, the frontal lobes are responsible for intelligence - So, the presence of cysts in this place reduces it. In addition, it is known that the normal brain, inside and out, has cavities filled with cerebral (cerebrospinal) fluid. After an injury, it can accumulate excessively in the cranial cavity - and, consequently, intracranial pressure increases. The fluid under pressure compresses the substance of the brain, causing its slow atrophy (these phenomena are also characteristic of the formation of cysts). The triggering of these pathological mechanisms depends on the severity of the injury: the more severe it is, the more pronounced the disturbances, the worse the outcomes, and the longer the recovery period. With mild traumatic brain injury (TBI), the prognosis is usually favorable - subject to the recommended regimen and treatment. After recovery, asthenization phenomena are possible - the child quickly gets tired, becomes inattentive, irritable. In this case, the baby is more inhibited, which can lead to repeated injuries. These phenomena can affect the child's intellectual development in the future. With TBI of moderate severity, it is often possible to achieve a complete recovery of activity, although a number of children develop asthenia, increased intracranial pressure, frequent headaches, and impaired coordination. In severe TBI, the prognosis may be unfavorable - mortality in these cases reaches 15-30%. After recovery, a wide variety of consequences are possible: from varying degrees of motor disorders, pronounced convulsive seizures to gross mental disorders, consciousness, which leads to disability. With open TBI, purulent-inflammatory complications often occur (for example, meningitis - inflammation of the meninges, etc.). ), which can also lead to death. There is still no clear answer to the question of how long it takes for the body to fully recover even after mild TBI. It was believed that after such an injury, recovery occurs within a few days, a maximum of 2-3 weeks. Nevertheless, studies have shown that 1-3 months after a concussion, at least half of the children have some or other deviations from the norm, which sometimes persist for a longer time. The speed of recovery depends primarily on the severity of the injury, the age and previous state of health of the child.

How to reduce the risk of traumatic brain injury

Injuries in children happen most often in the presence of adults, and this once again indicates our inattention or frivolity and carelessness, as well as the fact that we have a poor idea of ​​the motor skills of the baby. Parents should provide for the emergence of new motor skills in the child and take safety measures. So, a month-old baby, lying on his stomach, can push off with his feet from the side of the changing table, from the back of the sofa, bed and fall. Each next skill or movement of the baby (attempts to sit down, crawl, stand, etc.) can also lead to "unexpected" injuries. A child, trying to get up, may fall out of the stroller, out of the child's chair, especially if they forgot to fasten it. Parents, unaware of the new possibilities of the baby, are unnecessarily careless, leaving him unattended. If you need to move away, do not leave the child alone lying on any high (and not very) surface, put the baby in a crib, playpen, or even on the floor. Secure your child in the highchair and stroller. If your home has stairs, put up a safety rail to prevent your baby from falling down or climbing high and then falling. "Walkers" can also be unsafe: children, while in them, can strongly push off, hit something, roll over, and also fall down the stairs. It is better to refuse to use such a vehicle. "Jumpers" are dangerous because of the unpredictability of movements: for example, a child in them may collide with a wall. The most important role in reducing child injuries is given to prevention, and the main thing in it is the attentive attitude of adults to children and their safety. Among the various injuries of the body, head injuries account for 30-50% of all injuries in children. And every year this figure increases by 2%.

Pediatricians state that they are most common in childhood. These statistics have their explanations. In children under 5 years of age, the head is relatively heavy and large in comparison with other parts of the body. This physiological feature of babies affects the coordination of their movements. Just a slight push is enough for the baby to lose balance and fall headfirst.

Fortunately, most falls pass without consequences for the health of the baby and injure only the nervous system of relatives.

In stock, nature has a number of protective devices that protect the brain from the consequences of falls: fontanelles of the skull, an excess amount of shock-absorbing cerebrospinal fluid, etc.

The task of parents is to know the symptoms that indicate that a head injury is potentially dangerous and requires mandatory medical attention.

Physiological features of the child's brain

The head of a child has a slightly different structure than that of an adult. The bones of the baby's skull are soft and flexible, which avoids serious damage when colliding with a hard surface. During the impact, the elastic bones shift and return to their original position.

Another important feature of the child's brain is its immaturity and high content of cerebrospinal fluid. A child's head is much easier to withstand blows.

Baby fall off couch

Many children under 1 year of age often fall out of bed. At 4 months, the baby is already actively moving lying down, can roll over, tries to crawl. Doctors advise at such a time to constantly monitor the little researcher.

Children at this age cannot yet assess the danger of their actions and roll to the floor in a split second. Even a very attentive mother may not see the baby, turning away for a bottle. And, of course, when falling, the head suffers first.

Toddlers are just learning to use their hands and do not yet have the reflex to put them in front of their heads for protection. According to pediatricians, in most cases there is no cause for concern: the height of the sofas is about 50 cm or even less.

A fall from such a height, as a rule, cannot significantly damage the brain. Worse, falling to the floor, touching the wooden sides of the sofa or other sharp or hard objects.

Rare, but the most unfortunate consequences of a fall of a baby can be a concussion and an open craniocerebral injury.

Observation after the fall

If the child fell and hit his head, it is necessary to observe him within the next 24 hours.

The task of parents is to provide the child with peace and not allow too active games on this day.

If in the first hours after the fall the child does not complain about anything and feels good, then damage to the internal organs is unlikely, which means there are no reasons for panic and indications for ultrasound.

anxiety symptoms

Doctors identify a number of serious signs, regardless of the age of the child, to which parents should pay attention:

  • disturbance of consciousness of any intensity and duration;
  • inappropriate behavior;
  • speech disorder;
  • unusual sleepiness;
  • intense headache that persists for more than one hour after the injury;
  • convulsions;
  • repeated bouts of vomiting;
  • dizziness and/or imbalance that persists for more than one hour after the injury;
  • pupils of different sizes;
  • inability to move an arm or leg, weakness in an arm or leg;
  • the appearance of dark (dark blue) spots under the eyes or behind the ears;
  • bleeding from the nose or ears;
  • discharge of a colorless or bloody fluid from the nose or ears;
  • any violations of the senses (even minor ones).

The presence of at least one of these signs indicates the need for immediate medical attention!

1. Reassure the child.

2. Put the child on the bed in such a position that the spine and head are at the same level.

3. Examine the child for abrasions, bumps and wounds on the head. Observe his reactions and behavior, check for warning signs, as well as signs of external trauma. A limb bruise or dislocation is usually noticeable, if something hurts more, the baby will definitely let you know.

4. Noticing a swelling bump in the affected area, it is recommended to immediately apply a cold compress for three minutes to prevent further formation of severe swelling.

Pay attention to the quality of the bud: a tall and firm bud is a good sign.

But if the bump does not appear immediately, but a little later, if it is low, large in area and soft (like jelly), you need to seek urgent medical help.

5. If there is an abrasion, gently wipe it with hydrogen peroxide. In case of bleeding, monitor its duration - if it continues for 10 minutes, call your doctor immediately.

6. If there is vomiting, the baby should be laid on its side so that the discharge easily leaves and does not prevent the victim from breathing normally.

7. Provide peace to the child.

8. If the injury is severe, it is important to keep the child awake until the ambulance arrives. Following this recommendation will also prevent you from missing other symptoms.

10. If you have at least one alarming symptom, you should immediately seek medical help. During the examination, the doctor will be able to determine the severity of the blow and draw a conclusion about the need for hospitalization.