If the child has fallen: injuries in children. The child fell and hit his head - what to do

30.08.2019

Perhaps there is no such child who has never fallen and hit his head. This is especially true for babies who are learning to crawl or walk. At this age, small falls and bruises are inevitable. The task of parents is to ensure maximum safety for the child and teach him to properly coordinate his movements.

However, there are situations when, after a fall and a blow to the head, a child may experience alarming symptoms that indicate a head injury. In this case, it is necessary to show the child to the doctor as soon as possible. What should you do if your child has fallen and what should you pay attention to in the first place.

How dangerous are head blows in young children?

Many parents may recall that their children, when they were young, kept falling and hitting their heads. After all, at first the baby learns to sit and cannot always keep his balance, then he learns to crawl and walk, not always deftly and quickly gets up. And the head, as the heaviest part of the body, takes most of the blows on itself.

Yet it provided by nature, since children have large and small fontanelles on their heads, it is thanks to them that the blow is amortized and does not always pose a danger to the health of the baby. In addition, in younger children, there is more fluid between the bones of the skull and the brain than in adults. It also performs a protective function for the child.

Therefore, most of the blows and falls for the child end safely. However, parents need to know which signs and characteristics of the child's behavior may indicate and require immediate medical attention.

Inspection of the impact site and first aid

If your child has fallen and hit his head, the first thing to do is examine the impact site and try to qualify the severity of the damage.

A lump (hematoma) formed at the site of impact. In this case, first of all, a cold compress should be applied - it can be any fruit or a bag from the refrigerator, or a bottle of chilled liquid. Try to hold the compress on the bruised area for at least 3-4 minutes, this will help prevent severe swelling.
A wound formed at the site of impact and blood flows from the abrasion. Moisten a cotton swab or gauze pad with hydrogen peroxide and apply it to the abrasion to prevent infection. If after ten minutes the bleeding has not stopped, call an ambulance!
There is no visible damage at the impact site.. In this case, you only have to carefully monitor the child's condition for 2-3 days and note uncharacteristic behavior for him. This may be excessive, drowsiness, complaints of headache, excessive tearfulness, and so on.

Before seeing a doctor, do not give your baby no painkillers, as this will significantly complicate the examination of the child.

Immediately after the injury, try don't let the baby sleep since in this case you will not be able to fairly objectively assess his condition.

Provide your child peace, do not play outdoor games. Let the child lie quietly on his side.

Warning symptoms after hitting your head: when to see a doctor

In any case, after any head injury, it is necessary watch the child especially carefully - a few hours after the impact, and pay attention to his well-being for another two to three days.

What symptoms should be looked out for? If you notice one or more of these signs of a traumatic brain injury, contact your doctor immediately. Of course, this may turn out to be a mere coincidence, but in this case, it is better to play it safe in order not to lose time if the child needs treatment.

Drowsiness, lethargy, lethargy
Tearfulness uncharacteristic for a child
Different sizes of pupils of the eyes
Episode of loss of consciousness immediately after impact
Vomiting or child's complaints
For infants - frequent and uncharacteristic regurgitation
Dizziness, inability to balance
Complaints about tinnitus
Bleeding from the nose or from the ears
Lack of appetite or complete refusal to eat
Bad disturbing dream
Speech or hearing disorders in a child, complaints of poor vision
Headache
Paleness of the skin
The appearance of bruises under the eyes

Possible injuries and consequences of hitting the head in a child

Traumatic brain injuries that a child could have received during a fall are divided into open and closed.

TO closed injuries in turn are

brain compression
brain contusion
brain concussion

The most serious damage is compression- in this case, a bruise may be accompanied by rupture of blood vessels, with a bruise foci of destruction of the substance of the brain are observed. Shake the brain is the easiest injury. In this case, the brain is not damaged, and at the site of impact, we can detect a hematoma or bruise.

Prevention of head injuries in children (VIDEO)

Babies under one year old often fall off beds, sofas, or changing tables. Never leave them unattended at a height from the floor! Even if the child is not yet able to roll over or crawl, he can reach the edge of the table or bed and fall headfirst. If the baby already knows how to roll over, crawl, then it is safest to leave him on the floor. Lay out a rug or a diaper for him and put it down if you need to go away on business. In this case, you can be sure of its safety. Children fall off the couch most often when their mothers leave them "just for a minute." On the changing table, always hold the baby with one hand. If you need to go away or even turn away for a diaper or powder, take your baby with you.

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:

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.
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 compression of the brain are the accumulation of blood inside the skull as a result of a rupture of the vessel, or the brain can compress fragments of the skull with 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, lengthens 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 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%.

Good day to all! I propose to do without long prefaces today. A head injury in a baby is a very serious situation.

If a child hit his head, what should I pay attention to so that trouble does not happen? Now I will tell you everything.

Ksenia Remizova, a neurologist and mother of two children, helped me write this article. She shared her own story:

“When my youngest son was 10 months old, he managed to fall out of his chair. The child was in the kitchen with dad. The husband turned away for a moment to put a dirty plate in the sink - and the son at this time got up and rolled over the back. He fell headlong onto the hard floor. The baby was crying, I was in a panic. We called an ambulance.

By the time we got to the emergency room, my son calmed down. He slept a little, then woke up, looked at the new place with interest, smiled ... We hoped that everything worked out. What was our horror when a fracture of the parietal bone was found in a child!

Then there was treatment in the children's neurosurgical department, observation by a neurologist in a polyclinic ... Now my son is almost 3 years old. He doesn't have any side effects."

My child also has a history of trauma, at the age of 2, 10, he jumped on the bed, and ran with a swing on my ... knee. I myself was very hurt, and the child did not even cry. I limped all day, and was surprised that my son didn’t even have a bump, and he was cheerful and cheerful.

Unfortunately, the next morning, the consequences began - he lost his orientation in space, he could not be pushed, he could not focus when looking at me, plus there was vomiting. It was terrible for me, I was very scared, and we had to go to the hospital. They diagnosed me with a concussion, it's good that everything recovered pretty quickly.

From these stories, I want to draw your attention to two points:

Head injuries can be insidious.

The kids are recovering well. They can endure even severe head injuries without consequences.

Let's see how dangerous a head injury is.

A blow to the head: options for the development of events

Option 1, happy - everything worked out

Let's say the kid, running, hit the wall. I got a little headache and everything went away. The only memory of the injury is a bump on his forehead.

Option two, concussion

From the impact, the brain cells stopped working normally for a while. The headache does not go away, vomiting may occur. The head is spinning, vomiting is possible.

Option three, brain injury

The blow was so strong that a part of the brain was damaged. The head hurts, the child vomits, the head is spinning. Speech or coordination may be impaired.

Option four, the most dangerous - hemorrhage in the cranial cavity

This situation is urgent. Blood is an additional volume inside a cramped cranium. If it doesn't stop, it can compress the brain. This can lead to death from cardiac or respiratory arrest. Immediately ambulance!

Head injury - how to react?

So, the child hit his head hard. What to do in such a situation? The UN formula will help you. Look here:

stop the blood
Restrict Activity
Observe

Let's understand it thoroughly.

Obecome blood

To do this, apply any frozen food from the freezer to the injury site. Best of all - something loose. Such an “ice pack” will easily take the shape of a head. Just wrap it in a towel.

Wash the wound with hydrogen peroxide. Put on a bandage.

Take note of this:

A wound wider than 0.7 cm and longer than 2 cm requires suturing. You to the doctor!

Oborder activity

During the day after the injury, all active games are contraindicated for the baby. It is also better not to watch TV, and not to read books on your own.

Let him lie in bed and listen to audiobooks. You can draw, play board games... You know better what to do with your child.

The day after the injury, do not send the "victim" to school or kindergarten. Let him stay at home, under the supervision of relatives.

So we got to the most important point:

Hobserve

From what height did the baby fall? When?
What did he hit?
Did he lose consciousness?
Was there vomiting, how many times?
What did you complain about?
How did you behave after the injury?

Keep an eye on your child for 24 hours after the injury. If he's asleep, wake him up every three hours, day and night, to make sure he's okay. To do this, ask some elementary question, and let the baby answer you. Did he answer correctly? Is it normal speech? Let him sleep on.

Keep in mind, it happens that the consequences of a bruise can begin on the second and third days. Therefore, the first three days require your attention to the condition of the child.

Red flags for head injuries

Finally, I will list the symptoms of a severe injury, “red flags”, as doctors say.

If you see THIS, call 911 immediately!

Violation of consciousness. You can't wake up the baby. Or he is sluggish and has difficulty answering questions.
Change in speech. Slow speech, stuttering. The little child stopped talking.
Marked drowsiness.
Behavior change. The child is “something not like that” for no apparent reason.
Headache for more than an hour after the injury.
Vomiting more than once.
Dizziness for more than an hour after the injury.
Violation of coordination: the child is “like a drunk”, he is “carried away”.
Cramps - twitching of the arms, legs. Or the baby suddenly loses consciousness, and he is “shaking”.
Weakness in an arm or leg. An adult child limps, cannot walk on tiptoe, complains of awkwardness in an arm or leg. The baby cannot lean on the handle when crawling, cannot lift one leg when lying on its back.
Different pupils.
Symmetrical bruising under the eyes or behind the ears.
A colorless or bloody fluid flows from the nose or ear.

Brr! I wish you not to find any of these signs in children.

Dr. Komarovsky once said: "I have not seen a single child who would live to be a year old and not fall off the couch." Head injuries in children were, are and will be. But it is important to correctly assess the situation and consult a doctor in time.

Now you know what to do , if the child hit his head. In order not to lose important information, post the article on social networks. You will always have it at hand - and your friends can come in handy too!

I wish you and your children health, joy - and no injuries!

I hug

your Anastasia Smolinets.

Unfortunately, often the baby is on the floor. What are the actions of parents in this case?

Dangerous height or where a child could fall

A small child is surrounded by care and attention from birth. His relatives are doing everything possible so that nothing threatens the health of the crumbs. But even the most attentive mother can make a mistake. Sometimes it is enough just to turn away for a second - and the baby is already on the floor.

The fact is that not everyone correctly imagines the possibilities of crumbs. Even a newborn child, making chaotic movements with arms and legs, may well move to the edge and fall, although the likelihood of this is small.

Especially dangerous places from which a fall is possible for babies under 6 months old are the changing table, the sofa, and the parents' bed. After six months, the baby begins to actively master new movements, learns to sit, crawl, stand on his feet at the support, and then walk.

At this age, he may fall out of his crib, from a highchair, from a stroller, etc.?

Most often, when falling, babies hit their heads: up to 1 year old, the head is the most vulnerable place due to its rather large size and mass in relation to the body. But damage to other parts of the body is also possible. Most often these are bruises, in rare cases - a broken bone or a traumatic brain injury (TBI).

If a child hits his head...

Headbutting in babies under 1 year old is a fairly frequent phenomenon, while they do not have to fall at all, because the baby can accidentally hit the surrounding objects or furniture, making active movements. In this case, basically everything goes without consequences: there is not a traumatic brain injury, but only a bruise. However, when falling from a height, the likelihood of a traumatic brain injury (TBI) increases many times over.

What is a TBI?

Traumatic brain injury is a mechanical damage to the bones of the skull and soft tissues of the head (the brain, its vessels, cranial nerves, meninges).

Traumatic brain injuries include:
concussion (a mild form of TBI - there are no obvious changes in the structure of the brain, but functional activity may be impaired);
brain contusion of varying severity (accompanied by the destruction of the medulla in a certain area, causing severe functional disorders);
compression of the brain (severe pathology that occurs against the background of a brain contusion or rupture of a large blood vessel, which leads to the formation of an intracranial hematoma).

In children with typical falls, cerebral compression is extremely rare. To sustain this injury, the child must fall from a height of at least 2m or hit a very hard or sharp object.

We assess the situation. The symptoms of a traumatic brain injury in a child are not the same as in an adult, which is due to the peculiarities of the structure of the skull and the internal structures of the infant's brain. In some cases, a long asymptomatic course of TBI is possible or, conversely, a rapid manifestation of symptoms with minimal trauma. This is due to the flexibility of the bones of the skull, their mobility relative to each other in the region of the sutures, as well as to the age-related anatomical and physiological features of the brain. The brain cells in the baby are not yet fully differentiated, i.e. there is no strict division into zones of brain functions, therefore, the symptoms are most often blurred.

When hitting the head, the baby feels pain, redness appears at the site of impact. In the future, a slight swelling may develop. If nothing else has alerted you, you should not worry: this is not a traumatic brain injury, but a bruise of the head tissues. In this case, it is necessary to give the child a cold compress and calm him down. Cold constricts blood vessels, stopping subcutaneous bleeding, has anti-inflammatory and some analgesic effect.

For a compress, an ice pack, a small plastic bottle of cold water, and any cold non-traumatic object will do. It must be wrapped in a diaper or towel, applied to the site of injury and held for 10-15 minutes. It is important that the exposure to cold be directed strictly to the bruised place - the surrounding tissues should not be affected. If the child does not allow the compress to be kept - he is naughty, dodges, - you can moisten a gauze, bandage or piece of cloth in cold water and tie it to the damaged area. The bandage should be changed as it warms up for half an hour.

Loss of consciousness can be one of the symptoms of a brain injury. But for babies, this phenomenon is quite rare, and often it does not accompany even severe damage. This is due to the underdevelopment of the cerebellum and the vestibular apparatus as a whole in infants, which are responsible for the coordination of movements. You also can't tell if the baby is having a headache. Thus, the most characteristic signs of a traumatic brain injury in infants are:

loud cry as a reaction to pain;
increased motor activity, general anxiety or, conversely, lethargy and increased drowsiness;
vomiting, refusal of food;
pallor of the skin.

These signs are characteristic of a concussion. For a brain contusion of varying severity (damage to the medulla itself), the following symptoms are characteristic, in addition to the above (or without them):

eye rolling, temporary strabismus, or difference in pupil diameter;
loss of consciousness (it can be assumed if, after the fall, the baby did not cry immediately, but after one or several minutes).

There are three ways to evaluate a child's consciousness after a fall:

Eye opening (whether the baby opens his eyes himself, or to a loud sound, or to a painful stimulus, or does not open at all).
Motor reaction (here it is important to assess the movements of the baby: is there any motor activity at all, does he move his limbs in the same way, is the tone of individual muscles increased).
Verbal contact (whether the child is cooing, smiling, crying, moaning, or no voice).

You can make such an assessment a few minutes after the fall, when the baby has already come to his senses. Normally, he should move normally, coo (or utter syllables) and open his eyes in the same way as he always did.

A dangerous symptom is a temporary external improvement, when after sleep the external signs of trauma that were present earlier disappear in the child. But after that, the condition of the baby can deteriorate dramatically.

There are also open craniocerebral injuries, when the integrity of the bones of the skull, and possibly the dura mater, is violated. In this case, there is a risk of infection of the brain tissue.

Thus, there are a lot of signs of brain injury. Therefore, parents should be alerted by any deviation from the usual behavior of the baby. You need to see a doctor in any case if the child has fallen and hit his head. If everything was limited to a bruise of the soft tissues of the head without other pathological signs, you need to show the baby to a pediatrician and a neurologist in the clinic. If symptoms of a brain injury appear (especially loss of consciousness and lack of reactions to external stimuli - light, sounds), as well as with an open craniocerebral injury, an ambulance should be called immediately.

If a blow to the head was not accompanied by the appearance of dangerous symptoms (for example, loss of consciousness), the child should be shown to the pediatrician on the same day or, in extreme cases, the next day after the injury (you can call the doctor at home or bring the baby to the clinic). If necessary, the pediatrician will refer the baby for a consultation with other doctors (neurologist, traumatologist).

Delay in seeking medical help is fraught with a deterioration in the child's condition.

Before the arrival of the doctor

All that a mother can do before the doctor arrives is to calm the baby, put a cold compress on the site of the bruise and ensure peace for the baby. If a child has an open craniocerebral injury, you need to cover the damaged area with a sterile gauze bandage and urgently call an ambulance. With an open craniocerebral injury, cold cannot be applied.

When the doctor arrives, he will examine the child and, if necessary, take you and your baby to the hospital for additional tests and treatment.

TBI diagnostics

The first link in the diagnosis is an examination by a doctor. The doctor assesses the general condition of the child, his consciousness, the state of reflexes, physical activity, the integrity of the bones of the skull. The appointment of further studies depends on the preliminary diagnosis after examining the crumbs and on the capabilities of a particular medical institution. Sometimes only one study is enough to make a diagnosis, and sometimes, if doctors have doubts, they have to be done several at once.

If the large fontanel on the top of the baby has not yet been overgrown, it is possible to conduct neurosonography in a hospital or clinic - an ultrasound examination of the brain through a large fontanel. X-ray computed tomography (CT) is widely used in the diagnosis of brain pathologies. Currently, CT is the most reliable method for examining the brain.

Magnetic resonance imaging (MRI) is not related to X-rays, but is based on the absorbing abilities of magnetic fields. MRI provides a more contrast image of brain tissue than CT. However, CT and MRI are rarely prescribed for infants, since one of the conditions for their implementation is the complete immobility of the patient, which is almost impossible to provide with a small child. These studies for babies are possible only under anesthesia if absolutely necessary.

To assess the integrity of the bones of the skull, craniography (X-ray of the skull) is performed. Ophthalmoscopy - examination of the fundus - is an additional method of research. It allows you to identify signs of increased intracranial pressure, which is important for the diagnosis of intracranial hemorrhage or cerebral edema.

Lumbar puncture is a more reliable diagnostic method for suspected intracranial hemorrhage. Liquor is taken with a needle inserted between the spinous processes of the 3rd and 4th lumbar vertebrae. But during the puncture, the child must be motionless, since there is a risk of damage to brain tissue.

How is TBI treated?

Treatment is based on examination data and clinical studies. With concussion and bruises of the brain, treatment is usually medication. With a concussion, a baby is usually treated at home, and with bruises of the brain - in a hospital. As a rule, the child is prescribed drugs that have anticonvulsant, antispasmodic, hypnotic effects. Also, the crumbs will recommend rest for 4-5 days. The word “peace” for a baby should be understood as the absence of new impressions, limiting the number of people around to mom and dad, maintaining silence in the room where the baby is.

Consequences of TBI

After a concussion, the brain usually recovers within 1-3 months without any long-term consequences. With more serious injuries - bruises of the brain - the consequences depend on the severity of the damage. They can vary from dizziness and incoordination to increased intracranial pressure and epileptic seizures (convulsions with loss of consciousness).

The result of a severe injury may be psycho-emotional disorders (up to dementia) or movement disorders (for example, the inability to make any movements). With open craniocerebral injuries, there is a risk of infection of the brain tissue (encephalitis) and the development of meningitis - inflammation of the membranes of the brain.

If the baby does not hit his head ...

The first step is to quickly assess the condition of the child and examine the site of the bruise. If you saw the very moment of the fall, then finding the place of possible damage is not difficult. If you were not around, you should, if possible, reassure and carefully examine the baby.

We assess the situation. The site of the bruise can be seen by the characteristic redness that appears in the first seconds after the fall. Over the next few minutes, it is possible to increase the reddening of the skin, as well as the development of swelling, followed by the formation of a hematoma. A hematoma occurs when a large number of subcutaneous blood vessels rupture from impact, resulting in accumulation of liquid blood in the tissues, which has a red-burgundy color. A small hemorrhage cannot be called a hematoma - it's just a bruise (a bruise when a small number of subcutaneous blood vessels are damaged).

When the site of the bruise is found, you need to immediately make the baby a cold compress, as described above - in the section on TBI.

With a normal course, the hematoma decreases every day, and its color changes. A fresh hematoma is dark red, gradually turning blue, and then yellow. To speed up the resorption of the hematoma, you can use heparin-containing ointments that prevent blood clotting and, therefore, have a resolving effect, or make an iodine mesh, which has a similar effect.

Parents should be alerted by the reddening of the skin over the hematoma that suddenly appeared during the healing period (in the first 2–3 days after the injury), the baby’s general malaise, the rise in body temperature, the increasing pain at the site of the bruise (the child in this case will begin to show anxiety, and on touching the place hematomas will respond with a sharp loud cry). All this may indicate suppuration. In this case, the baby must be urgently taken to the surgeon. He will open the hematoma so that the purulent contents can flow out, and apply a bandage.

If, after falling, the hematoma continues to increase in size, you should also urgently consult a surgeon, as this may indicate continued bleeding. If the baby remains restless with a visible bruise, it is better to consult a doctor, since the crumbs may have a bone crack. This phenomenon occurs in young children more often than a fracture. You can suspect a crack when swelling appears at the site of impact, and also if the baby starts to cry when you try to move his injured limb.

Inspecting the impact site, it is important to determine if there is a fracture. Its signs:
severe pain at the fracture site; if a limb is broken, it will be very painful for the baby to move it;
severe swelling and bruising at the fracture site;
change in the shape or length of a broken limb (shortening or lengthening);
limitation of limb mobility or, conversely, its excessive mobility;
crunching when moving the injured limb.

If one or more of these signs appear, you should call an ambulance. In this case, the injured area should, if possible, be immobilized, for example, with a stick or plank tied with any piece of tissue to a broken limb. If the child cannot calm down due to pain, you can give him an anesthetic based on PARACETAMOL or IBUPROFEN in accordance with the age of the baby and the dosage indicated in the instructions for the drug.
If there is an abrasion at the site of the bruise (this is possible when falling on an uneven floor), you need to do the following:

wash the wound with soap under running cool water;
treat damage with hydrogen peroxide;
treat the edges of the wound with an antiseptic solution (iodine or brilliant green);
dry the wound with a gauze cloth;
apply a sterile bandage: cover the injury site with a sterile napkin (it can be purchased at a pharmacy - the napkin is sold in a sealed package with the inscription “sterile”) and fix it with a bandage or adhesive tape. If there are no sterile dressings, you can use a bactericidal patch.

Fracture treatment

In the hospital, after the examination, the doctor may prescribe an x-ray, and then, depending on the severity of the damage, measures will be taken:
The imposition of a splint - one-sided plaster in the form of a long strip - consisting of several layers of a plaster bandage, which is shaped into an injured limb and fixed with a bandage (for simple fractures without displacement of bone fragments).

An operation lasting several minutes under general anesthesia, followed by the application of a plaster cast (for fractures with displacement and comminuted fractures). During the operation, bone fragments are compared, which is necessary for a full restoration of function and the absence of complications after a fracture.

When applying a splint, you and your baby will need to visit a traumatologist for examination.
ra once a week - provided that redness does not appear under the bandage and there is no loss of sensitivity of the injured limb. (Parents should be alerted by blanching, as well as coldness of the injured limb relative to other parts of the body).

If an operation is required, then you and your baby will have to stay in the hospital for 3-5 days so that the doctors make sure that everything went well. Then the baby will be discharged home with a cast, and the traumatologist will observe him on an outpatient basis.

The gypsum, as well as the splint, are removed when the bone is completely fused, which can be checked by taking an x-ray. Depending on the location of the fracture, the duration of this period can range from 2 weeks (for example, with a fracture of the phalanx of the fingers) to 3 months (with damage to the bones of the lower limb and pelvis).

Prevent injury

As already mentioned, babies fall most often due to the fact that parents underestimate their capabilities. Very young, newly born children also fall - most often due to the fact that mothers leave them unattended on the changing table to run for cream or answer the phone. Making chaotic movements, the baby is able to move quite well, so in no case should you leave even a newborn child alone where he can fall. In order not to be absent during a diaper change, changing clothes, etc., prepare everything you need in advance. And if you need to answer the phone or open the door, it is better to take the baby with you or put it in a crib. Do not leave the baby unattended on an adult bed or sofa. Although their height is less than, for example, a changing table, for a small child this can be enough to cause serious injury.

It is also necessary to raise the side of the bed in a timely manner when the baby learns to roll over. And when the child starts to get up, it is necessary to lower the bottom of the crib - preferably to the lowest level, so that the baby cannot fall out, leaning over the sides.

In order to be able to leave the baby alone and not be afraid for his safety, you can purchase a playpen or make the floor in the room as safe as possible (remove wires, put plugs on sockets, remove all small and traumatic objects, put blockers on boxes that the baby can reach, protect sharp corners of furniture).

Statistics show that very often babies fall out of highchairs or strollers. Therefore, putting the baby on a chair, you should definitely fasten it with a five-point seat belt. A baby carriage should also be equipped with such belts, and you should definitely use them, even if the baby is constantly in your field of vision. After all, even if the mother is distracted only for a second, there is a risk that the child will fall. And the consequences of a fall, as we have seen, can be very severe.

Did your child hit his head in the fall? What are the possible consequences of a head injury in children and what symptoms should you see a doctor in this article.

Healthy children are usually very active, move a lot and often fall, getting injuries of varying severity. Most often, this does not have serious consequences, and bumps, bruises and small wounds pass quite quickly and without much hassle. But there are times when, due to injury, the threat to the health of the baby can be significant, especially when the child is bruised by the head.

Consider the various options for head injuries, how dangerous they can be, in which cases you should not worry about the consequences, and also for which symptoms you need help and medical supervision.

The child hit his head

There is no need to be scared if even a big bump has grown in the baby after hitting his forehead. The frontal bone is quite strong, and edema (bloating, bump) at the site of the bruise appears due to damage to small vessels and filling of soft tissues with blood. to avoid the formation of a hematoma. Apply any cold object to the impact site. As for the swelling, it will disappear on its own after some time.

the child cannot be soothed and he constantly cries,

With timely treatment, all these factors, as well as their consequences in later life, can be avoided.

Prevention of childhood head injuries

Children in general, and especially small ones, should be supervised by adults. It is the responsibility of adults to ensure that children play in a safe and well-lit area and are appropriately dressed, both outdoors and indoors. If necessary, parents are obliged to take care of special protective equipment (for example, a helmet on the head when riding a bicycle).

When traveling in a car, the baby must sit in a special seat, and an older child must be fastened with a seat belt.

Watching children play, it is necessary to control the situation in order to prevent any possible dangers in time.

It is very good if children develop physically. doing sports or dancing, which strengthens their muscles and improves coordination of movements. Such children manage to better group themselves when falling and thus avoid serious injuries.