Pediatric Head Trauma

Children nowadays can be very active. Chances are they can get hurt and may need immediate treatment. One of the injuries in children that must be prevented is head trauma. Head trauma has been found to be the common cause of death and disability in children. The brain of a child is relatively bigger than its body, any trauma or excessive impact may cause instability on the supporting structures.

When it comes to disability it brings to children, mentally and physically they can be affected. Head trauma can be secondary to fall, vehicular accident or accidental mauling. Head trauma can actually be divided into two categories:

1. Primary injury – This is the initial damage on the head upon the impact on the brain. The brain might be pushed near on the skull, a break on the sutures of the skull or even punctured wound on the head part are some of the primary injury.

2. Secondary injury – After the impact of the primary injury, systemic effects may occur. Altered neurological activity as well as bleeding tendencies can happen as a secondary injury. Increased intracranial pressure can actually happen causing the patient to vomit. Other than that, some of the part of the body may not function as normal previously.

Management of Head Trauma as it occur:

A child recognized to have a head trauma must be brought to the nearest hospital. The cervical spine must be stabilized during the transport. Supplemental oxygen must be administered in order to prevent respiratory arrest. The intubation can done in order to optimize air flow into the respiratory pathways.

Bleeding on the head can actually be stopped through direct pressure while performing immediate assessment of the contour of the skull as well as the consciousness of the child. Elevating the head within 30 degrees is advised.

The true picture of the damage of the head can only be visualized through a CT scan. With this advancement in imaging, immediate interventions can be made. Immediate cranial surgery can be advised when evacuation of large clots must be made.

Increasing pain can be managed through analegisics via intravenous route. Proper observation of the response of the child to injury must be done. The patient will be admitted in a pediatric care intensive unit. During the stay, a standby stock of diazepam is prepared in order to prevent seizure attacks. Aside from that, the intracranial pressure can be prevented through induction of mannitol. Urine output and blood pressure must also be monitored during the administration of mannitol.

After a child has survived this ordeal of head trauma, he or she may still wear supportive cervical spine collar in order to prevent instability on the flow of blood to the brain. Given this situation, proper follow up with a neurosurgeon must be done as well as a developmental psychologist.

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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