Jewish World Review March 17, 2003 / 13 Adar II, 5763

Brain damage rarely results, but parents need to pay careful attention to a range of symptoms

By Valerie Ulene | I can still picture the egg-shaped purple swelling that developed on my son's forehead when, at 12 months of age, he tripped over his own feet and landed face-first on our concrete driveway. And I can still remember the panic I felt when -- eight months later -- he toppled backward off a picnic bench and hit his head on the hard ground.

As any parent can attest, such experiences are all too common. No matter how closely you watch a child, it's unlikely that he or she will make it through childhood without at least one strong blow to the head. In my son's case, neither incident resulted in injury to his brain, but not all children are as fortunate.

Every year almost 100,000 American children suffer significant brain injury because of head trauma; the good news is that the vast majority of children who strike their heads do not suffer injury to the brain. The soft, delicate brain tissue is fairly well protected by the hard skull bones and a "cushion'' of surrounding cerebrospinal fluid.

But the protection is not perfect. If forceful enough, any blow can cause the brain to be slammed against the inside of the skull, and that impact can result in bruising or swelling of the brain. It can also tear blood vessels inside the skull, causing bleeding around the brain. Because the skull is unable to expand, the swelling of the brain or the accumulation of blood around it can cause life-threatening brain compression.

The likelihood of brain injury after a blow to the head is directly related to the force of the blow. That fact favors younger children. "Up to about age 6 or 7, it's unlikely that children will generate enough force themselves to cause a significant brain injury,'' says Dr. Mark Krieger, an assistant professor of neurosurgery at Childrens Hospital of Los Angeles. "Tripping on the pavement or careening into a wall while running, for example, probably isn't enough to do it.'' (The situation is different in older children because they weigh more and generate more force when falling.)

A fall from a height, however, is a different story. The child's speed accelerates during the fall, so the force of the blow is greater. The same is true of high-speed injuries, such as biking accidents or falls from a horse.

After a child suffers a head injury, parents are faced with several difficult questions: Has the blow to the child's head caused an injury to the brain? Does the child need to be taken to the doctor or emergency room? Except with the most severe and obvious injuries, the answers to these questions are not simple.

"Any child who experiences a seizure or suffers a loss of consciousness after sustaining a head injury should be evaluated promptly by a physician,'' says Krieger. Even if the child has not lost consciousness, a doctor should be contacted if the child is complaining of a headache that is more than just soreness at the site of impact or if the child is vomiting or feeling nausea. Any notable change in activity level should also prompt a call to the doctor. (While fatigue and lethargy are generally well-recognized signs of head injury, agitation or hyperactivity are also warning signs.)

Ultimately, there is only one hard and fast rule to follow: If there is any question about whether the child has suffered a brain injury, contact a doctor.

Dr. Valerie Ulene is a specialist in preventive medicine practicing in Los Angeles. Comment by clicking here.


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