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> Trauma

Trauma is a broad topic. It can be broken down into three large epidemiological categories:

First Category:
Injuries occurring at birth, during infancy and during childhood. Often the injuries are accidental or due to a failure in the child’s protective environment.

There are many types of birth related injuries that lead to involvement of a neurosurgeon. Luckily, most do not require surgical treatment. Common problems are bleeding under the scalp or membranes of the skull bone and small fractures. These are best left alone and will heal spontaneously.

Rarely there may be bleeding inside the head. This may cause seizures or irritability or some change in the baby’s activity. Often the bleeding is trivial and will spontaneously resolve. Very rarely does a surgeon need to operate to remove a blood clot from an infant’s brain. The outlook for most children is excellent.

Another type of injury to the nervous system at birth is injury to the brachial plexus. These are nerves that arise from the spinal cord in the neck to supply strength and sensation to the arms. This injury arises from the stretching of the nerves as the baby is being delivered.

The injury may range from subtle weakness to complete loss of use of the arm. The great majority improve spontaneously. Under rare circumstances surgery may be required if the arm function does not return.

Second Category: Injury occurring in infancy.

Often these are due to unfortunate accidents or moments of distraction when a parent will turn their back for a second and somehow the baby will fall off of something like a changing table.

The types of injuries that babies get are primarily bruises and only rarely do fractures or bleeding occur. It is difficult to say when a physician should be notified but, in the absence of obvious trauma to the head, use your best judgment. If the baby quickly returns to their normal activity then usually things are okay. If the child becomes irritable or unusually sleepy or starts to vomit or have seizures then certainly they must be evaluated promptly.

Unfortunately, children under the age of three are brought to the hospital with injuries that are inflicted upon them by adults. This so- called “shaken baby” type trauma often will require a neurosurgeon to evaluate injuries such as skull fractures, subdural hematomas and diffuse axonal injury.

Third Category:
Injury occurring in older and adolescent children.

As children start to venture out into the world and start to ride bikes and play on swings and gym sets, the types of injuries they get are more like those of adults. These include skull fractures and bleeding into or around the brain. Some require surgery and others can be followed without any need for an operation. The best advice for parents is to minimize the risk for these injuries. This includes:
  • bike helmets
  • seat belts
  • supervised play
  • good judgment
Still, kids are kids and accidents will happen. Warning signs of an injury are similar to infants:
  • worsening headaches
  • vomiting
  • seizures
  • lethargy
  • confusion
Concussions are a common type of minor head injury that occur. Most of these children do not require admission to the hospital.  Many children, especially after more than one concussion, may have a protracted course of headaches, irritability and poor school performance.