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  • What to do with a child's head injury

    In Singapore, head injury is one of the most common injuries occurring in children. About 50% of children who seek treatment in the Children's Emergency for injuries sustained head injuries. More than 80% of head injuries in young children occur at home. Common situations include falls from being left unattended on an adult bed, falls from chairs and tables and falls related to the use of baby walkers and sarong cradles.

    Most head injuries do not cause complications but sometimes children may have skull fractures and internal brain injuries which can potentially be serious. About 20% of the patients seen in the Children's Emergency for head injuries require treatment by specialists from the Paediatric Neurosurgery Department.

    You should bring your child to see the doctor if he sustains a head injury. Drowsiness, unconsciousness, vomiting or bleeding from the ears or nose are especially serious symptoms and signs of head injury.

    Here's what the caregiver or parent/s should do in case the child suffers from head injury:

    Bring the child immediately to the emergency department if any of the following signs and symptoms appear within the first 72 hours after discharge.
    • Any unusual behaviour not considered normal for your child
    • Confusion about familiar names and places
    • Worsening or persistent headache
    • Seizures ("Fits")
    • Unsteady gait (not able to walk normally or steadily)
    • Unusual drowsiness (feeling sleepy all the time)
    • Inability to wake your child from sleep
    • Persistent Vomiting
    • Double or blurred vision
    • Bleeding or watery discharge from the ear or nose
    • Avoid giving your child any medication that may cause drowsiness (or sleepiness) unless instructed by your doctor.

    Childhood Head Injury Prevention - Tips For Caregivers:

    Nothing can replace close adult caregiver supervision in childhood injury prevention.

    Children are not able to identify the potential injury hazards in their environment and they need your care and protection.

    Infants and toddlers:

    1. Do not leave your baby unattended, even for a few seconds, on an adult bed or baby cot without proper barriers.
    2. Do not use the sarong cradle. Head injuries, skull fractures and even deaths have occurred when infants fall off the sarong or when the springs or attachments of the cradle breaks.
    3. Do not use a baby walker. They can topple over and many falls causing head injuries have been documented locally and overseas. Some cases of deaths as a result of these injuries have been reported.
    4. Do not shake violently even when your may feel frustrated or angry. This can cause severe and fatal internal head bleeding.
    5. Ensure that the high chair your child uses is of a sturdy design and use the appropriate restraints when your child is seated in it.
    6. Use an age-appropriate car seat for your child.

    School-going children:

    1. Supervise children closely in playgrounds. Prevent them from climbing onto unstable and high structures. Avoid playgrounds that are poorly maintained or have unsafe designs (e.g. hard flooring, rusted or broken metal parts).
    2. Ensure that a properly fitted protective helmet is used for activities like cycling, skating, skateboarding, roller blading, or during the use of the skate scooter.
    3. Teach your child road safety habits. Do not allow your child to play or go on the roads unsupervised.
    4. Ensure that your child puts on age-appropriate seat belts or booster seat restraints while in a vehicle.
    5. Teach your child sports and recreational safety rules.

    Does My Child Need A Skull X-ray?

    Skull X-rays help to identify skull fractures. However, they do not directly show brain injury or bleeding within the skull. It is not a reliable indicator of bleeding within the skull or brain injury. Your doctor will examine your child and decide if a skull X-Ray is really necessary. Skull X-rays are seldom necessary.

    Clinically abnormal signs and symptoms as mentioned above are much more reliable than skull X-rays as predictors of injury or bleeding within the skull.

    A normal skull X-ray does not rule not bleeding within the skull or brain injury.Close monitoring of the child's behaviour over the next 72 hours of head injury is still necessary even though the skull X-ray may be normal.

    If brain injury or bleeding within the skull is suspected, the patient will need urgent CT scan.

    Where to Seek Treatment

    The medical institutions within SingHealth that offer consultation and treatment for this condition include:
    KK Women's and Children's Hospital
    Children's Services
    100 Bukit Timah Road Singapore 229899

    Central Appointments:
    Tel: +65 6294 4050

    International Enquiries, please contact:
    Tel: +65 6394 8888
    Email: international@kkh.com.sg

    This article is originally written for Singhealth.com.,sg

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