Head Injury in Children

Head injury is pathological result of any mechanical force to the skull, scalp, meninges, or brain. The manifestations of head injury depend on the type of injury and the amount of increased intracranial pressure (ICP).


Sign and Symptoms of Head Injury:

Early Signs:

• Headache
• Nausea and vomiting
• Visual disturbances and diplopia
• Slight changes in vital signs
• Dizziness or vertigo
• Change in pupillary response and equality
• Slight change in level of consciousness
• Signs in infants: bulging fontanel, wide sutures, increased head circumference, high pitched cry, and dilated scalp vein

Late Signs:

• Cushing’s triad: increased systolic blood pressure and widened pulse pressure, bradycardia, and irregular respiration
• Significant decrease in level of consciousness
• Decorticate posturing (see picture)
  
• Decerebrate posturing (see picture)
  
• Fixed and dilated pupils

Nursing Intervention in Head Injury:

1. Monitor and assess the airway, breathing, and circulations
2. Assess the injury and immobilize the neck if a cervical injury is suspected
3. Monitor vital signs and neurological function
4. Monitor level of consciousness
5. Initiate seizure precaution
6. Keep patient a nothing by mouth status until determined that vomiting will not occur
7. Administer oxygen and intravenous fluid as prescribed
8. Elevate the head of bed at 15-30 degrees if not contraindicated
9. Keep head in midline position to facilitate venous drainage and avoid jugular vein compression
10. Monitor for nose or ear drainage which could indicate leakage of cerebrospinal fluid (CSF) as a sign of skull fracture
11. Avoid suctioning through the nares
12. Administers acetaminophen (Tylenol) for headache, anticonvulsants for seizures, antibiotic, and tetanus toxoid as prescribed
13. Monitor for signs of brainstem involvement: deep, rapid, or intermittent and gasping respirations; wide fluctuations or noticeable slowing of the pulse; widening pulse pressure or extreme fluctuations in blood pressure
14. Monitor for epidural hematoma: asymmetric pupils