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Key Points

  1. The predominant mechanism of head injury in children varies with age. The leading cause of severe head injury in infants is nonaccidental, or inflicted, trauma.

  2. The physiologic processes resulting from acute head injury are divided into primary brain injury and secondary brain injury.

  3. Children with extensive cerebral shear injury on admission often have protracted hospitalizations with permanent neurologic deficits and poor functional outcomes.

  4. Avoidance of systemic hypotension, hypercarbia, hypoxemia, hyperglycemia, intracranial hypertension, and seizure activity can significantly minimize secondary injury following moderate or severe traumatic brain injury, thereby substantially reducing morbidity/mortality and improving functional outcomes.

  5. Children with a post-resuscitation GCS of ≤8 should generally undergo continuous ICP monitoring as part of their management.

  6. The classic triad of findings in children with inflicted injury includes subdural hematomas, retinal hemorrhages, and evidence of skeletal injury.

Three out of four children hospitalized for trauma have sustained a head injury. While most pediatric head injuries are minor, requiring only brief hospital stays for observation, injuries to the central nervous system still represent the most common cause of mortality in pediatric trauma patients. Management of the child with severe head injury requires special consideration be given to fundamental differences in pediatric and adult neurophysiology. In addition, certain mechanisms of traumatic brain injury (TBI), such as the “shaken baby syndrome,” are unique to infants and young children and can be quite devastating to the developing brain. Similarly, recovery patterns and potential following brain injury differ significantly between children and adults, affecting long-term rehabilitation strategies in the pediatric population. This chapter characterizes the major types of pediatric head injury and their treatment, highlighting similarities and differences between pediatric and adult management strategies where appropriate.

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