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The statement that children are not small adults particularly applies when considering the developing nervous system. The nervous system is constantly changing throughout childhood. Thus the way trauma to the developing nervous system affects the child depends on where along the neuraxis the trauma occurs, at what age and developmental stage, and the mechanism of the trauma. These specifics are important to consider in the context of the most frequent causes of trauma, the implications, and the outcomes. Trauma usually results in acute deterioration in neurologic function but late sequelae or delayed effects must also be anticipated. In this section, discussion will focus on the most commonly encountered scenarios of trauma to the nervous system in pediatrics. This includes accidental traumatic brain injury, inflicted neurotrauma, spinal cord injury, and associated injury to adjacent tissues, such as bone in skull fractures and blood vessels in hemorrhage. The acute management of these injuries is further discussed in Chapter 104. Trauma to the brachial plexus during delivery will be briefly discussed.

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Under normal circumstances, the skull protects the brain from minor trauma by cushioning the sensitive contents from external blows. The surrounding cerebrospinal fluid (CSF) assists in reducing any force by providing a fluid layer in which the brain may “float.” However, with more severe trauma, the differential rate of movement of the skull, brain, CSF, and blood vessels causes acute injury to the contents. Traumatic brain injury results from the sudden acceleration or deceleration of the brain relative to the skull or from penetrating injury. The degree of injury manifests along a spectrum from mild functional impairment without obvious visible injury (either on physical examination or neuroimaging) to severe, generalized, or focal/multifocal injury.

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Head injury is one of the most common neurologic disorders in pediatrics. Millions of children and adolescents suffer an injury to the head each year but most do not seek medical attention or are seen by a primary physician well after the event. Thus, the incidence and characteristics of these head injuries are not fully known. Of those who seek care in a hospital-based setting, each year, approximately 475,000 traumatic brain injuries (TBIs) occur in children ages 0 to 14 years.1 More than 90% of these (435,000) present to emergency rooms for immediate care, 37,000 are hospitalized, and 2685 are fatal. The rate of TBI-related emergency room (ER) visits, hospitalizations and deaths is greater than 50% more common in boys than girls ages 0 to 14. Across all ages in children and adolescents, TBI is more common in males than in females. Falls are the most common cause of TBI from ages 0 to 14, accounting for 39% of all TBIs in that age range. After age 14, motor vehicle accidents become the most common cause, followed by assaults and falls. Most fall-related TBIs are evaluated in the emergency room and more than 90% of patients are released to their home. However, after age 4 years, motor vehicle ...

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