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  • Carefully rule out mild head injury in the context of other facial or scalp injuries.
  • Suspect nonaccidental trauma in infants and toddlers, especially when the history is not consistent either with the child's developmental milestones or with the physical findings.
  • Have a lower threshold for imaging younger children (<2 years old) because they are at greater risk of asymptomatic intracranial injury.
  • Do not hesitate to observe the child for a few hours, especially if there is any discomfort on the part of the physician or the caregiver(s).
  • Evaluate concussed athletes carefully: They are very motivated to hide their symptoms so that they can return to play. The player may not have had any loss of consciousness, but may still have sustained a significant concussion.
  • Discharge instructions and counseling are critical, especially as to reasons to return to the emergency department, return to play criteria, and the possible duration of concussive symptoms.

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Unintentional, blunt traumatic brain injury (TBI) is the leading cause of death and disability in the under-20 age group. There are 7440 deaths, 642 000 emergency department (ED) visits, and 65 000 hospitalizations annually because of TBI.1 The majority (84%) of these head injuries is classified as mild traumatic brain injury (MTBI). Unfortunately, there is significant variability in how investigators define MTBI; they also disagree over whether any lasting effects may result (Tables 15–1 and 15–2).

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Table 15-1. Definition of MTBI by the American Academy of Pediatrics
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Table 15-2. Definition of MTBI by American Congress of Rehabilitation Medicine
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Concussion is included in the spectrum of MTBI. Physicians have long regarded concussion to be a benign condition, but its role in long-term brain damage is being investigated and argued. The American Congress of Rehabilitation Medicine has a slightly different definition, based on the belief that the trauma has induced a physiologic disruption of brain function with possible prolonged or permanent sequelae. The inclusion criteria comprise at least one of the following.

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The infant's head has a disproportionately large size and weight relative to the rest ...

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