In this section
Head injuries are common in children of all ages. Causes include falls, sporting accidents, road traffic accidents and non-accidental injuries.
A key aim of head injury management is to prevent or minimise secondary brain injury which occurs as a result of hypoxia, poor cerebral perfusion, cerebral bleeding, hypoglycaemia, seizures and fever
· ABC: ensure that the child's airway, cervical spine, breathing and circulation are secure.
· Rapidly assess the child's mental state using the AVPU scale. Use firm supraorbital pressure or jaw thrust as the painful stimulus.
* suspect basal skull fracture if these signs present
Multiple trauma present, see Major trauma guideline
Cervical spine imaging
Venous blood gas and blood sugar level (especially in small children and in adolescents who have been drinking alcohol)
ECG (query arrhythmia as cause of fall)
≥ 4 years
< 4 years
To verbal stimuli
To painful stimuli
No response to pain
Best verbal response
Orientated and converses
Appropriate words or social smile, fixes, follows
Confused and converses
Cries but consolable; less than usual words
Moans to pain
No response to pain
Best motor response
Obeys verbal commands
Spontaneous or obeys verbal commands
Localises to stimuli
Withdraws to stimuli
Abnormal flexion to pain (decorticate)
Abnormal extension to pain (decerebrate)
Minor – jump to Management
Minor head injury:
Moderate Head Injury:
Severe Head Injury:
The initial aim of management of a child with a serious head injury is prevention of secondary brain damage. The key aims are to maintain oxygenation, ventilation and circulation, and to avoid rises in intracranial pressure (ICP).
Urgent CT of head and c-spine. Ensure early neurosurgical and ICU intervention.
Cervical spine immobilisation should be maintained even if cervical spine imaging is normal.
Intubation and ventilation:
In consultation with the neurosurgeon consider measures to decrease intracranial pressure:
Control seizures: see Afebrile seizures
Analgesia: sufficient analgesia should be administered by careful titration. Head injured children are often more sensitive to opioids.
Head injury - general advice information sheet - should be given to all parents.
Ensure the parents have clear instructions regarding the management of their child at home especially to return to hospital immediately if their child:
Head Injury handout - Return to sport
For advice and inter-hospital (including ICU level) transfers ring the Sick Child Hotline: (03) 9345 7007
Please see our clinical practice guideline Immunisation of Outpatients
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