In this section
Major paediatric trauma – Primary survey
Major paediatric trauma - Secondary survey
Cervical Spine Assessment
Primary survey and
Rapidly assess the child's mental state using the AVPU scale.
V Responds to voice
P Responds to pain
Assess pupil size, equality and reactivity
< 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
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)
Neuroimaging (discuss with senior doctor or neurosurgeon)
The need and timing of neuroimaging for children requires weighing the clinical benefit with the risk of radiation exposure and the need for sedation. For children other than the above, this decision should be made by a senior clinician – if in doubt, call the paediatric retrieval service to discuss with a paediatric emergency physician.
Consider other investigations
If other injuries present, as clinically indicated.
Consider investigation for causes of falls e.g. alcohol,
other ingestions, arrhythmias, hypoglycaemia
Signs of severe head injury include GCS
<8, presence of focal neurological signs, signs of increased intracranial pressure or signs of basal skull fracture.
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 consideration of imaging of c-spine. Ensure early neurosurgical consultation
Cervical spine immobilisation should be maintained until formal assessment occurs. See
Cervical Spine Assessment.
Intubation and ventilation:
In consultation with the neurosurgeon consider measures to decrease intracranial pressure:
Analgesia and sedation:
For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.
The child is acting normally as per the parents and can tolerate fluids.
Ensure the parents have clear instructions regarding the management of their child at home especially to call 000 or return to hospital immediately if their child:
Advise parents that children with anything other than a trivial head injury may take up to 4 weeks to recover, and graded return to activity is recommended.
Head injury - general advice
Head Injury - Return to school and sport
Raising Children Network Concussion
Last Updated October 2018