Head Trauma for the Pediatrician

¹ Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore

A physician's concern about continued or progressive alteration in consciousness or neurologic function will result in the early recognition of head trauma complications that require medical or surgical intervention. The role of the pediatrician following "minor" head trauma is to serve as the overseer, coordinating observations and providing informed decisions on the necessity of additional medical or diagnostic requirements. This article provides an approach to handling the patient with mild head trauma based upon our experiences and interpretations of the literature.

In conclusion, we emphasize the following points: (1) patients with head trauma, especially if associated with loss of consciousness, should be examined and subsequently evaluated by reliable observers; (2) skull x-ray films rarely provide information that affects medical management; (3) deterioration in the patient's clinical condition demands consultation and appropriate neuroradiologic studies; (4) the presence of a seizure or basilar skull fracture does not in itself necessitate therapy; and (5) continued evaluation of head trauma management is required to determine the optimal approach.