HEAD INJURY, SKULL FRACTURE
DESCRIPTIONA skull fracture may be either a closed, or simple, break in the bone, leaving the skin or bone covering (periosteum) intact, or an open, or compound, break that breaks the skin and periosteum.
Appropriate health care includes: doctor's diagnosis and care; hospitalization (serious skull fractures); home care if hospitalization is not necessary.
SIGNS AND SYMPTOMS
Pain and swelling over the skull fracture.
Bruising over the fracture and around the child's eyes and nose.
Profuse bleeding from the scalp if the skin is broken.
Leakage of clear fluid (cerebrospinal fluid) into the ear or nose.
Additional signs, if brain damage accompanies the skull fracture: drowsiness or confusion; vomiting and nausea; blurred vision; loss of consciousness--either temporarily or for long periods; amnesia or memory lapses; irritability; headache.
A direct blow to the child's head.
RISK FACTORSContact sports, especially if the child's head is not protected adequately.
Sports that involve heavy equipment such as baseball bats or golf clubs, or sports in which falling on the head is possible, such as basketball, gymnastics, diving, or cycling.
PREVENTING COMPLICATIONS OR RECURRENCEYour child should wear a protective helmet or other appropriate headgear during athletic activity in which head injury is possible.
MEDICAL TESTSYour own observation of symptoms; physical exam by a doctor (the total extent of injury may not be apparent for 48 to 72 hours); X-rays and CAT scan of the head and neck; laboratory studies of blood and cerebrospinal fluid.
Hematoma (a collection of blood) that creates pressure on the brain. This can cause permanent brain damage or death, depending on the extent of injury.
Infection if skin over the skull fracture is broken.
Most skull fractures without complications heal within 4 to 6 weeks. Complications can be life-threatening or cause permanent brain damage (see HOME CARE below).
FIRST AIDUse instructions for R.I.C.E. See Appendix 39 for details. This is critical to minimize bleeding and swelling!
After a doctor's examination, the injured child may be sent home -- but a responsible person must watch for symptoms. The first 24 hours are critical, but serious aftereffects can appear later. Awaken the child every hour for 24 hours. Report to the doctor immediately if you can't arouse the child of if there is vomiting, inability to move arms and legs equally well on both sides, temperature above 100F (37.8C), stiff neck, pupils of unequal size or shape, convulsions, noticeable restlessness, severe headache that persists longer than 4 hours after injury, or confusion.
Don't give any medicine--including non-prescription acetaminophen or aspirin -- until the extent of the child's injury is certain.
The child should rest in bed until the doctor determines that the danger of complications--especially hematomas -- is over. Normal activity may then be resumed as symptoms improve.
DIET & FLUIDS
Your child should have only liquids until the danger of complications passes.
OK TO GO TO SCHOOL?Yes, when condition and sense of well-being will allow.
CALL YOUR DOCTOR IF
Your child has signs of a skull fracture after a blow to the head.
After returning home, any symptoms appear that are listed under HOME CARE.