Influence of age and fall type on head injuries in infants and toddlers

Abstract

Age-based differences in fall type and neuroanatomy in infants and toddlers may affect clinical presentations and injury patterns. Objective Our goal is to understand the influence of fall type and age on injuries to help guide clinical evaluation. Design/Setting/Participants Retrospectively, 285 children 0–48 months with accidental head injury from a fall and brain imaging between 2000–2006 were categorized by age (infant=<1 year and toddler=1–4 years) and fall type: low (≤3 ft), intermediate (>3 and <10 ft), high height falls (≥10 ft) and stair falls. Outcome Measures Clinical manifestations were noted and head injuries separated into primary (bleeding) and secondary (hypoxia, edema). The influence of age and fall type on head injuries sustained was evaluated. Results Injury patterns in children <4 yrs varied with age. Despite similar injury severity scores, infants sustained more skull fractures than toddlers (71% v. 39%). Of children with skull fractures, 11% had no evidence of scalp/facial soft tissue swelling. Of the patients with primary intracranial injury, 30% had no skull fracture and 8% had neither skull fracture nor cranial soft tissue injury. Low height falls resulted in primary intracranial injury without soft tissue or skull injury in infants (6%) and toddlers (16%). Conclusions Within a given fall type, age-related differences in injuries exist between infants and toddlers. When interpreting a fall history, clinicians must consider the fall type and influence of age on resulting injury. For young children, intracranial injury is not always accompanied by external manifestations of their injury.

Fatal Head Injuries in Children Under the Age of 5 Years in Pretoria

“…23 Ibrahim et al (Philadelphia, 2012) reviewed children under the age of 4 years who had sustained accidental head injury in a fall and found that there were age related differences in the nature of injuries sustained. 24 This study found skull fractures to be more common in infants (79% of cases) than in children aged 1-4 years (39%). They also indicated that in falls from a low height (≤ 3 feet) resulted in primary intracranial injury without scalp or skull injury in 6% of infants and 16% of toddlers.…”

“…They also indicated that in falls from a low height (≤ 3 feet) resulted in primary intracranial injury without scalp or skull injury in 6% of infants and 16% of toddlers. 24 We identified six cases of homicide for inclusion in our study sample: four of these fatalities were due to gunshot wounds, with 3 of these coming from 2 homicide-suicide events. Byard et al have reported on children involved in murder-suicide cases, stating that when the father was the perpetrator, they tended to kill the children and the adult in the relationship.…”

Neuroimaging differential diagnoses to abusive head trauma

“…7 Accidental trauma in a 4-year-old boy. Axial CT shows left-side subdural hematoma (arrows) with a mixed-density appearance cause of subdural hematoma; in contrast, epidural hematoma is commonly seen in accidental falls [33] (Fig. 10).…”

Influences of Developmental Age on the Resolution of Diffuse Traumatic Intracranial Hemorrhage and Axonal Injury

“…3,[8][9][10][11][12][13][14][15][16][17][18][19] During the first four years of life, numerous cerebral developmental changes occur, which may contribute to these differences within the pediatric population, including continued myelination, changes in cerebrovascular tone, and increases in both brain size and neurotransmitter density. [20][21][22] Experimental studies of the age-dependent response to a scaled cortical impact found larger lesion volumes at seven days and one month post-TBI in four-week-old piglets, compared with five-dayold piglets.…”