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Influence of age and fall type on head injuries in infants and toddlers
Nicole G Ibrahim1, Joanne Wood, Susan S Margulies
1Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA. nicole.ibrahim@fda.hhs.gov
Insights
Infants and toddlers experience different fall-related head injuries based on age and fall type. Intracranial injuries in young children may occur without external signs, necessitating careful clinical evaluation.
Area of Science:
- Pediatric Traumatology
- Neuroimaging in Children
- Injury Biomechanics
Background:
- Age-based differences in neuroanatomy and fall biomechanics influence injury patterns in young children.
- Understanding these variations is crucial for accurate clinical assessment of head injuries in infants and toddlers.
Purpose of the Study:
- To investigate the impact of fall type and age on the characteristics of head injuries in children aged 0-48 months.
- To guide clinical evaluation by clarifying injury patterns related to fall mechanisms and patient age.
Main Methods:
- Retrospective analysis of 285 children (0-48 months) with accidental head injury from falls and brain imaging.
- Categorization by age (infant ≤1 year, toddler 1-4 years) and fall type (low, intermediate, high, stair falls).
- Evaluation of clinical manifestations and classification of head injuries into primary (bleeding) and secondary (hypoxia, edema).
Main Results:
- Infants sustained more skull fractures than toddlers (71% vs. 39%) despite similar injury severity.
- A significant percentage of children with skull fractures lacked external soft tissue swelling (11%).
- Primary intracranial injury occurred without skull fracture in 30% of cases and without external signs in 8%.
Conclusions:
- Age-specific injury patterns exist between infants and toddlers, even within the same fall type.
- Clinicians must consider fall type and patient age when interpreting fall histories and assessing head injuries.
- Intracranial injuries in young children may not always present with external signs, highlighting the importance of imaging and thorough evaluation.
Unlabelled:
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 and 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 years varied with age. Despite similar injury severity scores, infants sustained more skull fractures than toddlers (71% vs. 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.
