Morbidity following minor head trauma in children

Head trauma, the most common form of accidental injury among children, is a source of concern for parents and pediatricians. Parents worry about a child's loss of intellectual function. Pediatricians often see the well-documented sequelae of severe head trauma as a basis for parental instructions on observation of a child after minor head injury. A prospective study of 321 children, 6 months to 14 years of age, who had sustained minor head injury within the previous 24 hours was conducted in the emergency department of the Children's Hospital of Philadelphia. Parents of all children completed a ten-minute triage questionnaire and received discharge instructions after their child had received standard medical management. One month after the injury, a questionnaire was administered in a telephone interview to assess the child's physical health status, social or functional limitations, and behavior problems. Physical morbidity was rare, and headache, the most frequent complaint, occurred in only 7% of the children. However, parents reported substantial functional morbidity, and there were significantly more behavioral problems in the 2- to 14-year-old head trauma patients than reported for the standard normal population. Therefore, children who have sustained minor head trauma manifest substantial functional morbidity despite the rarity of physical sequelae. This functional morbidity probably reflects parental overreaction and possibly family dysfunction. It is recommended that pediatricians who have determined that a child's head injury is mild should focus parental education on the rarity of physical sequelae and the importance of the child's returning to a normal routine.