Skull Fracture In Children

What is a skull fracture?

  • A skull fracture (FRAK-chur) is also known as a cranial fracture. This occurs when a part of your child's skull (bones of the head covering the brain) is broken. Children have heads that are large in size, as compared to the rest of their bodies.

  • The skull supports the structures of the face and protects the brain against injury. It is made up of small bones that are connected to each other. These bones include the frontal, parietal, temporal, occipital, sphenoid, and ethmoid bones. With a skull fracture, the brain and its outer lining, spine, and spinal cord may also be damaged.

What causes a skull fracture?

A skull fracture in children is caused by an injury or trauma to the head. This usually happens when a child falls from a high place and lands on his head. He may have fallen from a bed or down the stairs. Most injuries occur while the child is at play. A direct blow to the head may also cause a skull fracture. This may occur during a fight, physical abuse, a car accident, or in contact sports. Skull fractures may also occur during birth when the head passes through the narrow birth canal. Birth delivery using forceps may also fracture the soft skull of the baby.

What are the signs and symptoms of a skull fracture?

Your child may have one or more of the following:

  • A cut, bruise, or swelling on his head. Your child may also have bruises around his eyes and behind his ears.

  • Blood or clear fluid coming out from his head, ear, or nose.

  • Bump or lump on his head. If your child is an infant, he may also have a tense or bulging fontanel (soft spot on the top of his head).

  • Deformed or dented head.

  • Dizziness, feeling tired, or not seeing clearly. He may pass out, have problems fully waking up, or seizures (convulsions).

  • Pain or tenderness on his head.

  • Very bad headache, nausea (upset stomach), or vomiting (throwing up).

How is a skull fracture diagnosed?

Your child may have one or more of the following:

  • Computerized tomography scan: This is also called a CT or CAT scan. A special x-ray machine uses a computer to take pictures of your child's head. It may be used to look at your child's bones, muscles, brain, and blood vessels. Your child may be given dye by mouth or in an IV before the pictures are taken. The dye may help your child's caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your child's caregiver if he is allergic to shellfish, or has other allergies or medical conditions.

  • Magnetic resonance imaging scan: This test is also called an MRI. An MRI uses magnetic waves to take pictures of your child's head. During an MRI, pictures are taken of his bones, brain, or blood vessels. He will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This may cause serious injury.

  • X-rays: Your child may need to have x-rays of his skull or spine taken to check for broken bones.

How is a skull fracture treated?

Treatment will depend on the damage and the type of fracture your child has. Most skull fractures heal within 3 to 6 months. The younger your child is, the faster the fracture will heal without further problems. Your child may also need any of the following:

  • Irrigation and debridement: This is done when there is an open wound on the scalp. This helps to clean and remove objects, dirt, or dead tissues from the fracture area.

  • Medicines: These may be given to help ease or prevent your child's symptoms.

    • Antibiotics: This medicine is given to help prevent or treat an infection caused by bacteria.

    • Anticonvulsant medicine: Anticonvulsants are given to control your child's seizures.

    • Antinausea medicine: This medicine may be given to calm your child's stomach and control vomiting (throwing up).

    • Diuretics: Your child may get diuretic medicine to help decrease the swelling in his brain. This may help his brain get better blood flow and avoid further problems.

    • Pain medicine: Your child may need medicine to take away or decrease pain. Know how often your child should get the medicine and how much. Watch for signs of pain in your child. Tell caregivers if his pain continues or gets worse. To prevent falls, stay with your child to help him get out of bed.

    • Anti-tetanus: This medicine keeps your child from getting tetanus if the fracture also has an open wound. It is given as a shot. Your child should have a tetanus shot if he has not had one in the past 5 to 10 years. Your child's arm can get red, swollen, and sore after getting this shot.

  • Surgery: Your child may need surgery to return the bones to their normal position if the fracture is bad. A bad skull fracture includes a depression (caving in) of the skull or a large fracture that involves blood vessels. Surgery may also be needed to correct a deformity or fix damaged tissues underneath the skull. Pins, plates, and screws may be used to hold the bone together. Injury to the brain, spine, nerves, or blood vessels may also be treated with surgery.
With proper treatment, such as medicine and a brace, your child has a greater chance of having a full recovery.

What first aid should be done for a head trauma?

You may do the following if your child has head trauma:

  • Check if your child is breathing or has a pulse. Start rescue breathing and CPR (basic life support) if needed. Have someone call 911 or a hospital for medical assistance.

  • Do not move your child until there is medical help available. If your child is vomiting and needs to turn on his side, make his head and neck stable first. Do this by holding both sides of his head and shoulders and moving them together. Do not allow his head to bend forward or backward, or to twist and turn.

  • Do not pour any liquid into your child's mouth or offer food or medicines until he is fully awake.

  • Do not remove or pull anything that is sticking out from his head.

  • If your child's head is bleeding, apply direct pressure on the wound using a clean cloth. Place another cloth on top of the first cloth if it gets soaked with too much blood.

  • If your child is having a seizure, stay with him until the seizure ends. After the seizure, log-roll him onto his side. Do not try to log roll your child while he is having a seizure. To log roll your child, put his right arm up by his head and roll him to his side. You may also put your hand behind his head to steady it as you roll him. This will keep your child from choking. Let him rest until he is fully awake. Take your child to the emergency room after he is awake.

How can a skull fracture be prevented?

  • Always put your child in a car safety seat in the back seat. Do not start the car until your child's seat belt is fastened. Ask your caregiver for more information about car safety seats. If your child is old enough, he should wear a seat belt when driving or riding in a car.

  • Do not leave your baby alone on the bed, changing table, or couch. Place him in a crib or playpen if you must leave him unattended.

  • Do not let your child dive into a shallow pool area or in water where the depth is not known.

  • Make sure your child wears proper padding and protective gear when playing sports. These include wrist guards, a helmet, kneepads, and a mouth guard that meet safety standards. Teach your child about following safety regulations. Ask your caregiver for more information about bicycle helmet safety.

Where can I find support and more information?

A skull fracture is a life-changing injury for your child and your family. Accepting that your child has a skull fracture may be hard. You, your child, and those close to you may feel sad, angry, depressed, or frightened. These are normal feelings. Talk to your child's caregivers, your family, or friends about your feelings. You may also want to join a support group. This is a group of people who have had head injuries or skull fractures. Contact the following for more information:

  • American Academy of Family Physicians
    11400 Tomahawk Creek Parkway
    Leawood , KS 66211-2680
    Phone: 1- 913 - 906-6000
    Phone: 1- 800 - 274-2237
    Web Address: http://www.aafp.org
  • American Academy of Orthopaedic Surgeons
    6300 North River Road
    Rosemont , IL 60018-4262
    Phone: 1- 847 - 823-7186
    Web Address: http://www.aaos.org/

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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