Ms. Richardson apparently had no symptoms immediately after the fall. She got up, smiled, and said she felt fine. She started to complain of a headache about an hour later and her condition deteriorated very rapidly thereafter. Likely, the fall ruptured a blood vessel in her brain, with the rupture gradually becoming larger and culminating in a massive hemorrhage.
Here is what is known – and even more about what is not known – on preventing and handling head trauma in infants and children.
1. In the U.S, each year, there are more than 500,000 cases of pediatric head trauma sufficiently serious to warrant a visit to an emergency room. About 95,000 children require hospitalization and about 7,000 die. The most common causes of head injuries are motor vehicle accidents, falls, bicycle accidents and trauma related to sports.
2. Helmets. Helmets. Helmets. (This is what we wrote in our TenTips article about winter safety in January.) Wearing helmets is mandatory for children on most ski slopes. But safety experts recommend them for all winter activities that may result in head trauma – snowboarding, snowmobiling, ice skating and sledding, for example.
3. There are no excuses for not wearing helmets in sports that call for them. Ms. Richardson was on a snow-covered beginners’ slope where serious accidents “don’t happen.”
4. Helmet use should be expanded to many (all?) outdoor recreational activities, say safety officials. Each year, in the U.S., approximately 150,000 children ages 5 to 14 are seen in emergency rooms with injuries involving playground equipment, for example. Many are hospitalized; about 10 die.
5. Children are drawn to outdoor activities that may result in head trauma. Depending on their age, they like nothing better than participating in unplanned pastimes such as walking on narrow ledges, jumping from rock to rock, and climbing trees, for example, and there are many good reasons that they should be encouraged to do so.
6. Recommending helmet use for many (all?) outdoor recreational activities raises many issues. Helmets are sports-specific. Dozens of children have been seriously injured and several have died from bicycle helmets becoming caught in swings and other standard playground equipment. Should children change helmets for each activity? Also, helmets must fit infants/children properly, meaning that helmets must be replaced as children grow. And helmets must we worn properly or they may do more harm than good.
7. Should toddlers wear helmets for all outdoor activities – or, perhaps, even at home? The definition of “toddler” is to walk with uncertain steps. They fall innumerable times every day, often landing on their heads. Even before “toddlerhood,” most infants fall off a changing table, bed or couch at least once by the time they reach one year of age. And though the comparison is somewhat stretched, major head trauma – in boxers, for example – is cumulative for life. There are no statistics on minor head trauma. It, too, may be cumulative for life.
8. When do children experiencing head trauma need medical attention? Expert opinion ranges from “always” to “only if the trauma is severe or the child shows symptoms.” Moreover, a physical examination is not necessarily helpful. Detecting all head trauma requires imaging, usually a CT scan. It is not practical to take toddlers to the ER every time they fall on their head. Most ERs are already overloaded.
9. Would Ms. Richardson or others with similar accidents have survived if they were rushed to the hospital immediately upon falling? It is not feasible to transport everyone who experiences a minor fall on a ski slope (or elsewhere) to a major trauma center by ambulance (or helicopter, if necessary). By the time Ms. Richardson experienced symptoms, it was probably too late.
10. Helmets are available for infants and children. Helmets have been available for some time for children with special needs – those subject to seizure and poor balance, for example. But some enterprising entrepreneurs have come up with many different lines of helmets for all kinds of activities. Some of the helmets look like ordinary ski caps. See them on the web at helmets/children and helmets/toddlers.
But it may be premature to order these helmets now. More has to be learned about who should wear them and when they should wear them. Another issue will be how to get children/infants to wear them. Much research is going on. We will keep you posted.
