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:

Antibiotics may be given to help your child fight an infection caused by a germ called 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:

Caregivers may give medicine to decrease your child’s pain. Tell a caregiver if your child’s pain does not go away or comes back after taking this medicine. Pain medicine can have side effects. Tell a caregiver if your child has trouble breathing, is very sleepy, or has an upset stomach. Tell a caregiver if your child is allergic to any medicine.
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.

Tags: frontal, occipital, parietal, skull fracture, temporal