Head injuries in paediatric patients
This section summarises assessment and early management of head injury in infants and children for emergency practice and exam revision.
It emphasises paediatric anatomy and physiology, age‑appropriate assessment (including the paediatric GCS), guideline‑based imaging thresholds and timing, safeguarding/non‑accidental injury (NAI) considerations, cervical‑spine principles, and initial measures to prevent secondary brain injury.
Recommendations follow NICE NG232 and the CT service standard (QS74) and reflect accepted paediatric trauma practice (RCEM).
Why children are different Children are not small adults - several features change presentation and risk:
- Larger head‑to‑body ratio increases the chance of head impact and force transmission.
- Open sutures and fontanelles in infants (up to ~12-18 months) alter clinical signs of raised intracranial pressure and may allow temporary compensation.
- Thinner subarachnoid space and higher cerebral blood flow increase vulnerability to secondary injury from hypoxia or hypotension.
- Vomiting is common after head injury in children and has low specificity for intracranial pathology.
These factors support a lower threshold for senior review and imaging in infants and pre‑mobile children.
Initial approach and priorities
- Use a calm, age‑appropriate approach: reassure caregivers, explain procedures simply, and involve parents where helpful.
- Primary survey (ABCDE) and resuscitation override all other assessment priorities in moderate-severe injuries.