pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Head Injury in a Two Year Old

[Head Injury in a two year old, follow-up testing and behavior changes.]

My 21 month old daughter was running and fell face 1st into the corner of our wall. She split her head open which required 6 stitches. We took her to the ER and they fixed her head…Four days later we took her to her pediatrician and he removed the stitches and then super glued the wound. She never lost consciousness, never puked, never lethargic. no obvious neuro signs. Over the past week. she isn’t eating well. she wants to stand up in her high chair. she is crying more than usual.. she is hard to put to sleep… I am thinking she has had a head ache all week and treated w/Motrin and Tylenol…Is she just acting her age (terrible twos) or should I be concerned that she has some sort of internal head injury like a skull fracture or a bleed. I have been reading articles about head injuries and changes in personality and behavior? Does she need an MRI?
What an event for a two year old!

I’m assuming, at that age, she probably didn’t handle either the head injury or the treatment very well. Depending upon how she was treated in the ER, the doctors office and how she took it all in, it may have changed her behavior. Usually, however, IF it is caused by such an event, it makes them more clingy and less adventuresome – at least for awhile. The thought about a headache is reasonable, and you seemed to have treated it well; but, by now (a week or so out) it shouldn’t still be an issue.

I can tell you that the “terrible two’s” is a REAL phenomenon whenever, between the time they learn to walk and go to college, it occurs. And it is not uncommon for injuries to increase during that time when their motor works better than their brakes.

It sounds like you’ve watched for the usual neurological signs, which have all been negative, so it would be very unlikely that behavioral changes would be due to a subdural or other skull phenomenon. That said, the decision to perform an MRI would be based more upon the neurological PHYSICAL EXAMINATION than upon taking a history, no matter how thorough the history is given. (Of course, the physical examination is, however, driven by what a doctor hears in the history). So, if you believe you have noticed a distinct difference in her behavior that troubles you, your pediatrician should perform a thorough exam with that knowledge, even a “second look.” He/She will look “more closely” for the subtle signs of neurological trouble.

Although I don’t know what articles you’ve read, any of them which talk about personality changes after a head injury are undoubtedly referring to injuries where there were neurological signs and symptoms to begin with (like unconsciousness, fracture, subdural, anoxia, etc.) It’s got to be very rare indeed that such behavioral changes could be blamed upon a head-conk just requiring stitches without any other neurological signs. Like I said, however, if you were a patient of mine, and I was talking to you on the phone, I would say: “bring her on in and let me check her out to see if anything else is needed.” [In the majority of cases of toddler head lacerations, without neurological signs, neither an MRI nor a head X-ray is required.]

Hope that helps – although by now you and your doctor have probably already taken care of it.
Thank you so much for your response!… I tend to think the worst because I am a neonatal nurse and of course think about bleeds…I found your answer very helpful!… Have a wonderful week!/Becky… P.S. I will tell others about your site!
[Addendum (2013) – Although it is still true that xrays, CTs and MRIs are probably not helpful in cases like she described (no neuro findings or events), recent studies do now clearly show that children can have symptoms of a concussion (i.e. behavioral changes) without any loss of consciousness or evidence of other trauma. Such information comes from thorough studies in child sports participation where moodiness, sleep disturbance and depression can be seen after head trauma commonly two to three weeks and even several months.]

Share on Google+Tweet about this on TwitterShare on LinkedInPin on PinterestShare on FacebookEmail this to someone
Please share...