Last month, my 6-month-old daughter fell off of the changing table. I looked away for only a second to grab a diaper and she rolled over; it happened so fast! She was crying and there was a bump on her head. I panicked and took her to the emergency room. After the examination, the doctor said that although she looked fine, he wanted her to stay for observation. We were released a few hours later with a clean bill of health. However, my mother-in-law scolded me and said I should have demanded a CT scan. I just want what is best for my child. Should I be worried?
You did the right thing by bringing your daughter to the emergency room after her fall. Unlike other types of injuries, injuries to the head can’t always be seen with the naked eye, which is why computed tomography scans are sometimes ordered when a child comes to the emergency room after experiencing trauma to the head.
The scan takes a series of X-rays and combines them to give a multi-dimensional image. They are especially useful for providing sharp images of soft tissue, blood vessels, and internal organs, and, in cases of head trauma, are helpful in detecting brain injury, such as internal bleeding or skull fracture.
While a scan can be an extremely helpful tool in diagnosing brain injury, it exposes the child’s still-developing brain to radiation, and should only be used when absolutely necessary. To that end, pediatric emergency medicine physicians follow a strict protocol in determining whether a child with head trauma should receive a scan or if staying in the department for observation will be sufficient.
As you may remember from your trip to the emergency room, the doctor will ask about behavior changes: is the child acting abnormally in any way? Did the child lose consciousness after the fall? The doctor will feel the head for hematoma or possible skull fracture. If the child is acting normally, and there is no palpable skull fracture, the physician will most likely avoid ordering a scan and instead ask that you stay in the emergency room for observation.
On the other hand, if your child is behaving unusually or if the doctor feels that there may be skull fracture, he or she might recommend a scan for further review.
Scans are excellent tools, but should only be used when indicated. Otherwise, the risks outweigh the benefits. If a scan is recommended, your doctor will probably explain why he or she believes that it is indicated.
Babies can give you a lot to worry about — whether a CT scan is the right choice shouldn’t be one of them.
