A prospective study of 100 children aged 24 months or younger who were admitted with a diagnosis of head injury is reported from the Children’s Hospital of Philadelphia and Rhode Island Hospital, Providence. Falls accounted for the majority of injuries (73) and motor vehicle accidents occurred in 9, the child being unrestrained in 6. Thirty-two children had a soft tissue injury and/or concussion only. Twenty-seven had a linear skull fracture with or without loss of consciousness. There were 8 depressed fractures, 3 children had epidural hematomas and 22 had intradural hemorrhages. Twenty-four children had inflicted injuries and an additional 32 had child maltreatment consults because of social problems and suspicion of neglect. Most household falls were neurologically benign. Intradural hemorrhage was more likely to occur from motor vehicle accidents and inflicted injury. Retinal hemorrhages found in 10 patients were related to inflicted injuries in 9 and all had subdural hemorrhage, the majority complicated by seizures. Of 4 deaths in the series, 1 was accidental and 3 were inflicted; all had subdural hemorrhage. These more serious injuries were related to rotational rather than translational forces. [1]

COMMENT. Accidental head injuries in very young children are common and inflicted injury accounts for nearly 1/4 of admissions. The occurrence of retinal hemorrhages and more severe brain damage should arouse suspicion of an inflicted injury. Social or family problems are a major risk factor for the occurrence of severe head injuries in the very young.

Serial head circumference determinations may help in the diagnosis of subdural hemorrhage following head injury in young children. A study which limits the value of the head circumference test is reported from the Bnai Zion Medical Center, Haifa, Israel [2]. Of 415 healthy children studied, 51% demonstrated variable HC tracking of which 19% showed acceleration in head growth. This so-called “physiological variability” in HC can involve more than 2 centile lines and the fluctuations stabilized usually by the age of 13 months. The authors suggest a period of clinical observation rather than imaging procedures in a baby whose HC crosses centile curves but whose general health, psychomotor development and neurological status are all within normal limits.