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Head injury is one of the more common reasons for children to attend for urgent medical care, whether to accident and emergency departments or their general practitioner. Often these attendances are accompanied by a high degree of anxiety, both by the parents or guardians with the child and the doctors and nurses providing medical care. In the UK most of these children will receive their initial care and attention in accident and emergency departments from relatively junior members of medical staff, often working in difficult situations. This has led to the development of guidelines for the safe management of children presenting with head injury to accident and emergency departments.1 2 There is, however, scepticism in some quarters about the extent to which these guidelines are used.3
In addition, publications on head injury are confusing with, on occasion, diametrically opposed methods of management being advocated. The purpose of this review is to highlight the problem of minor head injury in children and to further discuss some of the issues affecting patient management.
Most children receive a head injury as a result of a fall.4 5 Most of these occur while the child is running on a level surface or when the child falls from a short height. Only a minority of all head injuries due to falls occur from a fall of more than 3 m.6 With regard to morbidity and mortality, those children who fall from a height of greater than 5 m are most at risk.7 Falls from windows account for the most significant morbidity and virtually all mortality.8
Although road accidents account for only 2% of all attendances at accident and emergency departments, they account for 55% of all fatalities.9 Most of these deaths will be the result of a head …