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Injuries in Children
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
A meticulous examination of the injured child’s head is required, looking specifically for evidence of bruising, wounds, lacerations, abrasions and boggy swellings, as well as areas of tenderness that may indicate underlying fractures. Any lacerations should be carefully examined (but not probed) in order to exclude a depressed fracture. Signs of basal skull fractures should be excluded by checking for periorbital bruising, haemotympanum, bruising over the mastoid process and cerebrospinal fluid and blood leakage from the nasopharynx and ears. In infants, the tension of the anterior fontanelle should be assessed. The fundi should be examined in all children with head injury, especially in the setting of NAI, and specific findings are pathognomonic in the shaken baby syndrome. If suspected, this examination must be performed by an ophthalmologist as bilateral retinal haemorrhages strongly suggest NAI. If the child is under 5 years old, the modified version of the GCS should be used. Assessment of cranial nerves, peripheral nerves, motor function, posture and pupils may be possible only by observation alone, especially in the very young. The examination of the child’s head circumference as a baseline measurement is important, especially in infants.
Abnormal Labour
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
The attitude of the fetal head refers to the degree of flexion or extension at the upper cervical spine. Different longitudinal diameters are presented to the pelvis depending on the fetal attitude. In a well-flexed head, the anterior fontanelle is not easily felt, and the presenting diameter is the suboccipito-bregmatic, which measures about 9.5 cm at term (Figure 8.5A). In OP and occipitotransverse (OT) positions, which are often associated with deflexion of the fetal head, the anterior fontanelle is felt at a lower plane and assumes a more medial position compared to the posterior fontanelle, and the presenting diameter is the occipito-frontal which measures about 10.5 cm at term (Figure 8.5B). The extension of the fetal head leads to brow and face presentations (Figures 8.5C and D).
Growth and development
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
1.42. The anterior fontanelleusually closes by 3 months of age.is rarely pulsatile.marks the junction of the sagittal and coronal sutures.may not bulge in the presence of meningitis.is usually smaller than the posterior fontanelle.
Norrie disease with a spontaneously shrinking choroid plexus abnormality: a case report
Published in Ophthalmic Genetics, 2021
Subhi Talal Younes, James Mason Shiflett, Kristin Weaver, Andrew Smith, Betty Herrington, Charlotte Taylor, Kartik Reddy
At 9 months of age, the patient was seen by pediatric neurosurgery for evaluation of this mass. No neurologic symptoms were noted by the parents. At that time, he did not have evidence of seizures, headaches, or recurrent episodes of emesis. He was meeting developmental milestones appropriately including sitting up, imitating speech sounds, transferring objects, and rolling over (note that the patient would go on to develop speech and gross motor delay which are being treated with speech and physical therapy). A hearing evaluation was normal. On physical exam, the patient preferred to keep his eyes closed. The cornea was clouded, restricting any pupillary or visual acuity exam. Otherwise, there were no significant neurologic findings. The anterior fontanelle was soft and flat. The patient’s face and facial expressions were symmetric. The palate elevated symmetrically, and the tongue protruded in midline. The patient moved all of his extremities well with normal bulk and tone, both spontaneously and in reaction to touch. The reflexes were symmetric without any pathologic reflexes present.
Decompressive craniectomy in pediatric non-traumatic intracranial hypertension: a single center experience
Published in British Journal of Neurosurgery, 2020
Vijai Williams, Arun Bansal, Muralidharan Jayashree, Javed Ismail, Ashish Aggarwal, SK Gupta, Sunit Singhi, Pratibha Singhi, Arun Kumar Baranwal, Karthi Nallasamy
ICH is common in both traumatic and non-traumatic brain injury. However, the incidence of NTC (30.8 per 100,000 per year) in children is 6 times higher than in adults.6 Common causes of NTC in LMIC are infections, toxins, metabolic and intracranial bleed.1 Non-traumatic causes are also known to lead to significant ICH. In a study by Singhi et al.19 almost half of the children with acute bacterial meningitis had ICH at presentation itself. Children differ from adults in that they remain in a compensated state for a long period before they rapidly decompensate. An open anterior fontanelle in infants though may confer certain degree of protection from ICH, but is not always complete.20–22 Hence, irrespective of etiology and age, uncontrolled ICH can rapidly lead to secondary brain injury.
Medical devices and the pediatric population – a head-to-toe approach
Published in Expert Review of Medical Devices, 2019
Joy H. Samuels-Reid, Judith U. Cope
The head is large relative to the body in infants and young children. The skull is thinner and more flexible. This requires different types of considerations for the pediatric population and age-appropriate medical devices. Head circumference is a significant metric in assessing growth and development of the neonate and infant and is measured across the frontal-occipital prominence, the area of greatest diameter. While head circumference is an indicator for growth and development in the pediatric population, it is not in adults. It is tracked on growth charts during pediatric exams from birth through the first few years. Newborns have greater brain weights in proportion to body weight. The anterior and posterior fontanelles close at different times: the anterior fontanelle is the last to close between 1 to 3 years (the median time is about 13.8 months) and the posterior closes 2–3 months after birth. Depressed fontanelles may indicate dehydration, while bulging fontanelles may indicate swelling in the brain [6]. Early closure of fontanelles may lead to microcephaly, misshapen head and delay in closure may signal hydrocephalus. Cranial sutures close at different rates. It is important that use of devices take into consideration the status of cranial sutures and the stage of growth and development of the skull. If sutures close prematurely, they result in craniosynostosis [7]. Devices such as cranial helmets are often used to correct positional head deformity such as plagiocephaly.