Pediatric issues in head trauma.

Injuries are the leading cause of death in children, and brain injury is the most common cause of pediatric traumatic death. Numerous mechanisms of injury are unique to the child, including walker injuries, skateboard injuries, falls, and child abuse, as well as those injuries common to all age groups. Motor vehicle accidents account for the largest number of severe injuries in children. The cerebrovascular response of the child is different from the adult's in severe head injury. The patient's resting cerebral blood flow is higher. There seems to be a higher incidence of cerebral swelling, although not as frequent as previously thought. Special attention should focus on the small systemic blood volume, temperature instability, and difficulty in intubating small children. Intracranial pressure (ICP) monitoring should be performed in patients with severe head injuries. The occurrence of increased ICP in severe head injury may be as high as 60% during the patient's course. Child abuse, as well as the "shaken baby" syndrome, is a particular problem that should be recognized and appropriately handled. The outcome should be carefully assessed in the young patient. While the injury may be the cause of a patient's abnormal development, other factors should also be considered.