Brain trauma is an important public health problem. It usually develops as a result of traffic accidents, falls, beatings and sports injuries. It is among the most common reasons for admission to hospital in adults and children under the age of 45. Head traumas are not always in the form of severe traumas, they are also classified as mild head trauma, which is sometimes seen as insignificant or causes a very short-term loss of consciousness and recovers, and no serious primary damage is observed in the examinations. In recent years, studies on this subject; It is claimed that repetitive traumas can damage the higher functions of the brain and affect the intelligence functions. It is not just minor traumas that should be considered here, but permanent and recurrent traumas. In addition, the experience of all of us does not grow without falling from any child. A distinction must be made here. Falls and head traumas are common problems faced by parents in preschool children. It would be correct to examine this period by dividing it into two as before the age of 2 and between the ages of 2-7.
In the pre-two-year-old period, our baby has just started to walk, the functions of the brain and muscles are just formed and maturation continues. They do not have the ability and reflexes to protect themselves, stay away from dangers while lying, sitting and walking. According to his age, he can turn around, crawl, sit, walk with or without support. While doing these, he may fall from where he is lying or sitting, he may lose his balance while walking or his foot may trip and fall. In this age group, the head is very large compared to adults, the skull bones are not mature and hard enough, trauma can directly damage the brain tissue. On the other hand, nature has tried to reduce this weakness by increasing the elasticity and flexibility of the brain. In blows to the head in this age group, the skull collapses as if it were a ping pong ball and then immediately regains its original shape, trying to overcome this with the least damage since the underlying brain tissue is extremely elastic. However, all this happens within certain limits. If the trauma is severe enough, the defense mechanisms are not sufficient, and various levels of damage and bleeding may occur in the bone and brain tissue.
We, as physicians, look for some signs in a traumatized or suspected infant. The age of the child, the height at which he fell, the ground, the speed of the fall form an idea about the severity of the trauma in the first place. In the second stage, the changes that occur in the child after this event, loss of consciousness, sleepiness, vomiting or anything that is not normal attract our attention. In the third stage, examination and, if necessary, radiological findings lead us to the conclusion. The first 24 and 48 hours are always important, and although the child is completely normal at first, new findings may appear later. For this reason, we recommend that the child be followed up by the family or, if necessary, by the doctor in the hospital for 24-48 hours after the trauma, and re-checked at the end of this period.
When such an event is encountered in practice, if the child has abnormal vomiting, sleepiness or loss of consciousness, if there is visible swelling, bruising and seizures, it should be taken to the doctor quickly regardless of the severity of the trauma. In unconscious children, tilting the head back and pressing the tongue with the back of a spoon is an extremely useful procedure that will keep the airway open, which is very important. Applying cold to the swollen area reduces both bleeding and swelling. Meanwhile, time is the biggest enemy and it is necessary to act quickly but without panic.
To protect from such traumas:
1- Removal of hard, sharp, pointed and edged objects at home, or covering them with soft rubber or sponge,
2- Covering the floor with high and thick carpet-like materials,
3- Closing the things that the child can climb over, such as chairs,
4- Having protective barriers on the sides of the bed or making the bed close to the floor
5- Keeping children under supervision as much as possible,
6- Precautions such as holding them in their hands, including their wrists
, will be beneficial. Falls between the ages of 2 and 7 are different from falls in infancy, as children are more mobile and their muscle structures are stronger. In these periods, falls from places such as balconies, windows, trees are more frequent and they result in more serious results, including internal organ damage and joint fractures and dislocations. As the skull bones harden and lose their flexibility in this age group, the risk of fractures, cracks, collapse and brain tissue damage has increased. Unlike babies, they are more comfortable to follow because they express themselves better. The severity of trauma, post-traumatic period, clinical findings and follow-up are the same as in infants. In addition to the above measures in this age group;
1- Doors and windows are not kept open, items and other materials that they can climb on are removed,
2- It will be appropriate to use helmets, knee pads and chin guards while using bicycles and similar vehicles.
