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Posted: August 16th, 2022

Evaluation of a Nurse’s Knowledge and Abilities for Kids with Head Injuries

Evaluation of a Nurse’s Knowledge and Abilities for Kids with Head Injuries

Head injuries are among the most common causes of disability and death in children. According to the Centers for Disease Control and Prevention (CDC), about 812,000 children visit emergency departments for traumatic brain injury (TBI) each year in the United States . TBI can result from falls, motor vehicle crashes, sports, violence, or abuse. TBI can affect a child’s physical, cognitive, emotional, and social development, and may require long-term care and rehabilitation .

Nurses play a vital role in the assessment, diagnosis, treatment, and prevention of head injuries in children. Nurses need to have adequate knowledge and skills to identify the signs and symptoms of head injury, provide appropriate interventions, monitor the child’s condition, educate the family and caregivers, and coordinate the care with other health professionals . This article will discuss some of the key aspects of nursing care for children with head injuries, based on the latest evidence and guidelines.

Signs and Symptoms of Head Injury in Children

The signs and symptoms of head injury in children may vary depending on the severity, location, and mechanism of injury. Some of the common signs and symptoms include:

– Loss of consciousness or altered level of consciousness
– Headache
– Nausea or vomiting
– Dizziness or balance problems
– Confusion or disorientation
– Memory loss or amnesia
– Blurred vision or eye movement problems
– Pupillary changes or unequal pupils
– Hearing loss or ringing in the ears
– Nosebleed or ear discharge
– Scalp lacerations or hematomas
– Seizures
– Weakness or numbness in the limbs
– Changes in behavior or personality
– Irritability or agitation
– Mood swings or depression
– Difficulty concentrating or learning

Some of these signs and symptoms may appear immediately after the injury, while others may develop hours or days later. Therefore, nurses need to monitor the child closely for any changes in their neurological status and vital signs. Nurses also need to assess the child for any signs of increased intracranial pressure (ICP), such as:

– Decreased level of consciousness or coma
– Dilated or nonreactive pupils
– Cushing’s triad (hypertension, bradycardia, and irregular breathing)
– Posturing (decorticate or decerebrate)
– Papilledema (swelling of the optic disc)
– Projectile vomiting
– Bulging fontanelle (in infants)

Increased ICP can indicate a life-threatening condition, such as cerebral edema, hemorrhage, contusion, or herniation. Nurses need to act quickly to reduce the ICP and prevent further brain damage.

Interventions for Head Injury in Children

The interventions for head injury in children depend on the type and severity of injury, as well as the child’s age and medical history. Some of the general interventions include:

– Maintaining a patent airway and adequate ventilation
– Administering oxygen as prescribed
– Monitoring vital signs and neurological status frequently
– Maintaining cervical spine immobilization until cleared by radiology
– Elevating the head of the bed to 30 degrees (unless contraindicated)
– Avoiding hypotension, hypoxia, hyperthermia, and hyperglycemia
– Administering analgesics, sedatives, anticonvulsants, antiemetics, diuretics, corticosteroids, or mannitol as prescribed
– Inserting an intracranial pressure monitor as indicated
– Performing frequent neurologic checks using a standardized tool, such as the Glasgow Coma Scale (GCS) or the Pediatric Glasgow Coma Scale (PGCS)
– Assessing for signs of increased ICP and reporting them promptly
– Providing fluid and electrolyte balance and nutritional support
– Preventing infection and skin breakdown
– Providing sensory stimulation and environmental control

Nurses also need to provide emotional support and education to the child and their family. Nurses should explain the diagnosis, prognosis, treatment plan, possible complications, and discharge instructions in a clear and simple manner. Nurses should also encourage the family to participate in the care process and provide them with resources and referrals as needed.

Prevention of Head Injury in Children

The best way to prevent head injury in children is to avoid situations that can cause trauma to the head. Some of the preventive measures include:

– Wearing a helmet when riding a bicycle, motorcycle, skateboard, scooter, or rollerblades
– Wearing a seat belt when riding in a car or a booster seat for children under 4 feet 9 inches tall
– Using appropriate child safety seats for infants and toddlers
– Avoiding contact sports or activities that can cause head collisions or falls
– Supervising children closely when playing or swimming
– Installing safety gates, window guards, and stair railings in the home
– Removing or securing any objects that can fall or cause injury, such as furniture, toys, or cords
– Educating children about the dangers of head injury and how to protect themselves


Head injury is a serious and potentially fatal condition that can affect children of all ages. Nurses need to have adequate knowledge and skills to provide optimal care for children with head injuries. Nurses need to assess the child for signs and symptoms of head injury, provide appropriate interventions, monitor the child’s condition, educate the family and caregivers, and coordinate the care with other health professionals. Nurses also need to promote the prevention of head injury in children by teaching them how to avoid situations that can cause trauma to the head.


: CDC. (2020). Traumatic Brain Injury & Concussion. Retrieved from https://www.cdc.gov/traumaticbraininjury/index.html
: Mayo Clinic. (2019). Traumatic brain injury. Retrieved from https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/symptoms-causes/syc-20378557
: Hockenberry, M. J., & Wilson, D. (2019). Wong’s essentials of pediatric nursing (11th ed.). St. Louis, MO: Elsevier.
: MedlinePlus. (2021). Head injury – first aid. Retrieved from https://medlineplus.gov/ency/article/000028.htm
: Lippincott Williams & Wilkins. (2018). Lippincott manual of nursing practice (11th ed.). Philadelphia, PA: Wolters Kluwer.
: Ignatavicius, D. D., & Workman, M. L. (2018). Medical-surgical nursing: Patient-centered collaborative care (9th ed.). St. Louis, MO: Elsevier.
: American Academy of Pediatrics. (2020). Head injury prevention tips for parents and caregivers. Retrieved from https://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Head-Injury-Prevention-Tips-for-Parents-and-Caregivers.aspx

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