Understanding Skull Fracture (Child)

A skull fracture is a type of head injury. It is a break in the skull bone.

Types of skull fracture

There are 4 types of skull fractures:

• Linear skull fracture. This is a break in the bone, but it does not move the bone. In many case, no treatment is needed. A child can go back to normal activities in a few days.
• Depressed skull fracture. Part of the skull is sunken in from the injury. If the inner part of the skull is pressed against the brain, this needs treatment right away with surgery.  
• Diastatic skull fracture. This kind of fracture occurs along the suture lines in the skull. These are the areas between the bones in the head that grow together (fuse) as a child grows. With this type of fracture, the suture lines are widened. This type of fracture is more common in newborns and young babies.
• Basilar skull fracture. This is a break in the bone at the base of the skull. It can be a serious type of skull fracture. Children with this type of fracture often have bruises around their eyes and a bruise behind their ear. They may also have clear fluid draining from their nose or ears. This is because of a tear in part of the covering of the brain.

What causes a skull fracture?

The most common causes of skull fracture in children are:

• Falls
• Leisure activities
• Sports
• Physical assault
• Motor vehicle accidents

Boys tend to have traumatic head injuries more often than girls. These kinds of injuries are more common in spring and summer months, when children are active outdoors. Activities such as bike riding, in-line skating, or skateboarding can cause injury.

Symptoms of a skull fracture

The symptoms of a skull fracture can include:

• Confusion
• Trouble with balance
• Sleepiness
• Headache
• Changes in pupil size
• Bump on the head
• Bleeding from a head wound
• Restlessness or irritability
• Stiff neck
• Changes in vision
• Slurred speech
• Nausea and vomiting
• Loss of consciousness
• Seizures
• Bruising behind the ears or under the eyes
• Drainage of clear or bloody fluid from ears or nose

The severity of symptoms can vary. They depend on how serious the injury is.

Diagnosing a skull fracture

The healthcare provider will ask about your child’s health history and symptoms. He or she will ask about recent accidents or injury. Your child will have a physical exam. Your child may also have tests such as:

• Blood tests. These are done to check for signs of infection and other problems.
• X-ray. This test uses a small amount of radiation to create images of bones and other parts of the body.
• MRI. This test uses large magnets, radio signals, and a computer to create images of tissues in the body.
• CT scan. This test uses a series of X-rays and a computer to created detailed images of the body. This test can show broken bone as well as injury to the brain.
  

What to watch for after your diagnosis

• Most of these injuries heal without any difficulties or complications
• Some swelling around the site is normal and may increase over the course of several days.  However, if you are concerned about the amount of swelling, please call your child’s doctor.
• If your child is in pain, you can give acetaminophen (for example, Tylenol) .  Use the dose your child’s doctor tells you, based on your child’s weight.  If the pain does not get better or gets worse, call your child’s doctor right away.
• Call your child’s doctor right away if your child has any nausea or vomiting, change in behavior, or if your child does not seem to be acting normally, or if you have any other concerns. 
• The recommended follow up varies based on type of fracture and age, so be sure to speak with your physician about recommended follow up appointments.