title: Influence of age and fall type on head injuries in infants and toddlers.
abstract: Age-based differences in fall type and neuroanatomy in infants and toddlers may affect clinical presentations and injury patterns.
  
  
  OBJECTIVE
  Our goal is to understand the influence of fall type and age on injuries to help guide clinical evaluation.
  
  
  METHODS
  Retrospectively, 285 children 0-48 months with accidental head injury from a fall and brain imaging between 2000 and 2006 were categorized by age (infant ≤1 year and toddler=1-4 years) and fall type: low (≤3 ft), intermediate (>3 and <10 ft), high height falls (≥10 ft) and stair falls.
  
  
  METHODS
  Clinical manifestations were noted and head injuries separated into primary (bleeding) and secondary (hypoxia, edema). The influence of age and fall type on head injuries sustained was evaluated.
  
  
  RESULTS
  Injury patterns in children <4 years varied with age. Despite similar injury severity scores, infants sustained more skull fractures than toddlers (71% vs. 39%). Of children with skull fractures, 11% had no evidence of scalp/facial soft tissue swelling. Of the patients with primary intracranial injury, 30% had no skull fracture and 8% had neither skull fracture nor cranial soft tissue injury. Low height falls resulted in primary intracranial injury without soft tissue or skull injury in infants (6%) and toddlers (16%).
  
  
  CONCLUSIONS
  Within a given fall type, age-related differences in injuries exist between infants and toddlers. When interpreting a fall history, clinicians must consider the fall type and influence of age on resulting injury. For young children, intracranial injury is not always accompanied by external manifestations of their injury.
authors.affiliation: Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA. nicole.ibrahim@fda.hhs.gov
authors.forename: Nicole G
authors.initials: NG
authors.lastname: Ibrahim
authors.forename: Joanne
authors.initials: J
authors.lastname: Wood
authors.forename: Susan S
authors.initials: SS
authors.lastname: Margulies
authors.forename: Cindy W
authors.initials: CW
authors.lastname: Christian
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D017677:Age Distribution; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors
references.citation: J Neurotrauma. 2000 Sep;17(9):729-37
references.pmid: 11011813
references.citation: Pediatr Emerg Care. 2005 Oct;21(10):639-44
references.pmid: 16215464
references.citation: Arch Pediatr Adolesc Med. 2004 May;158(5):454-8
references.pmid: 15123478
references.citation: Pediatrics. 2007 May;119(5):922-9
references.pmid: 17473092
references.citation: Pediatrics. 2003 Jun;111(6 Pt 1):e683-92
references.pmid: 12777586
references.citation: J Trauma. 1991 Oct;31(10):1353-5
references.pmid: 1942142
references.citation: Pediatrics. 1994 Nov;94(5):679-81
references.pmid: 7936895
references.citation: Am Surg. 2000 Sep;66(9):863-5
references.pmid: 10993618
references.citation: Pediatrics. 2005 Jul;116(1):180-4
references.pmid: 15995050
references.citation: J Trauma. 2007 Jul;63(1):70-4
references.pmid: 17622871
references.citation: Pediatrics. 1998 Aug;102(2 Pt 1):300-7
references.pmid: 9685430
references.citation: Pediatrics. 2003 Apr;111(4 Pt 1):e365-70
references.pmid: 12671153
references.citation: Childs Nerv Syst. 1988 Feb;4(1):30-3
references.pmid: 3135935
references.citation: Clin Radiol. 2005 Apr;60(4):464-8
references.pmid: 15767104
references.citation: J Pediatr Surg. 1999 Jul;34(7):1060-3
references.pmid: 10442588
references.citation: Yonsei Med J. 2004 Apr 30;45(2):229-32
references.pmid: 15118993
references.citation: Clin Orthop Relat Res. 2003 Feb;(407):148-51
references.pmid: 12567141
references.citation: Neurosurg Focus. 2000 Jan 15;8(1):e3
references.pmid: 16906699
references.citation: Ann Emerg Med. 2001 Jan;37(1):65-74
references.pmid: 11145776
references.citation: J Pediatr Surg. 2001 Oct;36(10):1528-34
references.pmid: 11584402
references.citation: Pediatrics. 1992 Aug;90(2 Pt 1):179-85
references.pmid: 1641278
references.citation: Pediatrics. 1993 Jul;92(1):121-4
references.pmid: 8516056
references.citation: Pediatrics. 2004 Mar;113(3 Pt 1):522-9
references.pmid: 14993544