Ask an Expert: Child skull fracture

Injury Prevention and Safety

Child skull fracture
02/02/2007

Question:

my child and I were involved in a car accident. As far as I know, she may have hit her head on her right side as she had a bruise on her right eye. However, she sustained a skull fracture on her left side. Is this possible?

Answer:

Yes, it is absolutely possible because of a phenomenon known as rebound injury, wherein the brain opposite the injury is also damaged. When the force that directly impacts the skull is significant, it causes the brain, it's blood vessels, nerves, and cushioning fluid to move swiftly across the space inside the skull and literally smash up against the other side of the bony skull. This applies shearing or tearing forces to all of these tissues as they move at high velocity to slam into a the bony skull barrier and then rebound again to inflict more damage at the original site of impact.

I don't know how old your child is, but the bony plates that make up the skull do not fuse completely with one another until sometime after 10 years of age. This allows for the rapid growth of brain tissue that occurs in the first decade of life that is necessary for normal development and learning. In younger children bones are also more likely to fracture than they are in adults because they are less calcified.

Your experience highlights the critical need for the proper restraint of all children in appropriate car seats and booster seats until they meet the weight AND the height criteria for moving into standard seatbelt usage. These milestones are 80 pounds and four feet nine inches. Use of booster seats and car seats reduces serious injury by 60-80%. Regular seat belts used on smaller individuals result in cutting across the trachea or windpipe,potentially collapsing it or the esophagus as the windpipe is driven back into the esophagus or food pipe, making swallowing and eating painful and difficult. They also can inflict significant bruising injury on the abdominal organs leading to internal bleeding as well as painful bruising over bony areas.

I hope both you and your daughter heal quickly and consistently use good restraint practices when back out on the road.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN
Associate Professor, Specialty Program Director
Pediatric Nurse Practitioner Program
College of Nursing
The Ohio State University