Is It Normal for Hospitals to Not Do Scans or X-rays on Head Injuries??

Updated on August 03, 2010
N.O. asks from Rowlett, TX
14 answers

Within the past year I've had to take both of my boys in to the ER for head injuries. The first was when my 1 yr old hit his head on the brick fireplace (yes it's all padded up now) and the second was recently when my 4 yr old slipped and fell on the hardwoods hitting the back of his head very hard.

Both times the hospitals would not do an Xray or MRI. With my first son going, the physician just looked at the injury saying it was ok and he didn't want to expose him to radiology.

With my second going who I was a little more concerned about because it was the back of his head, the physician (different hospital) pretty much said the same thing, That he could do an MRI but he strongly recommends we wait and watch his symptoms before exposing him to the radiology. He even said himself that after the skier actress who hit her head and died they look and treat patients differently then before but that we wait a little longer to watch his "symptoms'.

I just don't really understand. I would think it's safer to rule out bleeding from the brain or any head trauma then to send him home and wait to see if he gets worst when they could have done something right thne and there. I feel like it's almost pointless anymore to take my kids to the ER if they hit their heads since both times, we were sent back out with nothing being done!
So Is it normal for the hospitals to treat head injuries like their nothing now? Why would they think it's better to "wait and see" if he gets worst? I would think it's safer to expose him to some radiology then let him bleed internally right?
Well days have passed now and my son seems to be doing great so I'm sure everythings ok but that doesn't make me feel any better with as bad as he hit his head and the ER didn't do anything.

P.S. We called his pedi first who recommended we take him straight to the ER to get the scan done.

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L.C.

answers from Raleigh on

I dropped my youngest son out of the carseat (had him sleeping in it while we were in the house, he was not buckled and I picked the car seat not realizing that handle was not snapped in)on the tile floor, head first......he was 6 weeks old. Took him to ER,he was bleeding from his nose so they did the CAT scan, there was NOTHING. No bleeding on the brain, no brusing, not even a mark on his face the next day. I think doctors know what symptoms to look for, so I would not worry.

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D.B.

answers from Boston on

The back of the head is really strong, says my pedi. Young children often have to be protected from radiation. Checking for signs of a concussion is important but it occurs over the next 24 hours and the scan doesn't always pick it up if done shortly after the injury.

Natasha Richardson, the actress, had symptoms of a head injury but didn't do anything until it was too late. My son was injured as a teen and they did a CT scan. We still had to check him every hour for signs of a concussion but we could do that at home without staying in the hospital. I don't think an xray shows blood.

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S.B.

answers from Redding on

Little kids have really hard heads.
Actually, that's not true....their skulls haven't completely hardened like an adult's and they can take quite a bit of hits. God knew what he was doing because little kids fall, bump their heads on furniture and brick hearths and some even deliberately head bang when they get mad.
I'm a mom, I know it scares the crud out of you when your kid's head gets hit really hard. It's good to take them to the ER to get checked out because they can look into the pupils and ears and look for signs of concussion.
I personally don't feel you were being dismissed in the occurances when you took your little ones in. I know you would have felt better having pictures and confirmation everything was okay, but it's not easy taking x-rays of children and they have to be sedated for MRI's because you have to be absolutely completely still. If you drug a child, that can mask or confuse symptoms in order to do something that might not be necessary. Loss of balance, extreme grogginess, nausea...those are symptoms of a concussion but they are also side effects of sedation.
It's normal for kids to cry and even have a headache after hitting their heads, but that's not the same as a concussion.
One of my daughter's friends in the third grade thought she'd fly off a swing on a field trip that I went along to help supervise. She didn't land on her feet, she landed on her head and started vomitting uncontrollably immediately. I knew that was a serious sign and we got her to the ER right away. She did have a concussion and was kept for observation in the hospital then allowed to go home around 11pm that night. She had no lasting affects although she didn't remember anything after jumping out of the swing.
What happened to Natasha Richardson was a terrible tragedy, but she was an adult and adult head injuries are much different.
I know you were scared for both of your little ones, but I'm so glad they are both okay.
My nephew hit his head so many times my sister considered making him wear a helmet because it's like his head was a magnet for the ground, any piece of furniture or appliance, any door knob. He's 20 and perfectly healthy, but that kid had a bruise on his forehead more times than he didn't.
He would glow in the dark if my sister insisted on an x-ray every single time.

Know the signs of concussion. Take the kids to be checked if in doubt.

Best wishes.

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K.H.

answers from Washington DC on

Yes it is normal on little kids , because they would have to sedate them in order to do an MRI scan. They run the usual tests and if the results of those are normal then no need to scan. My 2 yr old fell down the stairs in June , she hit her forehead on the front of the wooden stair , flipped over and then hit the back of her head on the tile floor at the bottom , I was so freaked out thinking that she may have a fractured skull or could have broken her neck , but when I took her to ER along with the Q's of did she lose conciousness , vomit , eyes rolling etc , they held a pen above her and got her to reach up , they also threw several coins on the floor and got her to walk around and pick them up , all of that had normal results so all was ok.

Hope this answered your question

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A.T.

answers from Oklahoma City on

I didn't read everyones response so I may repeat. Part of the reason it takes sooo long in the ER is a big part of that time you are in the room they are actually observing. They check pupil/eyes, reactions, vomitting, contusions, speech, etc. They know what symptoms to look for. Some symptoms can occur hours later that's why they always give you instructions when you leave for what signs and symptoms you need to be watching for.

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E.M.

answers from Johnstown on

Apparently it is--my BIL fell yesterday while putting a new roof on his house. He had to be sent by life flight and yet neither the ER he was originally taken to, nor the major hospital bothered to do any kind of CAT or MRI last evening, even though he had severe neck pain and his arms/fingers are/were incredibly tingly/numb and he didn't pass the needle test. Instead, they went ahead, had him scheduled and prep'd for surgery for his shattered knee this morning and THEN decided he needed to have his head/neck looked at, but not until this afternoon. It doesn't make sense to me at all. Praying all goes well with you.

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A.B.

answers from Dallas on

I know it is hard to understand, but it is more dangerous to expose a child to these tests then most people realize. There is a specific protocol for head injuries, and the scans are not warranted "just because" a person hits their head. Unless you are a nurse or doctor, it is absolutely worth it to go to the ER with a head injury; they will provide a full examination and educate you on what needs to be observed, usually over a 12-24 hour period. If anything changes, then they will likely perform the tests. Trust that your doctors are doing the right thing... they are doing what they are trained to do and what is considered medically appropriate. Hospitals, despite what some believe, do act in the best interests of their patients. My husband is the Director of an ER, and my own children have been in the ER under observation for a head injury... and no, we didn't have x-rays or MRI's... my husband would never expose my kids to that unless it was ABSOLUTELY necessary. I hope this helps.

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N.O.

answers from Phoenix on

When my sister fell while holding her son (he was under age 1) she took him to the ER and not only did they do x-rays and MRIs they insisted that he stay overnight for observation and they had the fun dealing with Child Protective Services. They made them get follow up check ups where they had to see CPS certified doctors etc. and were threatened to have their other child taken away from them until they had a full diagnosis on her youngest. Talk about extremes...it must be regional.

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B.H.

answers from Tallahassee on

Hi there,

Yes, that is normal. You can't have a scan for every little/big bump. My kids have had big and little bumps and I have not taken to the dr for it yet for any of them. If they were showing signs I would.

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A.C.

answers from Cincinnati on

The MRI has been associated with notable increased risk for cancer later in life. Actually, there have been several studies recently reporting that the MRI is very much overused, and also a couple of articles about how the medical community has been ignoring data that indicates that the radiation in MRIs is much more dangerous than the public believes. Some scientists are growing increasingly concerned that the medical experts are not paying attention to the growing statistics that the MRI has been associated with several very dangerous forms of cancer and are choosing to use them and place (particularly) children at risk from radiation without just cause. I think you could probably demand an MRI if you were so inclined, or go to another hospital, but I wouldn't be so quick to judge the ER doctors. It sounds like they may be up-to-date on the current research and be hesitant to subject young children to radiation without an indication that something is very wrong. Of course, no one is perfect and they could guess wrong - but so could your pediatrician. I'm glad that your children are all right.

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J.T.

answers from Dallas on

whether or not it's "normal" depends on the situation. an ER is not going to do imaging on EVERY child that comes in with a head injury. most ER physicians are properly trained to do a fairly quick neuro exam that alerts them to danger signs, if they see the danger signs, then the child is typically sent in for imaging. when my oldest was about 20 months old, he hit the back of his head so hard that his nose started bleeding - the ER physician was nearly positive that he had a hairline fracture toward the base of his skull, but saw no signs of neuro impairments, we did not go forward with imaging. he sent me home with a list of symtpoms for which i would need to bring him back, but he was just fine. i would be mad if the ER physician didn't check my child's pupils, or do a physical exam, but beyond that - it would take a radical injury for me to demand imaging. glad your boys are doing well - and if at any point you are concerned, you do reserve the right to see your pedi and HE can order the imaging.

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D.K.

answers from State College on

Several years ago I hit mine dead center on the top and ended up with two staples. I was doing a balance beam dismount and missed my feet and flipped anyways and hit the edge of a concrete pit, so about a 10 foot drop. After icing it and calling my mom we headed to the ER, since we knew I needed something. They did the staples and told us to keep an eye on it and probably wake me up every so often that night. It was better to watch for any symptoms they said and we did not ask or push for a scan. I ended up back at the ER at 2am for vomiting, which they were pretty sure was unrelated. They did a catscan anyways, no problems noted and decided I probably had a touch of the flu too and it was just bad timing. I was compeletely recovered after a couple of days, the flu took longer then the head injury to recover from. I was a good bit older then your kids are, but I think they do try to avoid radiation if it is not needed and some of those machines put off a lot and you also have to hold really still for several minutes.

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L.O.

answers from Detroit on

if they did a cat scan on each child every time they hit their head.. each child would be glowing from radiation..

if the child is acting normal.. pupils are not dilated... the child is not vomiting they are probably OK.. they look at the overall picture to make the assessment. my friends kid hit hsi head and was complaining of double vision several hours later.. the hospital did do a cat scan on the child.

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M.R.

answers from Columbus on

You were sent to the ER so that a doctor could look for symtoms that would alert them to the need for a scan. They saw no reason to do one, and in both intances, it seems like they were right.

There is no reason to subject someone to an expensive test to rule out an injury for which there was no symptom, these are extreemly expensive tests and are not without risk because of the radiation exposure. If there were any symptom present when the doctor did the exam (they look at things like balace, eyes, consiousness, etc) they would do a scan in a heartbeat because they don't want to miss something. An injury alone is not one of the symtoms they are looking for, it is a reason to be evaluated.

Natasia Richardson had symptoms that would have caused an ER doctor to scan her had she been in an ER and not her hotel room, she was not taken to the ER until well after the symptoms developed. You would not have waited if your son was symtomatic because her experience brought this subject noteriety. That was the lesson, to recognize how serious the symptoms are, not that every hard bump requires a scan.

You did the right thing to get your children evaluated, but what happend was both normal, and right, as it turns out and it happens all the time. We had the top bar of a swing set fall and hit our child in the head, she required 8 staples, but while she was there, they were most concerned about the posility of a head injury, so she was taken back from triage to a room right away. After 90 minutes in the ER, and the staples, they never did a scan because she had no symptoms that required it. We were sent home with specifc instructions of what to look for and to come back right away if we saw any. I had a time clock fall of the wall at work and hit me in the nose (long story) it broke my nose, but the ER was most concerned about a posible head injury, no symptoms, no scan, also sent home with instructions. Not only is it normal, it is common.

M.

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