From the Guidelines
A 7-month-old should get a brain scan or CT after a head injury if they show concerning symptoms or are at high risk for clinically important brain injury per PECARN criteria. According to the American College of Radiology Appropriateness Criteria 1, imaging is not recommended for children with minor acute blunt head trauma with very low risk for clinically important brain injury. However, for those with intermediate or high risk, CT head without IV contrast may be appropriate for initial imaging 1. The PECARN criteria help identify children at low risk for clinically important traumatic brain injury, and those with very low risk can safely forgo imaging 1.
For minor bumps without concerning symptoms, observation at home is typically sufficient. Healthcare providers are cautious about ordering CT scans for infants due to radiation exposure concerns, so they carefully weigh the risks against benefits 1. MRI might be preferred when possible as it doesn't use radiation, though it often requires sedation. Parents should monitor their infant closely for 24-48 hours after any head injury, even if initially seeming minor, and seek medical care if symptoms develop or worsen.
Key concerning symptoms that warrant immediate medical attention include:
- Persistent vomiting (more than 2-3 episodes)
- Unusual drowsiness or difficulty waking
- Seizures
- A bulging fontanelle (soft spot)
- Unequal pupil size
- Weakness on one side of the body
- Loss of consciousness for more than a few seconds
- A large bump or bruise on the head
- Clear fluid draining from the ears or nose
- Acting significantly different than normal
The decision to perform imaging should be guided by well-validated pediatric-specific clinical decision guidelines, such as the PECARN criteria, to minimize unnecessary radiation exposure while ensuring timely diagnosis and treatment of clinically important brain injuries 1.
From the Research
Head Injury in Infants
When a 7-month-old infant experiences a head injury, it is crucial to determine the appropriate timing for a brain scan or CT scan. The decision to perform imaging depends on various factors, including the severity of the injury and the infant's clinical presentation.
Imaging Modalities
- Computed Tomography (CT) scans are commonly used in emergency settings to quickly assess head injuries 2, 3.
- Magnetic Resonance Imaging (MRI) may be used as an alternative to CT scans in select patients with mild head injuries, as it can detect intracranial findings without exposing the patient to radiation 4.
Risk of Traumatic Brain Injuries
- Infants younger than 3 months with minor blunt head trauma are at risk of traumatic brain injuries, and the Pediatric Emergency Care Applied Research Network (PECARN) low-risk criteria can help identify those at low risk of clinically important traumatic brain injuries 3.
- However, even infants at low risk for clinically important traumatic brain injuries may still be at risk for traumatic brain injuries on CT scans, emphasizing the need for a cautious approach 3.
Timing of Imaging
- Routine follow-up CT scans are not necessarily indicated in the absence of clinical indications, as they may not alter patient management 2.
- The timing of imaging should be guided by the severity of findings on initial brain imaging and serial clinical examinations 2.
Specific Considerations for 7-Month-Old Infants
- While there is no specific study addressing the exact age of 7 months, the PECARN low-risk criteria can be applied to infants of this age group to determine the need for imaging 3.
- A thorough clinical evaluation, including assessment of the infant's mental status, pupillary examination, and motor function, is essential in determining the need for imaging 2, 5.