From the Guidelines
Yes, it is possible for a 7-month-old infant to sustain a brain injury without showing an altered level of consciousness. Brain injuries in infants can present with subtle or minimal symptoms, especially in cases of mild traumatic brain injury. While changes in consciousness are common indicators of brain injury, infants may instead display other symptoms such as unusual irritability, changes in feeding patterns, vomiting, seizures, or changes in muscle tone. The developing brain of an infant has different responses to injury compared to older children or adults, and the plasticity of the infant brain can sometimes mask immediate symptoms. According to the American College of Radiology 1, children under 2 years of age are considered at high risk for clinically important traumatic brain injury (TBI) by PECARN criteria, which includes those with a Glasgow Coma Scale (GCS) of 14, other signs of altered mental status, or signs of a basilar skull fracture, with an estimated risk of clinically important intracranial injury at approximately 4.3%. Some key points to consider in infants with suspected brain injury include:
- Unusual irritability or changes in behavior
- Changes in feeding patterns or vomiting
- Seizures or changes in muscle tone
- Any signs of trauma, such as bruising or swelling on the head Given the potential for subtle presentations of brain injury in infants, any suspected head trauma requires immediate medical evaluation, even without obvious consciousness changes, as early intervention is crucial for optimal outcomes 1. Parents should seek emergency care if they suspect their infant has experienced head trauma, as proper diagnosis typically requires medical imaging such as CT scans or MRIs, along with thorough neurological examination by a pediatric specialist.
From the Research
Brain Injury in Infants
- A 7-month-old infant can have a brain injury without an altered level of consciousness, as some studies suggest that mild traumatic brain injuries may not always present with obvious symptoms such as loss of consciousness 2.
- The Pediatric Emergency Care Applied Research Network (PECARN) algorithm can help identify children with a very low risk for clinically relevant brain injuries, including those with normal mental status and no loss of consciousness 2.
Diagnosis and Imaging
- Computed tomography (CT) scans are commonly used to screen for brain injuries in children, but magnetic resonance imaging (MRI) may provide more clinically relevant information, especially in cases of abusive head trauma 3.
- Advanced neuroimaging techniques, such as diffusion tensor imaging (DTI) and functional MRI, can help evaluate the severity of brain injury and predict recovery outcomes 4.
- MRI scans can detect more intraparenchymal lesions than CT scans, particularly in children with abusive head trauma 3.