Because most philosophies that frown on reproduction don't survive.

Saturday, December 31, 2011

So Baby Has A Skull Fracture

The drama, though not, as it proved, the events, started when I got home from work on the Tuesday night before Christmas, scooped up eighteen-month-old Pidge, and noticed that she had a soft, squishy lump on her head, slightly above her right ear. She had just started to walk consistently the weekend before -- by far the latest walker of the five -- and with five boisterous children in a house with hardwood floors the occasional lump is not unexpected, but I'd never encountered a soft lump before, except with the post-partum hemotoma our oldest had had. The lump didn't seem to bother her, however, and she had not had any notable accidents since taking a dive off the changing table the week before, so we decided to take the "wait and see" approach.

The lump remained for the next few days, and seemed like it was perhaps growing slightly, and so like the typical modern parent in times of nervousness, I began to consult Google. Soft lumps on toddler heads, I found, are usually associated with skull fractures. However, skull fractures are generally associated with vomitting, loss of balance, partial paralysis, loss of consciousness, etc., and Pidge seemed more healthy and full of personality than ever as she walked around the house talking to herself and others.

By Friday, however, with the lump no smaller and the prospect of the weekend and Christmas making doctors particularly hard to get hold of, we got nervous and took her in for an appointment at our doctor's office. Her usual doctor was on vacation, and the doctor who saw her pretty much echoed what I'd found in my online research: normally this kind of soft lump would be associated with a skull factor, but since she wasn't showing any symptoms at all, we should keep an eye on her and head straight to the emergency room if she showed any neurological symptoms. He advised we bring her on Tuesday for a followup with her usual doctor.

Pidge continued to seem as healthy as ever, but as the lump seemed to go down a little it seemed, to our nervous parental fingers and those of various visitting relatives as if there were lumps and depressions underneath. In the very center, it seemed like you couldn't feel the skull beneath it. By the time that Tuesday rolled around, we were well ready to get her usual doctor's advice.

Again, he confirmed that this kind of lump is usually only found with skull fractures, but that the total lack of symptoms seemed to make a skull fracture unlikely. However, to be sure, he sent her across the street to the hospital to get an x-ray. On the x-ray it turned out that she did indeed have a skull fracture. As best as we could figure out, it must have resulted from the fall off the changing table, at this point a week and a half in the past.

This left open the question of what, if anything, to do next. It turns out that there's not much that can be done about a skull fracture itself, other than giving the body time to heal itself. The danger comes in if the brain underneath is damaged -- either by the initial trauma itself, by a piece of bone pressing in on the brain, or by blood or other fluids building up inside the skull and putting pressure on the brain. The lack of symptoms seemed to suggest that none of these we going on, but the doctor wanted confirmation from someone with more experience dealing with toddler skull fractures, so he sent us down to Children's Hospital downtown to have them look at the x-rays and determine if a CAT scan was needed.

The specialist at Children's was able to fill in some basic questions that had built up:

- A skull fracture can result from a comparatively minor fall, one of his sons had also had a skull fracture from falling off a changing table.

- Even if it is a simple linear fracture (meaning there's a line of fracture but neither piece of bone is depressed) as the blood built up under the scalp (which is what forms the soft lump) drains and clots it can feel as if there are dips and bumps under the lump.

Once the radiologists finished looking at the x-rays that had already been taken, they were concerned that it looked like the two sides of the fracture were slightly out of alignment, which if it was causing pressure or bleeding on the brain could necessitate some kind of surgery to realign the bones. They wanted to do a CAT scan. Knowing that by this point we were going to have passed our deductible on the insurance anyway, we agreed to the CAT scan, but were seriously hesitant about the idea of signing up for skull surgergy on an apparently healthy child. If it came to that, we were going to have a lot of questions first.

Fortunately, Pidge was eminently calm as they wrapped her up like a papoose for her CAT scan. Her little face peering out of the restraints, with her yellow pacifier quietly bobbing up and down, was so incongruous in the room full of technology that I wished I could take a picture of her, but it was a "no cell phones" room.

The result of this was, thankfully, anti-climax. The CAT scan revealed that the bones of her skull were aligned enough that no intervention was necessary, and it made clear that there were no buildups of blood or fluid inside the skull. We had a very healthy (if thoroughly scanned) girl with a skull fracture, and were enjoined once again to watch out for vomitting, loss of balance, loss of consciousness, etc.

So:

- A comparatively minor fall can in fact cause a skull fracture.
- A soft lump does indeed often indicate a skull fracture beneath.
- But, a skull fracture can turn out to require essentially no treatment, so long as the brain isn't being put under pressure and the bones are aligned to heal properly.
- As the lump over even such a harmless fracture goes down, it can feel like are all sorts of depressions or lumps on the skull, but as the blood continues to clear away these go away.

Pidge continues to toddle around happily, unconcerned by it all.

23 comments:

Jamie said...

Ai yi yi! Glad to hear she is doing well.

Christopher said...

Quite the heart-stopping subject line - so glad she's all right.

(Now off to check my own little one for soft lumps)

Lauren said...

Wow! I'm so glad she's ok. What a trooper.

Julia at LotsaLaundry said...

Sorry you had so much pa-run-pa-pum-pum in your Christmas! Somehow one figures that by child #5 there won't be much new to learn about injuries, but they do surprise you!

Glad all is well.

cliff said...

I'm thinking Pidge might have a thing or two to say about all the holiday guests mushing around on her poor little boo-booed head. :)

Prayers sent. Glad all is well.

Leah said...

Gevalt! Good for you guys for being so diligent and checking her out even though she seemed to be doing fine. Pidge sounds like a trouper, and I bet this story will make her very popular in third grade or so. (Is that still the age where grievous bodily harm = cool?)

Catholic Bibliophagist said...

Whew! Prayers of thanksgiving going up right now.

Chris Burgwald said...

Wow! Glad to hear things will be fine.

Donald R. McClarey said...

Thank goodness she is ok. Life with kids, a never-ending adventure!

Melanie B said...

Oh my. That was a scary headline. I am very glad that she is doing so well. Thank God for a guardian angel working overtime.

Foxfier said...

0.0

Dorian Speed said...

Oh, how frightening! I'm very glad to hear she's okay. What a sweetheart - poor baby!

Rebekka said...

Eeeks! Thank God she's ok.

Emily J. said...

Maybe for Epiphany you can give her a crash helmet. Glad to hear no serious consequences.

RL said...

How scary! Happy the babe is going to be alright!

Happy New Years guys.

mary said...

Glad to hear she is healing.

Brandon said...

Occurrences like this always fill me with amazement over how durable children are. And over how durable parents are, because I don't think I could stand the stress.

Angelico Nguyen, Esq., OP said...

Thank God the headline was the scariest part of this post.

I pray you'll never have occasion to label another entry with 'TODDLER SKULL FRACTURE' ever again (unless it's an update on Pidge's healing!). As a phrase, it's too disturbing even for a band name.

ElizabethK said...

Well, I'm so glad she's ok. This made me anxious as anything, both for Pidge, and, oddly, for my own children even though they're now all far too old to roll off a changing table or anything else. Ah, parenthood! Again, so glad all is well.

lissla lissar said...

I'm glad she's okay.

I'm not going to tell Mr. Lissar about this, because he's having kittens about the way our kids climb, especially the toddler, who thinks he's part monkey and part squirrel.

Hearing this would not add to his comfort about our children's desire to die by falling.

Darwin said...

Thanks for all the concern and good wishes.

For what it's worth, it wasn't all that worrying an episode (though there was that gnawing, parental worry that "something might be wrong that I'm not doing something about") just because every time I turned to do any research what I was finding in articles by pediatricians was basically that skull fractures are dangerous to the extent they injure or put pressure on the brain, and injuring the brain is something that tends to have Very Obvious Symptoms. Given that the Pidge was absolutely and relentlessly cheerful and healthy, we remained fairly confident throughout that there was nothing too serious wrong, at least at the moment. I guess the most nagging worry was that there was a problem that wasn't causing issues at the moment but would somehow heal up wrong and cause problems later.

Even so, the thing to I was oddly surprised to find (I guess you get used to the idea that everything has a "cure") is that there's not really much of anything they can do about a skull fracture. If there are bones actively out of place, they try to put them back in place, and if there swelling or fluid build up inside the skull, they may try to relieve that. But the skull mostly just has to be left alone to heal itself. And since it's mostly symptoms being treated, if there are no symptoms there's not much to treat.

A lot of the reason I wrote it up is that the only pieces I could find by parents were cases in which there were lots of really bad symptoms and problems, and the articles I was able to find about skull fractures with no symptoms were by experienced pediatricians writing articles for other doctors with something of a "you may not believe this, but sometimes we find this" kind of tone. One of our most consistently high traffic posts over the years has been MrsDarwin's writing about dealing with Young Master Yack back when he was breech, and so I thought getting this out there are a parental experience might be of use to other Googling parents in the future.

Anonymous said...

Thank you so much for this post. Three weeks ago my two year old head slipped and head slammed the corner of a wall while running in a hall. He had no loss of consciousness and no other ill affects except a goose egg that went down after icing. We kept a careful watch on him for 12 hours (he did it in the morning, so we didn't let him nap) and then we put him to bed happy that night. He had no more swelling, no fever, and was happy- except a few days later some minor bruising showed up on the sides of his eyes. Again, he was completely happy, and has been completely happy, and I didn't think about it until tonight, when I decided to look it up. Now I see that his eye bruising can indicate a skull fracture. I was completely freaked out tonight and read all the horror stories. I was just about to wake him up and rush him to the ER when I read your post. He's now at the point where all the bruising and swelling is gone and he's still running around happily. So though I will take him to see our doctor just to check tomorrow, I think tonight he can sleep. Thank you for the sanity check.

Anonymous said...

My daughter in law and I went to the doctor when my grandson developed a squidgylump.We were told to go away similar to yourself and not worry. But we did worry.we went back, saw another doc, went to hospital, skull fracture diagnosed-we couldn't tie it to anything more recent than a bump 3 weeks before. My grandson was taken into care.Three months on,he is still away from his mum and dad.If you could spare a prayer for all the innocents who can't prove their innocence and the children taken away who lose their innocence so quickly in 'care' maybe god listens to you.