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.
- 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.
2 hours ago