When they need them—and when they don't
A blow to the head can be scary. But usually it is not very serious. Often there is just a mild concussion, with no serious injuries like bleeding or cracks to the skull. After a head injury, the doctor may order a test called a CT scan (pronounced "cat" scan).
A CT scan takes many X-rays, to create a 3D picture of the brain. But your child may not need a CT scan for a minor head injury. Here's why:
Often, CT scans aren't necessary.
About half of children in emergency rooms with head injuries get CT scans. But one in three of the CT scans aren't necessary. Before ordering a CT scan, the doctor should examine the child and ask about the injury and symptoms. If your doctor thinks your child has a mild concussion, a CT scan will probably not be helpful— the CT scan results are usually normal. CT scans are better for other kinds of injuries, such as skull fractures or bleeding in the brain. A concussion is not caused by bleeding in the brain.
CT scans have risks.
CT scans use radiation, which can increase the risk of cancer. Children, and especially infants, have greater risks because their brains are still developing. And unnecessary CT scans can lead to more tests and treatments, with more risks.
CT scans are expensive.
CT scans of the brain can cost between $500 and $900. Costs vary widely. It's okay to ask if the scan is really needed before spending the money.
When to see a doctor.
Go to the doctor right away if your child becomes unconscious, has a headache that won't stop, or is dizzy, confused, or nauseous. These symptoms may happen hours or days later. When to get a CT scan of the brain. A doctor should order a CT scan if it is likely that the child has a skull fracture or bleeding. The doctor should ask about the accident and symptoms listed below. The doctor should also examine the child for signs of skull fracture, such as black eyes and bleeding.
The accidents listed below are more likely to cause serious head injuries:
A motor vehicle accident
Falling from three or more feet off the ground
Falling down five or more stairs
Falling off a bicycle without a helmet
The symptoms listed below may be signs of serious injury:
Tingling on one side of the body
Being dizzy or losing balance
Loss of vision or hearing
A headache that gets worse
Being very sleepy or irritable
What to expect if a CT scan is needed.
The CT scan should happen soon. The child may need immediate treatment.
The doctor will use the lowest dose of radiation.
The scan will include only the head (unless there may be a neck or spine injury).
Repeated scans will be avoided.
Editor's Note: The American Academy of Pediatrics (AAP) released a list of specific tests or treatments that are commonly given to children, but are not always necessary, as part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation. CT scans for minor head injuries were identified; the full list gives more detail as to the reasons for taking a closer look at each item, and cites evidence related to each recommendation.
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