paediatric scalp swelling

Question 1

2 m.o. baby boy brought to A+E by his parents with a hx that he rolled off the couch. O/E: conscious but irritable and has cool hands and feet. temp 37.6˚C and he has no neck stiffness. boggy swelling on the right side of his scalp, some small bruises on his chest and extensive nappy rash. he is a first child of young unmarried parents.

(a) what is the most likely cause of the skull swelling?

Answer 1

skull fracture

Question 2

(b) what is the most likely underlying mechanism for this?

Answer 2

trauma (non-accidental injury i.e. shaken baby syndrome)

Question 3

(c) what medical ix (name at least 2) should be undertaken to identify the cause?

Answer 3

1. bloods
   
   • FBC (subdural bleed: reduced Hct / increased WCC), coag screen (may be underlying bleeding disorder)
2. LFTs
   
   • for assessment of NAI
3. imaging
   
   • cranial CT, cranial US, cranial MRI, skeletal survey (NAI)

Question 4

(d) parents are keen to take baby home as he is now looking better. as the FY1 in A+E what would you do?

Answer 4

• seek senior advice immediately
• inform parents due to nature of injury, you would need to ask a senior colleague to review child
• when speaking to senior colleague, you would inform them of your suspicion and ask them to review

Question 5

(e) the ophthalmologist is asked to see the child.

what features (name at least 1) are they looking for?

Answer 5

retinal haemorrhages

Question 6

(f) what is the key feature in the hx that raises concern?

Answer 6

child is 2 m.o. old and would have been physically unable to roll off the couch

Question 7

(g) name 3 other professionals or resources outside the hospital that might provide important information to elucidate the dx

Answer 7

1. social workers
2. health visitor
3. GP