Skull Fractures

The skull is made up of many small bones. It covers and protects the brain. A skull fracture is a break in one or more of these bones.

Types of skull fractures

There are four main types of skull fractures. Your child’s doctor will identify the type of skull fracture your child has, which may be:

  • A linear skull fracture is the most common type of skull fracture. It causes a break in the bone that looks like a thin line. The bone itself does not move. Children with this type of fracture usually have a short hospital stay and surgery is usually not needed.
  • A depressed skull fracture happens when part of the skull bones press inward on the brain. Surgery may be needed to prevent damage to the brain. Doctors repair the break by lifting pieces of the bone back into its usual place.
  • A diastatic skull fracture occurs along the suture lines in the skull and is more common in newborns and babies. Suture lines are the spaces in between the skull bones. They make room for the brain to grow, and as children grow, the spaces get smaller.
  • A basilar skull fracture is the most serious type of skull fracture. It is a break in the bone in the back of the head and at the bottom of the skull. It can cause bruises around the eyes and behind the ears. Cerebrospinal fluid (CSF) is a clear liquid that surrounds and cushions the brain and might drain from the nose with this type of fracture.

In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away.

Symptoms

Mild skull fracture symptoms may include:

  • Small cut, bruise or swelling to head; it can take up to 24 hours to see bruises and bumps
  • Pain or tenderness at the site of injury
  • Headache
  • Upset stomach
  • Vomiting
  • Sensitivity to noise and light
  • More fussy than normal
  • Have no memory of the event
  • Dizziness or loss of balance 
  • More severe skull fracture symptoms, in addition to mild skull fracture symptoms, include:
  • Headache that does not go away
  • Nausea or vomiting that does not go away
  • Inability to concentrate or remember
  • Slurred speech
  • Trouble walking
  • Weakness on one side or area of the body
  • Clear fluid or blood leaking from nose or ear
  • Bruises around the eyes 
  • Bruises behind the ears 
  • Ringing in the ears
  • Trouble seeing
  • Fainting
  • Seizure
  • Problems waking up
  • Coma

Treatment

Mild skull fracture treatments include:

  • Ice
  • Rest
  • Medicines by mouth to help with discomfort
  • Ointment for small cuts and scrapes
  • Stitches for larger cuts
  • Observation in the hospital for 24 to 48 hours

More severe skull fracture treatments, in addition to treatments for mild skull fractures, may include:

  • Oxygen
  • Special monitoring in the pediatric intensive care unit (PICU) for increased pressure inside the skull
  • Medicines and fluids through an IV

Other treatments to:

  • Support breathing, blood pressure and heart
  • Reduce brain swelling
  • Prevent or stop seizures
  • Fight infection
  • Stop stomach upset and vomiting
  • Relieve pain and discomfort
  • Surgery
  • Rehab

When to call the doctor

Most children with mild skull fractures can be cared for at home after being watched in the hospital for the first 24 to 48 hours. Once your child goes home, call a doctor right away if your child:

  • Is not eating or drinking well.
  • Vomits more than twice.
  • Has trouble seeing.
  • Acts differently than usual, such as avoiding play, acting fussy or seeming confused.
  • Cannot think clearly or remember things.
  • Has a severe headache.
  • Has clear fluid or blood coming from his nose or ears.
  • Is hard to wake up.
  • Is clumsy, dizzy or unsteady.
  • Has weakness in the arms or legs or does not move them as usual.
  • Has slurred speech.
  • Has a seizure.

Follow-up treatment

Healing time for a skull fracture depends on the type of fracture and its severity. Skull fractures can take three to six months to heal completely. They usually heal faster in younger children. Have your child avoid rough sports until the doctor tells you it is OK to begin again. Your child may need a follow-up CT scan to make sure the skull fracture is healing properly.