Author: Joshua Alexander, MD
HISTORY:
A 7-year-old boy with severe developmental delay and poor head control was seen in the emergency room of a large hospital with a large bleeding bruise on his forehead. He had just been a passenger in a car crash and, although he was wearing a seatbelt, his head had hit the front dashboard and caused his injury. He was awake but sleepy and his mother told the doctors that he was acting ?tired?.
He had a 3-inch cut on his forehead, but the bleeding from the wound stopped with pressure from bandages that were applied and the cut was closed with stitches. His eyes were open and he followed people?s faces, but he couldn?t hold his head up and had very low tone in all his muscles.
He was taken for a CAT scan x-ray of his head that showed no bleeding or new injury in the brain and no broken skull bones. He left the hospital and was driven home by relatives who held them in their lap until they got him and his mother to their apartment.
Over the next several weeks, he made a slow but steady recovery. He had always had low muscle tone and poor head control, but had used a car seat in the past to support his head and neck. Over the last year, however, he had outgrown the car seat so the family put him in a seatbelt like everyone else. Following the accident, the family?s service coordinator helped them find a new adaptive car seat that gave enough support to his head and neck.
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