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  #1  
Old 08-05-2019, 07:47 AM
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Default Fractured Skull- When to Return to Daycare

3yo dcb fractured his skull at home from falling off a chair. They kept him overnight at hospital to make sure therr wasnt any internal bleeding (there was none) but he was acting himself and they say it will heal on its own, just obviously need to watch him closely. When should i allow him back to daycare? Im thinking he should stay home at least 3 days..
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Old 08-05-2019, 07:56 AM
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Oh my gosh! I don't know how long I would require him to stay home, but I would be so paranoid.

What if he fell at daycare? Bonked heads with another kids? It's hard to keep a 3 year old confined to one spot.

Yikes. I would feel most comfortable if he stayed home until it was healed - although, that might be unrealistic because I have no clue how long that would take.
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Old 08-05-2019, 08:01 AM
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When he is cleared to actively participate in outdoor play?
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Old 08-05-2019, 08:07 AM
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From my experience he should have been released on a concussion noise and stress-reduction plan. We even had to keep low lighting for a couple of weeks.

It is to prevent increased intercranial pressure until the skull heals. Swelling and a soft skull is bad ju-ju. Sneezing, blowing of noses and lifting are also no-no's.

Is it posible is was not an actual fracture, just a small compression?

I'd ask for a doctors note and a copy of the discharge instructions.
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Old 08-05-2019, 08:08 AM
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They said it would take a couple weeks to heal. They didnt mention when he would be coming back...but i want to tell them when Im comfortable. I just dont know what is realistic and what is safe.
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Old 08-05-2019, 08:09 AM
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Quote:
Originally Posted by Cat Herder View Post
From my experience he should have been released on a concussion noise and stress-reduction plan. We even had to keep low lighting for a couple of weeks.

It is to prevent increased intercranial pressure until the skull heals. Swelling and a soft skull is bad ju-ju.

Is it posible is was not an actual fracture, just a small compression?

I'd ask for a doctors note and a copy of the discharge instructions
.
Before I even thought about when they could return I would want to know exactly what I was dealing with.
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Old 08-05-2019, 08:11 AM
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Originally Posted by Cat Herder View Post
From my experience he should have been released on a concussion noise and stress-reduction plan. We even had to keep low lighting for a couple of weeks.

It is to prevent increased intercranial pressure until the skull heals. Swelling and a soft skull is bad ju-ju.

Is it posible is was not an actual fracture, just a small compression?

I'd ask for a doctors note and a copy of the discharge instructions.
The dad told me a “fractured skull and a concussion im sure” Which tells me a concussion was not verified. They also didnt tell me any other info or how bad it really is. Fractured could be 1cm long or 5in long..
i was going to ask what the doctor suggested and then tell them “im going to reach out to my childcare resources” and see what they say. Im worried he will be back tomorrow otherwise.
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Old 08-05-2019, 08:11 AM
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Here's my biggest concern:

If you are licensed and god forbid, something happened to him in care, licensing would need to investigate even though there's a pre-existing condition that may factor into the equation. Your license may be suspended while this happens (worst case scenario). If you take him back before the injury has been cleared as healed, you need to be willing to take that risk.
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Old 08-05-2019, 08:13 AM
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Here's my biggest concern:

If you are licensed and god forbid, something happened to him in care, licensing would need to investigate even though there's a pre-existing condition that may factor into the equation. Your license may be suspended while this happens (worst case scenario). If you take him back before the injury has been cleared as healed, you need to be willing to take that risk.
This!
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Old 08-05-2019, 08:29 AM
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Im texting dcd and he said the Dr said to stay home 1 or 2 days. They think the drs are being overly cautious and that their child is fine.
They said they did a ct scan, the dr didnt say how big it was and that the ct scan was “non displaced” what does that mean?
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Old 08-05-2019, 08:59 AM
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Quote:
Originally Posted by MomBoss View Post
Im texting dcd and he said the Dr said to stay home 1 or 2 days. They think the drs are being overly cautious and that their child is fine.
They said they did a ct scan, the dr didnt say how big it was and that the ct scan was “non displaced” what does that mean?
Ummm I feel.like the parent should have wayyyy more information available for you, as well as for themselves!

I would ask for a dr note with more information in order to make a decision on what you can and can not care for, as well as a timeline for when he can return to care.

I would tell parent doctors note with diagnosis and instructions for care are required before even talking about coming back to daycare.
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Old 08-05-2019, 09:12 AM
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Ummm I feel.like the parent should have wayyyy more information available for you, as well as for themselves!

I would ask for a dr note with more information in order to make a decision on what you can and can not care for, as well as a timeline for when he can return to care.

I would tell parent doctors note with diagnosis and instructions for care are required before even talking about coming back to daycare.
I asked to see discharge/aftercare papers. Hopefully the papers will have more info for me
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Old 08-05-2019, 09:18 AM
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Even if Dr ok's return ,I would not allow for this week.A full 7 days from accident and I would insist on a return visit to Dr.I would insist on an all clear for inside and outside activities.
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Old 08-05-2019, 11:25 AM
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My own son had a concussion from a collision playing basketball in sixth grade. While he was allowed to attend school after a couple days, he wasn't allowed to do any PE or ball playing for 14 days per the school athletics protocol. The pediatrician had to clear him at the end of the 14 days. Ped said the first hit is not the bad one, but the second hit is the one that causes the most damage not allowing the original hit to heal first.

As for daycare, it would be hard because the child needs to be reasonably able to participate. I would go with whatever i felt comfortable with. Never had this happen to me within the child care setting....just the school issues.
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Old 08-05-2019, 01:44 PM
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Quote:
Originally Posted by MomBoss View Post
Im texting dcd and he said the Dr said to stay home 1 or 2 days. They think the drs are being overly cautious and that their child is fine.
They said they did a ct scan, the dr didnt say how big it was and that the ct scan was “non displaced” what does that mean?
That is actually good. Little kids skulls are not fused and are better pliable so it isn't quite the same as a teen (like when my 14yo did it in a bicycle accident) or adult.

Here is the case studies pdf. Linear nondisplaced skull fractures in children: who should be observed or admitted? https://thejns.org/doi/pdf/10.3171/2015.4.PEDS1545


"In conclusion, 23-hour observation or hospitalization
for many children with NDSFs is costly and not always necessary. As demonstrated in this study and previously
published reports, the likelihood of missing a delayed
hemorrhage or other life-threatening complication in patients with isolated NDSFs is extremely low.7,9,14 Based
upon the findings in this review, we plan to attempt to find
ways to minimize hospital transfers and admissions for
isolated NDSFs, and we hypothesize that doing so would
be worthwhile at other centers as well."
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Old 08-06-2019, 04:41 AM
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Quote:
Originally Posted by MomBoss View Post
I asked to see discharge/aftercare papers. Hopefully the papers will have more info for me
I would probably make him stay home until it is healed. So many what if's and I would hate for you to be responsible for it.
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Old 08-06-2019, 06:19 AM
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I would contact licensing. Just so there is documentation. Let them know what the situation is, maybe even share the doctor's discharge info and what if any other info you have required from the family.

I do agree with waiting atleast a week before re-admittance to care. Just to be on the safe side. I would also require detailed info from the doctor as far as diagnosis, care plan and what to watch for afterwards or what special precautions are necessary.
ALL in writing of course from the doctor not the parent.

It sounds scary and while I'm sure it's not completely uncommon I would be most concerned about covering my butt in regards to liability.

The best tool providers have to do that is through documentation.
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Old 08-08-2019, 06:16 AM
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They wanted him to return today but after i asked if he could play outside/run around..they found someone to watch him the rest of the week
Personally as a parent, i would be taking off at least a week or until my childs follow up appaointment. This isnt something i would take lightly with a child so young
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Old 08-08-2019, 06:51 AM
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Here a CT scan wouldn’t even be ordered for a fall less than 5ft. This seems crazy for such a small fall in my opinion!!
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Old 08-08-2019, 07:17 AM
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Here a CT scan wouldn’t even be ordered for a fall less than 5ft. This seems crazy for such a small fall in my opinion!!
He was standing on a chair, fell backwards, and hit his head on tile floor. What i dont understand is how a 3.5yr old didnt brace himself while he fell or try to put his arms out or anything
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Old 08-08-2019, 08:36 AM
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Here a CT scan wouldn’t even be ordered for a fall less than 5ft. This seems crazy for such a small fall in my opinion!!
My son didn't fall, he bumped heads full-force running with another basketball player and they run a CT scan. He had slurred speech for days afterwards.
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Old 08-08-2019, 11:45 AM
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My son didn't fall, he bumped heads full-force running with another basketball player and they run a CT scan. He had slurred speech for days afterwards.
Thats not a fall and has much more force than a fall from a chair. I am just thinking a fall from a chair is what? A foot maybe? Not very high. Just seems odd to me!

My daughter fell and the DRs were very concerned with how high up the fall was. They said anything 5ft and above could result in a fracture, less than that it is less likely. Maybe there were other factors involved. She did not lose consciousness.
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Old 08-08-2019, 02:09 PM
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Quote:
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Thats not a fall and has much more force than a fall from a chair. I am just thinking a fall from a chair is what? A foot maybe? Not very high. Just seems odd to me!

My daughter fell and the DRs were very concerned with how high up the fall was. They said anything 5ft and above could result in a fracture, less than that it is less likely. Maybe there were other factors involved. She did not lose consciousness.
It was definitely more than a foot. He was making cupcakes at the counter. So an adult chair or maybe even a bar stool. For young kids falling any height could cause a head injury depending on force or the surface the head hits. Seems odd a Dr would say that.
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Old 08-08-2019, 03:28 PM
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Head injuries are unpredictable. My DH once worked a case of a 22-year-old, healthy/fit, guy who was stopped on his bicycle talking to a neighbor. Somehow he fell over and died. At first, they thought aneurysm caused the fall, but in the end, it was the fall that caused the bleed that killed him. Just a freak accident. Of course, kids are more resilient by design.
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Old 08-08-2019, 03:45 PM
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Originally Posted by Cat Herder View Post
Head injuries are unpredictable. My DH once worked a case of a 22-year-old, healthy/fit, guy who was stopped on his bicycle talking to a neighbor. Somehow he fell over and died. At first, they thought aneurysm caused the fall, but in the end, it was the fall that caused the bleed that killed him. Just a freak accident. Of course, kids are more resilient by design.
True! Wasn't it Natasha Richardson that had a fall then felt fine then later died from her fall hitting her head. You just never know....better be safe than sorry for sure!
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Old 08-08-2019, 03:49 PM
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Originally Posted by MomBoss View Post
It was definitely more than a foot. He was making cupcakes at the counter. So an adult chair or maybe even a bar stool. For young kids falling any height could cause a head injury depending on force or the surface the head hits. Seems odd a Dr would say that.
A head injury possibly but not always a fracture. I guess my DRs were specifically talking about a fractured skull being more likely from a height over 5ft. These were paediatric specialists in one of the best Childrens hospitals in the country so I dunno!! I have had kids fall on cement from a chair height and barely even cried! I guess I am the only one that thinks a fractured skull from that fall is weird
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