A nurse in the emergency department is observing a 4-year-old child for signs of increased intracranial pressure after a fall from a bicycle, resulting in head trauma. Which of the following signs or symptoms would be cause for concern?
A. Bulging anterior fontanel.
B. Repeated vomiting.
C. Signs of sleepiness at 10 PM.
D. Inability to read short words from a distance of 18 inches.
Correct Answer: B. Repeated vomiting.
Increased pressure caused by bleeding or swelling within the skull can damage delicate brain tissue and may become life threatening. Repeated vomiting can be an early sign of pressure as the vomit center within the medulla is stimulated. Clinical suspicion for intracranial hypertension should be raised if a patient presents with the following signs and symptoms: headaches, vomiting, and altered mental status varying from drowsiness to coma.
Option A: The anterior fontanel is closed in a 4-year-old child. The average closure time of the anterior fontanelle ranges from 13 to 24 months. Infants of African descent statically have larger fontanelles that range from 1.4 to 4.7 cm, and in terms of sex, the fontanelles of male infants will closer sooner compared to female infants.
Option C: Evidence of sleepiness at 10 PM is normal for a four year old. Newborns spend most of their day sleeping, and they only wake up to be fed, on the other hand, 1-year-old infants sleep for 10 to 12 hours at night without waking. The coordination between biological rhythm and sleep-wake cycle develops over the first six months of life.
Option D: The average 4-year-old child cannot read yet, so this too is normal. Most children learn to read by 6 or 7 years of age. Some children learn at 4 or 5 years of age. Even if a child has a head start, she may not stay ahead once school starts. The other students most likely will catch up during the second or third grade.