Head injury in children below two years in Nigeria: Epidemiology, management and outcomes in a tertiary hospital

Background: Head injury in children younger than two years presents unique diagnostic and therapeutic challenges because of their distinct anatomical and developmental characteristics. Understanding the epidemiology, severity patterns, and outcomes in this vulnerable age group is critical for guiding interventions and informing policy development. 

Methods: This prospective descriptive study was conducted at Ekiti State University Teaching Hospital from November 2024 to October 2025. All children below two years who presented with head injury were enrolled. Data collected included demographic characteristics, aetiology of injury, and severity assessed using the Glasgow Coma Scale (GCS). Management approaches and outcomes, evaluated using the Glasgow Outcome Score (GOS), were also documented. Data were analyzed using SPSS version 27, with statistical significance set at p < 0.05.

Results: A total of 46 children met the inclusion criteria. Males accounted for 56.5% of cases, with a male-to-female ratio of 1.3:1. Toddlers aged 1–2 years constituted the majority (87.0%). Falls were the predominant mechanism of injury, accounting for 89.1% of cases, followed by injuries from falling objects (10.9%). Most injuries were mild (76.1%), while moderate and severe injuries accounted for 17.4% and 6.5%, respectively. Conservative management was employed in 93.5% of cases. Favourable outcomes were recorded in 93.5% of patients, whereas three deaths (6.5%) occurred, all among children with severe injuries. Injury severity was significantly associated with outcome (p < 0.001), while aetiology (p = 0.41) and treatment modality (p = 0.187) were not. 

Conclusion: Head injury in children below two years is predominantly caused by preventable domestic falls. Although most injuries are mild and associated with excellent outcomes, severe injuries carry significant mortality. Strengthening prevention strategies and improving paediatric trauma care systems are essential.