The features that place children less than years of age at higher risk of ciTBI include altered mental status, especially if the parent is concerned the child is acting abnormally, parietal, temporal, or occipital scalp hematoma, loss of consciousness >5 seconds, evidence of depressed or basilar skull fracture, bulging anterior fontanelle, persistent vomiting, posttraumatic seizure, focal neurologic examination findings, or suspicion of nonaccidental trauma The features that place children years of age and greater at higher risk of ciTBI include altered mental status, evidence of depressed or basilar skull fracture, posttraumatic seizure, prolonged loss of consciousness, worsening severe headache, and focal neurologic examination findings See Table 113.2 Emergent neuroimaging should be performed for any child with one or more of these features Just as certain features dictate the use of radiographic imaging, the absence of these features should allow the clinician to spare the patient unnecessary radiation exposure Children less than the age of who have a normal mental status with normal behavior, lack a scalp hematoma or have a frontal scalp hematoma, without evidence of skull fracture and a normal neurologic examination should not undergo radiographic imaging; nor should older children who have a normal mental status, no loss of consciousness, no vomiting, no severe headache, without evidence of a skull fracture, and a normal neurologic examination The diagnostically challenging patient population are the children in the intermediate-risk category These are the children who may have isolated features indicative of ciTBI with resolution or improvement of symptoms and a normal neurologic examination Observation for to hours after the injury may offer an alternative to emergent neuroimaging