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Head Injury

Types of head injuries:
SCALP injury: most head injuries only damage the scalp (a cut, scrape, bruise or swelling.) These injuries are common in young children as they learn to walk and climb. Big lumps and bruises can occur with minor injuries because there is a large blood supply to the face and scalp. For the same reason, small cuts may bleed a lot. Applying ice will minimize swelling.

SKULL FRACTURE: Only 1-2% of children with head injuries will get a skull fracture. Usually these are caused by falls from a significant height. Often there are no other symptoms other than swelling at the site of the injury, and perhaps a headache. Most skull fractures occur without any injury to the brain, and they heal easily.

CONCUSSION: A concussion is a mild injury to the brain that changes how the brain normally works. It is usually caused by a sudden blow or jolt to the head. Many children hit their heads without causing a concussion. The most common signs of a concussion can include a headache, vomiting, dizziness, acting dazed or being knocked out. A person does NOT need to lose consciousness to have had a concussion. Following a concussion, some children have ongoing symptoms such as mild headaches, dizziness, thinking difficulties, school problems or emotional changes for several days to weeks.
BRAIN injuries: These are rare but are recognized by the following symptoms: difficult to awaken or to keep awake OR confused thinking and talking OR slurred speech OR weakness of the arms or legs, OR unsteady walking.

It is NORMAL for you child to be pale and somewhat drowsy and fussy, have a headache, vomit once or twice, not remember clearly what happened, and to get sleepy at the usual times (naps or bedtime.)

WHEN TO CALL THE DOCTOR
Call 911 now (your child may need an ambulance) if:
  • A seizure (convulsion) occurred
  • Knocked unconscious for more than 1 minute
  • Not moving neck normally (caution: protect neck from ANY movement)
  • Difficult to awaken
  • Confused thinking, slurred speech, unsteady walking OR weakness of arms NOW
  • Major bleeding that can’t be stopped
Call your doctor now (night or day) if:
  • You think your child has a serious injury
  • Less than one year of age
  • Any fall more than 3 feet or more on the head of a child under age 2.
  • Neck pain
  • Knocked unconscious for less than a minute
  • Had confused thinking, slurred speech, unsteady walking OR weakness of arms BUT fine now
  • Blurred vision lasts more than 5 minutes
  • Skin is split open or gaping (may need stitches)
  • Bleeding that won’t stop after 10 minutes of direct pressure
  • Large swelling (larger than 1 inch or 2.5 cm in diameter)
  • Large dent in the skull
  • Injury caused by high speed (i.e. car accident), great height (i.e. twice the child’s height), or blow from a hard object (i.e. golf club or baseball bat.)
  • Vomited 2 or more times.
  • Watery fluid dripping from nose or ear while the child is not crying.
  • Severe headache or inconsolable crying.
  • Child can’t remember what happened.
Call your doctor with 24 hours (during regular office hours) if:
  • Headache persists for more than 3 days
  • No tetanus shot in over 5 years for DIRTY cuts (over 10 years for CLEAN cuts.)
  • You have other questions or concerns.
HOME CARE ADVICE:
  1. Wound care: if there is a cut or scrape, wash it off with soap and water. Then apply pressure with sterile gauze for 10 minutes to stop any bleeding.
  2. Local cold: apply an ice pack wrapped in a wet cloth to any swelling for 20 minutes (big lumps are common, icing will minimize them.)
  3. Observations: Observe your child closely during the first 2 hours after an injury.
  • Encourage your child to lie down and rest until all symptoms have cleared (note: mild headache, mild dizziness, and nausea or a single bout of vomiting are common.)
  • Allow your child to sleep but keep him nearby.
  • Awaken after 2 hours of sleeping to check the ability to walk and talk.
  • It is NOT necessary to awaken a child throughout the night for mild head injuries- if you are unsure, call your doctor for advice.
  • Diet: offer only clear fluids to drink, in case he vomits. Regular diet OK after 2 hours.
  • Tylenol is fine, avoid Motrin or aspirin.
  • Expected course: Most head impact only causes a scalp injury. The swelling may take a week or two to fully resolve. The local headache at the site of impact usually clears in 2 to 3 days.
IF YOUR CHILD BECOMES WORSE OR THE PAIN BECOMES SEVERE CALL YOUR DOCTOR OR 911.