Head Injury

Most childhood bumps on the head do not cause significant damage, although many result in a lump or “goose egg,” which may alarm parents when it appears soon after the accident. It is localized collection of blood, called a hematoma, and is not unusual because of the abundant blood supply in the scalp. The lump will gradually decrease in size over the next few days, although local discoloration may persist for weeks.

Head Injury Treatment

  • Typically a child will cry for a few minutes after bumping his head. He will need comforting and reassurance; a cold pack gently applied to the point of impact may help reduce local swelling.
  • If the pain continues after 15 or 20 minutes, acetaminophen (Tylenol) in a dose appropriate for his size may help. Do not give aspirin because it inhibits blood clotting. Stronger pain medication (such as codeine) might cause drowsiness, which could make evaluation of his condition more difficult later on.
  • Over the next few hours he may complain of a little dizziness, nausea, and fatigue. He may throw up once or twice and want to lie down or nap. It is not necessary to try to keep him awake, but after an hour or so make sure he can be awakened without difficulty.
  • Watch his progress over the next 24 to 48 hours because in very rare instances a blow to the head results in bleeding within the skull. This complication is commonly associated with increasing headache, repeated vomiting, and/or (most important) difficulty arousing the child. Observe his daytime behavior for possible signs of trouble and awaken him when you go to bed and once again three or four hours later. Make sure that he can be fully awakened, that he has normal strength and movement of arms and legs, and that he talks appropriately with you (or, if he is too young to talk, that he interacts normally in other ways).

Symptoms of More Serious Head Injury

While most bumps on the head will not need medical attention, you should contact your child’s doctor if one or more of the following occur:

  • There is loss of consciousness, even if it lasts only a few seconds. A child who remains unconscious for more than a few minutes after a head injury should be seen by a doctor immediately. If there is any possibility of a neck injury, he should not be moved until he has been properly immobilized using a backboard and neck brace provided by an emergency transport team.
  • The child is confused or disoriented following the accident or cannot remember what happened. If any alteration or loss of consciousness occurs following a blow to the head, the child is said to have a concussion. While a concussion does not necessarily indicate permanent damage to the brain or skull, closer observation in the hospital and/or at home will usually be recommended for at least one to two days following the injury.
  • The child becomes increasingly difficult to arouse.
  • The child is younger than 12 months of age.
  • Crying continues for more than 10 minutes after the injury.
  • The child complains of persistent or worsening headache. In an infant or a toddler who is too young to say what is bothering him, this maybe manifested by ongoing irritability.
  • The child vomits more than 3 times during the 24 hours after the accident
  • A seizure occurs.
  • There is a cut on the head (or elsewhere) that may require suturing.
  • Clear or bloody fluid is draining from the nose or ears.
  • You have any questions or concerns about the injury or your child’s behavior.

More Serious Head Injury Treatment

If your child appears to have had a more severe head or neck injury, keep him as still as possible, especially his head and neck. Check for more severe head or neck injury

Loss of consciousness in infants and children is most commonly caused by direct trauma to the head. But other conditions and illnesses can cause this event, including fainting episodes, seizures, severe allergic reactions, accidental or intentional drug ingestion, and diabetes. Losing consciousness is potentially very significant, even if it is brief and appears to resolve completely, and it should be evaluated by a physician.

• Check breathing and pulse. If they are absent, start rescue breathing or CPR immediately. Any apparent loss of consciousness can be confirmed by calling the child’s name, gently shaking him (unless there is concern about head or neck injury), or tapping his chest. An unconscious child will not respond.

Whenever a child has lost consciousness, it is important to consider the possibility of a head injury. If there is any evidence that this has occurred (for example, bleeding or visible swelling), keep the head and neck immobilized and call 911 for transport to an emergency facility.