Should Your Child See a Doctor?

Head Injury

Definition

  • Injuries to the head, including scalp, skull and brain trauma

Types of Head Injuries  

  • Scalp Injury: Most head injuries only damage the scalp (a cut, scrape, bruise or swelling). It is common for children to fall and hit their head at some point while growing up. This is especially common when a child is learning to walk. Big lumps can occur with minor injuries because there is a large blood supply to the scalp. For the same reason, small cuts on the head may bleed a lot. Bruises on the forehead sometimes cause black eyes 1 to 3 days later because the blood spreads downward by gravity.
  • Concussion: A concussion is an 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 bump or hit their heads without causing a concussion. The most common signs of a concussion are a brief period of confusion or memory loss following the injury. Other signs of a concussion can include a headache, vomiting, dizziness, acting dazed, or being knocked out. A person does NOT need to be knocked out (lose consciousness) to have had a concussion. Following a concussion, some children have ongoing symptoms for weeks.
  • Brain injuries  are recognized by the presence of the following symptoms:
    1. Difficult to awaken, or keep awake OR
    2. confused thinking and talking, OR
    3. slurred speech, OR
    4. weakness of arms or legs, OR
    5. unsteady walking.
     

When to Call Your Doctor for Head Injury

Call 911 If…

 
  • A seizure (convulsion) occurred
  • Your child was knocked unconscious for more than 1 minute
  • Your child is difficult to awaken
  • Your child shows confused thinking, slurred speech, unsteady walking OR weakness of arms/legs present now
  • Your child has major bleeding that can't be stopped or a large blood loss and fainted or too weak to stand
  • Penetrating head injury (for example, an arrow, dart, pencil)
  • Major injury such as a motor vehicle accident, trampoline, contact sports, a fall higher than 10 feet or hanging with neck pain or stiffness present now and began less than one hour after the injury
 

Call Your Doctor Now (night or day) If

  • You think your child has a serious injury
  • Age under 3 months
  • Neck pain or stiffness
  • Knocked unconscious for less than 1 minute and now fine
  • Had confused thinking, slurred speech, unsteady walking OR weakness of arms/legs BUT fine now
  • Blurred vision persists for more than 5 minutes
  • Skin is split open or gaping and may need stitches
  • Bleeding that won't stop after 10 minutes of direct pressure
  • Large swelling that is bigger than 2 inches if older than 12 months, but bigger than one inch if less than 12 months
  • Large dent in skull
  • Injury caused by high speed (e.g., auto accident) or blow from hard object (e.g., golf club)
  • Fall from a dangerous height, for example, twice the child's height
  • Vomited 2 or more times within 3 days of injury
  • Watery fluid dripping from the nose or ear while child not crying
  • Severe headache or crying that has not improved after 20 minutes of cold pack
  • Can't remember what happened
  • Black eyes on both sides and started within 24 hours of the head injury
  • High-risk child: for example, V-P shunt, bleeding disorder, neurological disease
  • Delayed onset of neurological symptoms but began within 3 days after the head injury
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Headache persists over 3 days
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • No tetanus shot in over 5 years for DIRTY cuts (over 10 years for CLEAN cuts). Call within 3 days.
 

Parent Care at Home If

  • Minor head injury and you don't think your child needs to be seen
 

Home Care Advice for Scalp Injuries

  1. Wound Care: If there is a scrape or cut, wash it off with soap and water for 5 minutes. Then apply pressure with a sterile gauze for 10 minutes to stop any bleeding. Apply an antibiotic ointment three times a day. For large scrapes or cuts, cover with a Band-Aid and change it daily or if it gets wet.
  2. Local Cold:
    • Apply a cold pack or ice bag wrapped in a wet cloth to any swelling for 20 minutes.
    • Reason: Prevent big lumps ("goose eggs"). Also reduces pain.
    • Repeat in 1 hour, then as needed.
     
  3. Observation: Observe your child closely during the first 2 hours following the injury.
    • Encourage your child to lie down and rest until all symptoms have cleared. (Note: mild headache, mild dizziness and nausea are common)
    • Allow your child to sleep if he wants to, but keep him nearby.
    • Awaken after 2 hours of sleeping to check the ability to walk and talk.
     
  4. Diet: Offer only clear fluids to drink, in case he vomits. Regular diet OK after 2 hours.
  5. Pain: Avoid pain medicines. If the headache is that bad, the child needs to be examined.
  6. Special Precautions at Night:
    • Mainly, sleep in same room as your child for 1 night.
    • Reason: If a complication occurs, you will recognize it because your child will first develop a severe headache, vomiting, confusion or other change in their behavior. Awaken your child at the parent's bedtime and again 4 hours later. Check the ability to walk and talk. (For infants, check the ability to become fully alert and move both arms and legs normally.)
    • After 24 hours, return to a normal routine.
     
  7. Expected Course: Most head impact only causes a scalp injury. The swelling may take a week to resolve. The local headache at the site of impact usually clears in 2 to 3 days.
  8. Call Your Doctor If:
    • Pain or crying persists after 20 minutes of an ice pack
    • Vomiting occurs 2 or more times
    • Your child becomes difficult to awaken or confused during the next 3 days
    • Walking or talking becomes difficult during the next 3 days
    • Your child becomes worse
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.

References

  1. Aitken ME, Herrerias CT, Davis R, Bell HS, Coombs JB, Kleinman LC, Homer CJ Minor head injury in children. Arch Pediatr Adolesc Med. 1998;152:1176-1180.
  2. American Academy of Pediatrics Committee on Quality Improvement, Commission on Clinical Policies and Research. The management of closed head injury in children. Pediatrics. 1999;104:1407-1415.
  3. Atabaki S. Pediatric head injury. Pediatr Rev. 2007;28(6):215-224.
  4. Atabaki SM, Stiell IG, Bazarian JJ, et al. A clinical decision rule for cranial computed tomography in minor pediatric head trauma. Arch Pediatr Adolesc Med. 2008;162(5)439-444.
  5. Coombs JB and Davis RL. A synopsis of the American Academy of Pediatrics' Practice Parameter on the management of minor closed head injury in children. Pediatr Rev. 2000;21:413-415.
  6. Dunning J, Daly P, Lomas J, et.al. Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child. 2006;21:885-891.
  7. Gedeit R. Head injury. Pediatr Rev. 2001;22:118-123.
  8. Goldstein B and Powers K. Head trauma in children. Pediatr Rev. 1994;15:213-219.
  9. Greenes DS and Schutzman SA. Clinical indicators of intracranial injury in head-injured infants. Pediatrics. 1999;104:861-867.
  10. Greenes DS. Decisionmaking in pediatric minor head trauma. Ann Emerg Med. 2003;42:515-518.
  11. Gruskin KD, Schutzman SA. Head trauma in children younger than 2 years. Arch Pediatr Adolesc Med. 1999;153:15-20.
  12. Haydel MJ, Shembekar AD. Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms. Ann Emerg Med. 2003;42(4):507-510.
  13. Kelly JR and Rosenberg JH. Diagnosis and management of concussion in sports. Neurology. 1997; 48:575-580.
  14. Lallier M, Bouchard S, St-Vil D, et al. Falls from heights among children: a retrospective review. J Pediatr Surg. 1999;34:1060-1063.
  15. Meehan WP, Bachur RG. Sport-related concussion. Pediatrics. 2009;123(1):114-119.
  16. Palchak MJ, Holmes JF, Vance CW, et al. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med. 2003;42:492-506.
  17. Palchak MJ, Holmes JF, Vance CW, et al. Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma? Pediatrics. 2004;113:e507-e513.
  18. Patel D. Managing concussion in a young athlete. Contemp Pediatr. 2006;23(11):62-69.
  19. Quality Standards Subcommittee of the American Academy of Neurology. The management of concussion in sports (practice parameters). Neurology. 1997; 48:581-585.
  20. Quayle KS. Minor head injury in the pediatric patient. Pediatr Clin North Am. 1999;46(6):1189-1199.
  21. Schutzman SA, Barnes P, Duhaime A et al. Evaluation and management of children younger than two years old with apparently minor head trauma: Proposed guidelines. Pediatrics. 2001;107:983-993
  22. Thiessen ML, Woolridge D. Pediatric minor closed head injury. Pediatr Clin North Am. 2006;53(1):1-26.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/30/2010 1:38:00 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.