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Topic Overview

Head injury

Almost all children will bump their heads, especially when they are
babies or toddlers and are just learning to roll over, crawl, or walk. These
accidents may upset you, but your anxiety is usually worse than the injury.
Most head injuries in children are minor.

Head injury occurs more
often in young children than adults. When compared with adults:

  • Young children can’t control the movement of
    their heads as well as adults.

    • Their heads are larger in relation to their
      bodies.
    • Their neck muscles are not as well developed.
  • Young children’s legs are somewhat shorter in
    proportion to the rest of their bodies. This makes a child’s center of gravity
    closer to the head than an adult’s center of gravity.
  • Young
    children are more likely to have an accident or fall as they learn new skills
    such as walking, running, and jumping.

Bumps, cuts, and scrapes on the head and face usually heal
well and can be treated the same as injuries to other parts of the body. A
superficial cut on the head often bleeds heavily because the face and scalp
have many blood vessels close to the surface of the skin. This bleeding is
alarming, but often the injury is not severe and you can stop the bleeding with
home treatment. When bleeding does not stop with home treatment, visit
a doctor because a young child can lose a large amount of blood from a deep cut
on the head.

The most common serious head injuries in young
children are caused by falls and abuse (inflicted head injuries), such as shaken baby syndrome. Serious head
injuries may involve injuries to the brain. The more force that is involved in
a head injury, the more likely it is that a serious injury to the brain has
occurred. If there has been a
high-energy injury to the head, there is a greater
likelihood that a serious injury has occurred. When a high-energy injury
occurs, it is even more important to assess the child for
signs of a serious head injury.

Following an injury, it can be hard to tell the difference between a
mild traumatic brain injury (concussion) and a more serious brain
injury. Watch the child carefully for 24 hours after a head injury to see
whether he or she develops any signs of a serious head injury.

When a head injury has occurred, look for injuries to other parts of the
body. The alarm of seeing a head injury may cause you to overlook other
injuries that need attention. Trouble breathing, shock, spinal injuries, and severe bleeding are all life-threatening injuries that may occur along with a
head injury and require immediate medical attention.
Injuries to the spine, especially the neck, must be
considered when a head injury has occurred. Be sure to check for other injuries to the face, mouth, or teeth whenever there is a head injury.

Many head injuries can
be prevented. Use car seats, seat belts, helmets, and
make your home safe from falls to prevent an injury. Establish good safety
habits early so your child will continue them when he or she is older.

Check your child’s symptoms to decide if and when your child
should see a doctor.

Check Your Symptoms

Has your child had a head injury?
Yes
Head injury
No
Head injury
How old are you?
Less than 4 years
Less than 4 years
4 years or older
4 years or older
Are you male or female?
Male
Male
Female
Female
Is the wound bleeding?
If you think the wound may need stitches, it’s best to get them within 8 hours of the injury.
Yes
Bleeding wound
No
Bleeding wound
Would you describe the bleeding as severe, moderate, or mild?
Severe
Severe bleeding
Moderate
Moderate bleeding
Mild
Mild bleeding
Does your child have symptoms of shock?
Yes
Signs of shock
No
Signs of shock
Do you think there could be a spinal cord injury?
Yes
Possible spinal cord injury
No
Possible spinal cord injury
These could appear at the time of the injury or later.
Yes
Symptoms of serious head injury
No
Symptoms of serious head injury
Did a seizure occur after the head injury?
Yes
Seizure after head injury
No
Seizure after head injury
Did the seizure occur within the past 2 days (48 hours)?
Yes
Seizure occurred within past 2 days
No
Seizure occurred within past 2 days
Is there a wound that goes through the skull, such as a knife or gunshot wound?
Yes
Penetrating wound
No
Penetrating wound
Yes
Symptoms of skull fracture
No
Symptoms of skull fracture
Is there swelling anywhere on the head?
Swelling in certain areas of the head can be a sign of a skull fracture.
Yes
Swelling on head
No
Swelling on head
Is the only swelling a bump or “goose egg” on the forehead?
Swelling in any other area of the head, such as the temple area or the side or back of the head, could be more serious.
Yes
Only swelling is bump or goose egg on forehead
No
Only swelling is bump or goose egg on forehead
Did your child pass out (lose consciousness) after the injury?
Yes
Lost consciousness after injury
No
Lost consciousness after injury
When did your child pass out?
Within the past 24 hours
Loss of consciousness within past 24 hours
More than 24 hours (1 full day) after the injury
Loss of consciousness more than 24 hours ago
Was there a lot of force involved in the head injury?
Some examples are a fall onto the head from a height taller than the child, or a very hard blow to the head, such as in a car crash or a forceful sports injury.
Yes
A lot of force involved in head injury
No
A lot of force involved in head injury
When did the head injury occur?
Less than 24 hours ago
Injury occurred less than 24 hours ago
From 1 full day (24 hours) to 1 week ago
Injury occurred from 1 day to 1 week ago
More than 1 week ago
Injury occurred more than 1 week ago
Has your child vomited more than once since the injury?
Yes
Vomited more than once after injury
No
Vomited more than once after injury
Do you think that the head injury may have been caused by abuse?
A head injury caused by abuse is serious at any age, but this is especially true for babies.
Yes
Injury may have been caused by abuse
No
Injury may have been caused by abuse
Some symptoms may appear days or even more than a week after a head injury.
Yes
Other symptoms after head injury
No
Other symptoms after head injury
Are the symptoms:
Getting worse?
Symptoms are getting worse
Staying about the same (not better or worse)?
Symptoms are unchanged
Getting better?
Symptoms are improving
Has your child had symptoms for more than 2 weeks after the injury?
Yes
Symptoms for more than 2 weeks after injury
No
Symptoms for more than 2 weeks after injury

Many things can affect how your body responds to a symptom and what kind
of care you may need. These include:

  • Your age. Babies and older
    adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart
    disease, you may need to pay closer attention to certain symptoms and seek care
    sooner.
  • Medicines you take. Certain
    medicines, herbal remedies, and supplements can cause symptoms or make them
    worse.
  • Recent health events, such as surgery
    or injury. These kinds of events can cause symptoms afterwards or make them
    more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug
    use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be
able to take care of this problem at home.

  • Try home treatment to relieve the
    symptoms.
  • Call your doctor if symptoms get worse or you have any
    concerns (for example, if symptoms are not getting better as you would expect).
    You may need care sooner.

With severe bleeding, any of these may
be true:

  • Blood is pumping from the wound.
  • The
    bleeding does not stop or slow down with pressure.
  • Blood is quickly soaking through bandage after bandage.

With moderate bleeding, any of these may
be true:

  • The bleeding slows or stops with pressure but
    starts again if you remove the pressure.
  • The blood may soak through
    a few bandages, but it is not fast or out of control.

With mild bleeding, any of these may be
true:

  • The bleeding stops on its own or with
    pressure.
  • The bleeding stops or slows to an ooze or trickle after
    15 minutes of pressure. It may ooze or trickle for up to 45 minutes.

Other symptoms related to a head injury that may appear later include:

  • Repeated episodes of feeling dizzy or
    lightheaded.
  • Changes in mood or personality. For a baby or toddler,
    you may notice this as the child being a lot fussier than
    normal.
  • Changes in the ability to concentrate and listen.
  • Ringing in the ears.

Symptoms of a spinal cord injury in a
child may include:

  • Severe neck or back pain.
  • Being unable
    to move part of the body.

Shock is a life-threatening condition that may occur quickly
after a sudden illness or injury.

Symptoms of shock in a child may include:

  • Passing out (losing consciousness).
  • Being very sleepy or hard
    to wake up.
  • Not responding when being touched or talked to.
  • Breathing much faster than usual.
  • Acting confused.
    The child may not know where he or she is.

Symptoms of a skull fracture may
include:

  • Clear or bloody fluid draining from the ears or
    nose.
  • Bruising under the eyes or behind the
    ears.
  • Drooping of the face.
  • A dent anywhere on the head.

Symptoms of a serious head injury may
include:

  • Passing
    out.
  • Becoming more and more drowsy, or hard to wake up.
  • Cannot stop crying.
  • A difference in the size of the pupils of the
    eyes.

Babies’ heads are easily damaged, and their neck muscles are
not strong enough to control the movement of the head. Shaking or throwing a baby can cause the head to jerk back and forth. This can
make the skull hit the brain with force, causing brain damage, serious vision
problems, or even death.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and
    arrange for care.
  • If you cannot reach your doctor or you don’t have
    one, seek care in the next hour.
  • You do not need to call an
    ambulance unless:

    • You cannot travel safely either by driving
      yourself or by having someone else drive you.
    • You are in an area
      where heavy traffic or other problems may slow you down.

Seek Care Today

Based on your answers, you may need care soon. The
problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms
    and arrange for care.
  • If you cannot reach your doctor or you don’t
    have one, seek care today.
  • If it is evening, watch the symptoms and
    seek care in the morning.
  • If the symptoms get worse, seek care
    sooner.

Call 911 Now

Based on your answers, you need
emergency care.

Call 911 or other emergency services now.

Put direct, steady pressure on the
wound until help arrives. Keep the area raised if you can.

Call 911 Now

Based on your answers, you need
emergency care.

Call 911 or other emergency services now.

Do not move the person unless there is an immediate threat to the person’s life, such as
a fire. If you have to move the person, keep the head and neck supported and in
a straight line at all times. If the person has had a diving accident and is
still in the water, float the person face up in the water.

Call 911 Now

Based on your answers, you need
emergency care.

Call 911 or other emergency services now.

Make an Appointment

Based on your answers, the problem may not improve without medical
care.

  • Make an appointment to see your doctor in the
    next 1 to 2 weeks.
  • If appropriate, try home treatment while you
    are waiting for the appointment.
  • If symptoms get worse or you have
    any concerns, call your doctor. You may need care sooner.
Head Injury, Age 4 and Older

Home Treatment

First aid for a head injury

Parents should watch their child for any problems after the injury. Home treatment can
help relieve swelling and bruising of the skin or scalp and pain that occurs
with a minor head injury.

  • If your child had an accident, try to remain
    calm and speak to your child in a calm, relaxed voice. This will help reduce
    your child’s fear and allow you to assess the situation.
  • To stop any bleeding, apply firm pressure directly over the cut
    with a clean cloth or bandage for 15 minutes. If the cut is deep and may have penetrated the skull,
    emergency treatment is needed.
  • Check for injuries to other parts of
    the body, especially if the child has fallen. The alarm from seeing a head
    injury may cause you to overlook other injuries that need
    attention.
  • Apply
    ice or cold packs to reduce the swelling if your child will let you hold a cold pack on the injury. A “goose egg” lump may appear
    anyway, but ice will help ease the pain. Always keep a cloth between your
    child’s skin and the ice pack. Do not apply ice for longer than 15 to 20
    minutes at a time, and do not let your child fall asleep with the ice on his or
    her skin.

If your child is seen by a doctor

Be sure to follow
the instructions given to you by your child’s doctor. He or she will tell you what problems to look for and how closely to watch your child for the next 24 hours or longer.

Do not give any medicine, including
nonprescription
acetaminophen, such as Tylenol, to a child
you are watching for signs of a more serious head injury unless your doctor
tells you to.

Symptoms to watch for during home treatment

Call your child’s doctor if any of the following occur during home
treatment:

  • New headache develops or headache becomes worse.
  • New nausea or vomiting develops or nausea or vomiting becomes worse.
  • Crying does not stop.
  • Drowsiness gets worse, or it is hard to wake up your child.
  • Weakness develops in any part of the body.
  • Confusion or not acting normally develops.
  • Bleeding or swelling increases.
  • Symptoms become more severe or more frequent.

Prevention

Prevent head injuries

Each new learning stage for your baby
requires increased attention on your part to prevent an injury. It may surprise
you how fast your baby can move from one stage to the next. Being aware of your
baby’s abilities and what skills he or she is likely to develop next will help
you prevent injuries. A nursery equipment safety checklist will help you keep your baby’s environment safe.

Always be gentle with your baby. Be sure to protect your baby from a brain injury.
Shaking or slapping a baby in anger can cause an
injury to the brain. If a baby has been shaken or slapped, it is your
responsibility to notify your doctor.

Be aware of your baby’s risk
of falling. Watch your baby carefully.

  • Never leave your baby alone in high places, such
    as on a tabletop, in a crib with the sides down, or even on a bed or
    sofa.
  • Do not leave your baby alone in any infant seat or “sitting”
    toy, such as a swing or jumper. Use all the safety straps provided.

Take steps to prevent falls:

  • Use
    stair gates to block stairways. Use gates at the top
    and bottom of the stairs, and use the gates properly.
  • Do not use
    baby walkers. Walkers have caused many injuries and are not safe even if the
    baby is watched closely.
  • Keep your baby away from elevated porches,
    decks, and landings.
  • Watch your toddler when he or she is outside.
    Uneven grass, sloping lawns, and hills may increase your toddler’s risk of
    falling.
  • Make your home safe from falls by removing hazards
    that might cause a fall.

Practice good safety habits early so your child will continue
them when he or she is older:

  • Place children in an approved
    child car seat when traveling in a motor vehicle.
    Follow the manufacturer’s directions for installing and securing the
    seat.
  • Have your children wear helmets whenever necessary, such as
    when they are passengers on a bike or riding a tricycle on their
    own.
  • Set a good example by always using your seat belt when
    traveling in a motor vehicle. Wear a helmet and other protective clothing
    whenever you are biking, skateboarding, skiing, motorcycling, skating,
    kayaking, horseback riding, or rock climbing.

For more information on health and safety for children, see the topics Health and Safety, Age Birth to 2 Years or Health and Safety, Ages 2 to 5 Years.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Questions to prepare for your appointment

You can help your
doctor diagnose and treat your child’s condition by being prepared to answer
the following questions:

  • When and how did the injury
    occur?
  • How did your child act after the head
    injury?
  • Did your child cry immediately after the
    injury?
  • What are your child’s main symptoms? How long has your
    child had symptoms?
  • Has your baby had a previous head injury? Does
    your child have any continuing problems because of the previous injury?
  • What object caused the injury? Was there or is there an object in
    a cut on the head?
  • Was this injury intentionally caused by another
    person?
  • What home treatment measures have you used to treat the
    head injury?
  • If a cut or scape occurred, is your child’s tetanus
    immunization up-to-date?
  • Was the use of alcohol or drugs by a
    caregiver involved in your child’s injury?
  • Does your child have any
    health risks?

Related Information

Credits

ByHealthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP – Emergency Medicine
Adam Husney, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Kathleen Romito, MD – Family Medicine

Current as ofMarch 20, 2017