Springdale Mason Pediatrics

Head Injury

Definition

  • Injuries to the head
  • Includes the scalp, skull and brain

Call or Return If

  • Pain or crying becomes severe
  • Vomits 2 or more times
  • Your child becomes hard to wake up or confused
  • Walking or talking is not normal
  • You think your child needs to be seen
  • Your child becomes worse

About This Topic

Types of Head Injuries

  • Scalp Injury. Most head injuries only damage the scalp. Examples are a cut, scrape, bruise or swelling.  It is common for children to fall and hit their head while growing up.  This is especially common when a child is learning to walk. Big lumps (bruises) can occur with minor injuries. This is 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. This is caused by blood spreading downward by gravity. 
  • Skull Fracture. Only 1% to 2% of children with head injuries will get a skull fracture.  Most often, there are no other symptoms except for a headache. The headache occurs at the site where the head was hit.  Most skull fractures occur without any injury to the brain. They heal easily.
  • Concussion. A concussion is a type of brain injury. It causes a temporary change in how the brain works. It is usually caused by a sudden blow or jolt to the head.  Most children bump or hit their heads without causing a concussion.  The most common signs are a brief period of confusion or memory loss. This happens after the injury. Other signs of a concussion can include a headache or vomiting. Dizziness, acting dazed, or being knocked out can also be signs.  A person does NOT need to be knocked out to have had a concussion. Following a concussion, some children have ongoing symptoms. These can include mild headaches, dizziness or thinking difficulties. School problems or emotional changes can occur. These symptoms can last for several weeks. 
  • Brain Injuries are uncommon, but are an emergency.

Symptoms of a Brain Injury

  • Hard to wake up or keep awake OR
  • Acts or talks confused OR
  • Slurred speech OR
  • Weakness of arms or legs OR
  • Walking is not steady
  • Any of these symptoms are an emergency. If they happen, call 911.

Symptoms of a Minor Head Injury

  • The main symptom is pain.
  • The scalp may bleed a little or develop a lump.

Prevention

  • Careful adult supervision of young children
  • Education of older children about high risk behaviors

After Care Advice

Overview:
  • Most head injuries only cause a swelling or bruise to the scalp. The main symptom is pain where the head was injured.
  • The skull bone protects the brain from getting injured.
  • Big lumps or bruising can occur with minor injuries to the scalp. This is normal. Reason: The scalp has a large blood supply.
  • Swelling of the scalp does not mean there is any swelling of the brain. The scalp and brain are not connected. They are separated by the skull bone.
  • The mildest brain injury is a concussion. Most of those also turn out fine.
  • Here is some care advice that should help.
Wound Care:
  • If there is a scrape or cut, wash it off with soap and water.
  • For any bleeding, put direct pressure on the wound. Use a gauze pad or clean cloth. Press for 10 minutes or until the bleeding has stopped.
Cold Pack:
  • Use a cold pack or ice bag wrapped in a wet cloth. Put it on any swelling. Do this for 20 minutes.
  • Reason: Prevent big lumps ("goose eggs"). Also, helps with the pain.
  • Repeat in 1 hour, then as needed.
Watch Your Child:  
  • Watch your child closely during the first 2 hours after the injury.
  • Have your child 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.
  • Wake him up after 2 hours of sleeping. Check that he is alert and knows who you are. Also check that he can talk and walk normally.
Diet:
  • Offer only clear fluids to drink, in case he vomits. Allow a regular diet after 2 hours.
  • Exception: Babies can continue breast feeding or formula.
Pain Medicine:
  • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
  • Exception: Do not give until 2 hours have passed from injury without any vomiting.
  • Never give aspirin to children and teens. Reason: increases risk of bleeding.
Special Precautions for One Night:
  • Mainly, sleep in same room as your child for the first night.
  • Reason: If a problem occurs, you will recognize it if you are close by. Problems include a bad headache, vomiting or confusion. Also, look for any change in your child's normal behavior.
  • Option: If you are worried, wake your child once during the night. Check how he walks and talks.
  • After 24 hours, return to a normal sleep routine.
What to Expect:
  • Most head trauma only causes an injury to the scalp.
  • The headache at the site of impact gets better in 2 to 3 days.
  • The swelling may take a week to go away.

Author: Barton Schmitt MD, FAAP
Copyright 2000-2020 Schmitt Pediatric Guidelines LLC
Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it.
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