Head injuries are a common occurrence in children. Fortunately, most of the time they are mild and do not cause serious injury to the brain. They often result in trauma to the scalp which can be frightening but does not usually lead to significant complications. The hard skull does an admirable job of protecting the delicate brain. The most common causes of head injury in children are falls, followed by sports-related trauma, car accidents, bicycle accidents, and child abuse.
There is a low risk of brain injury in low force injuries such as falls from a short distance. Conversely, a greater risk of brain injury is evident in high speed auto accidents, falls from great heights, certain sports related injuries, being hit by heavy or sharp objects and intentional abuse.
The common signs and symptoms seen after a head injury include:
- A “knot” or large swelling on the head – This develops because there are many blood vessels in the scalp which can bleed or leak fluid under the skin.
- Scalp laceration – Breaks in the skin often bleed profusely, even from small cuts.
- Headache – About 20% of children complain of headache after head trauma. In infants or toddlers this may manifest as irritability.
- Vomiting – One episode of vomiting does not necessarily indicate serious injury but could indicate a concussion.
- Seizures – A seizure occurs in less than 1% of children immediately following head trauma.
- Loss of consciousness – Rarely, a child will briefly pass out after hitting their head.
It is not always necessary for every child to be evaluated by a doctor after an episode of head trauma. Parents should call the doctor to discuss the situation if they are concerned, but can generally trust their instincts if the child is alert and behaving normally. The following scenarios may indicate a more serious injury and should prompt a doctor’s evaluation of the child – either over the phone, in the office or in the emergency room:
- An infant less than 6 months old
- Persistent vomiting (One episode of vomiting with a headache could indicate a concussion.)
- A seizure or loss consciousness
- A headache that is worsening – If your child has a headache and other physical or emotional symptoms, at least a phone conversation with the doctor is indicated.
- A significantly depressed area on the skull
- Clear or bloody fluid running from the ear
- Persistent clear fluid running from nose
- Abnormal behavior, difficulty walking, slurred speech or confusion
- Obviously becoming less alert or responsive
- Dizziness that persists or recurs
- Eye pupils of unequal size – they can both be large or both be small, but they should both be the same size
- Bleeding that does not stop after applying pressure
- A history of a high force injury
The past few years, there has become a greater awareness of CONCUSSIONS, especially during sporting activities, but they can occur from many types of trauma. Any injury could cause a concussion if it results in a persistent headache or any alteration in behavior, alertness, or memory. The child should be immediately evaluated “field side” and should not return to play if there is any suspicion of an injury or a concussion.The severity should determine the promptness and level of care sought, but your physician should be notified at some point if your child has a suspected concussion. In addition, the child should not return to activity until cleared by your physician. There are well defined guidelines for coaches, parents and physicians to follow for assessing and managing suspected concussions. Concussions can have long term affects on your child, therefore careful management is very important.
Most children with head injury can be managed at home. If there is swelling, an ice pack may be applied to the site. It should be wrapped in a thin cloth to prevent cold damage to the skin. A bag of frozen peas is often helpful for this purpose and is less threatening to young children. Tylenol may be given for headache; however, the child should be evaluated if the headache is severe or worsening. If the child is alert and acting normally and looks well to the parent, it is not necessary to keep the child awake or to wake them from sleep; but if you are unsure of the child’s well-being, check on the child periodically while asleep. Children often have a good, hard cry after an injury and then want to take a nap. As long as they are consolable and subsequently have normal behavior, it is fine to let them sleep. You should observe your child for at least 24 hours for the development of any of the above symptoms of a more serious injury and call if you see any of these signs. After a head injury, children may have a headache and be a little tired for quite a few days. This could be a concussion, thus your physician should be consulted. The headache and degree of alertness should not be getting worse. All sports and strenuous and risk activities (climbing, swimming, etc.) should be restricted while any symptoms exist, and activities should be gradually resumed when better.
If you are uncomfortable with your child’s condition, please feel free to call at any time.