Kids, especially toddlers as they are learning to walk and seem to want to climb all over everything, often fall and hit their heads.
They may fall so much that you have even thought of making them wear a helmet all of the time, not just when they are riding a bike or scooter.
Of course, that would be going too far in all but the most extreme circumstances.
It is much better to childproof your home, encourage them to wear a helmet when appropriate, and supervise your kids well when they are playing to try to prevent most head injuries. Keeping your kids safe in the car, including using an age-appropriate infant car seat, booster seat, or seat belts can also help to prevent a head injury in a car accident.
Accidents do happen though, so it is also a good idea to know what to do if you child does have a head injury.
A head injury often follows a fall, but can occur after any blow to the head.
This can include:
- getting hit by a ball, bat, golf club, or hard toy, etc.
- car accident
- child abuse, including shaking
- a fight
Most head injuries in children are caused by falls, though, including infants who might roll off the bed, toddlers and preschoolers who might fall while climbing or trying to walk down the stairs, and older children who often fall while riding their bike, skateboard, heelys or a scooter. Older children and teens often suffer head injuries while playing sports, too.
Head Injury Symptoms
One of the scariest things about head injuries is that sometimes, what seems like it should be a minor head injury -- like a fall from a short distance -- can sometimes cause more serious symptoms than a fall from a second story window.
That makes getting as many details about the head injury and your child's symptoms right after the head injury occurs very important.
It can be especially important to know if your child:
- had any loss of consciousness immediately after the head injury
- had a change in behavior immediately after the head injury, such as becoming irritable, lethargic, not remembering the injury or other things (amnesia), or having poor balance, etc.
- begins vomiting after the head injury, especially if he develops persistent vomiting, which is usually defined as vomiting more than three or four times
- has a seizure immediately after the injury or later that day
- can open his eyes fully after the head injury
- develops other symptoms after the head injury, such as a severe or worsening headache, stiff neck, or photophobia (sensitivity to light), etc.
In general, a loss of consciousness, seizure, persistent vomiting, or any change in behavior after a head injury would require immediate medical attention.
You should also usually seek medical attention if an infant under six months of age has a fall, even if they don't have a loss of consciousness or other symptoms.
Minor Head Injuries
Fortunately, most childhood head injuries are mild, and the child will not have a loss of consciousness or other serious symptoms.
These children usually cry when they first hit their head, but quickly settle down and return to their normal behavior.
Most of these children don't need a trip to emergency room or a CT scan. Instead, parents can usually treat and monitor their child at home, which might include:
- first aid for any areas that are bleeding
- ice or a cold pack on swollen areas of the scalp for 15 to 20 minutes or as long as your child will tolerate
- providing an age-appropriate dose of acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) for mild headache pain
- observing the child for 12 to 24 hours for symptoms of a more serious head injury, such as persistent vomiting, severe or worsening headache, seizures, poor balance, or any change in behavior
Be sure to seek medical attention if, even after a very mild head injury, your child later begins to show symptoms of a more serious head injury.
Minor Head Injury Myths
Some common myths about head injuries include:
- Head Injury Myth: You shouldn't let a child go to sleep after a minor head injury.
Fact: If you are too afraid to let your child go to sleep, then you should usually seek medical attention for your child's head injury. Most children with minor head injuries that don't have any serious symptoms can go to sleep if it is bedtime or time for a nap. Just check on them regularly (every few hours) to make sure they are sleeping comfortably, but you usually don't have to wake them up unless your doctor has told you to. For most young children, if you keep them up when it is time for bed, then they likely will become irritable, which will make observation difficult.
- Head Injury Myth: If you don't have any scalp swelling (a 'goose egg') after a head injury, then that means that the swelling went 'inside' and you have a skull fracture.
Fact: Most children without scalp swelling will not have a skull fracture.
- Head Injury Myth: If you don't have a loss of consciousness, then it isn't a serious head injury.
Fact: While your child is more likely to have had a serious head injury if he has a loss of consciousness, your child can rarely develop more serious head injury symptoms after having few or no symptoms at first, including not having any loss of consciousness.
American Academy of Pediatrics Clinical Practice Guideline. The Management of Minor Closed Head Injury in Children. Pediatrics 1999 104: 1407-1415.
Atabaki S. M. Pediatric Head Injury. Pediatr. Rev., June 1, 2007; 28(6): 215 - 224.
Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice, 6th ed.
Thiessen ML. Pediatric minor closed head injury. Pediatr Clin North Am - 01-FEB-2006; 53(1): 1-26.