When to worry when your child hits his head

Posted by: drmolly in headachehead injuryconcussion on Print PDF

Every kid will bonk his head at one time or another. It may be something minor like a fall to the floor when first learning to walk or something more serious like a fall from a tree. Common sense tells us that if your child is acting fine after it happens, there's no need for worry. Then the tragic story of Natasha Richardson's death after a skiing accident happens and we all begin to second guess ourselves.

In general, kids who don't pass out with their injury will not warrant much concern even if the child is upset and crying after the fall. Most kids can fall down a flight of stairs and not sustain a single significant injury, infants can roll off a couch to the hard wood floor and be fine, older kids can even have a skiing accident and as long as they don't lose consciousness, all will likely be well.

Just yesterday I had a mom in the office ask me about her 18-month-old daughter who was playing in the yard with her older sibling over the weekend and got hit with a plastic T-ball bat. The mother recognized her daughter was acting fine and didn't even cry for 10 minutes afterward, but the haunting thought of a more serious injury brewing inside her daughter's skull made her feel the need to ask me to assess her. I'm happy to report she was just fine, but I wanted to give parents some guidance about when to really worry.

What makes a head injury dangerous and sometimes deadly is the increasing pressure in the brain due to swelling of the brain itself (sort of like a twisted ankle will swell even if nothing is broken) or pressure on the brain due to bleeding that is occurring either quickly or more slowly over time. A concussion occurs when the brain is shaken, without any bleeding, and some mild swelling occurs that triggers headache, vomiting and sometimes memory loss. A more serious head injury requiring an ER or doctor's visit is one that causes passing out. When you get a really bad bonk, the brain tries to protect itself by shutting down until the trauma is over and for that reason, passing out, even if it is after what appears to be a more minor injury, is worrisome. That was Natasha Richardson's mistake. She did have a short time of passing out and even though she seemed fine afterward, she should have been seen by a doctor.

It generally takes a fall from 5 feet or higher for a serious injury to occur. But if your child is showing any of the worry signs, do take him in to be seen.

Besides passing out, there are other worry signs parents should look for to determine if they need to seek care for their injured child:

  • Vomiting more than twice because vomiting can be a sign of increased pressure on the brain.
  • Severe headache that is not improving much with Tylenol or Ibuprofen.
  • Slurred speech
  • Unsteady walking (in a child old enough to be walking well before the injury)
  • Constant or recurrent dizziness
  • Having a seizure
  • Having difficulty waking up
  • Clear or bloody drainage from the ear or one side of the nose that persists.

 

Here are some things parents worry or think about that aren't an issue:

  • Falling asleep after the injury. This is not a problem and can help the brain recover. Sleeping is only a problem if you cannot awaken your child.
  • That if there is no external sign of injury, there must be something more serious inside. This is just a myth.
  • That if there is a goose egg-size bump, you have more to worry about. This, too, is a myth unless the other worrisome symptoms are present.

 

When your child has had an injury without passing out or vomiting or any of the other worrisome signs, go ahead and give her some Ibuprofen or Tylenol, use a cold compress on the injured area and comfort your child. You don't need to wake her up overnight unless she goes on to have additional signs of concussion or closed head injury.


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