Head injuries are extremely common in childhood. Fortunately, most injuries are minor. Infants and toddlers have a relatively large head as well as limbs that don’t always do what they are supposed to do! Toddlers bump their head frequently as they learn to walk.

Usually these bumps are of no consequence, and the parent is often more upset by the episode than the child. Your child will probably cry for a short while after banging his head and may develop a bump (an “egg”). Most of these bruises will be on the forehead. Over the next day or two, the bruise will darken and a black eye may appear.

In fact, the injury often looks more impressive on day two or three than it did in the beginning! Bruises often take up to a week to fade. The crying will usually cease in 10 minutes or less. Some children are a little sleepy after a mild head injury and may even vomit once or twice. This is a common reaction and usually does not indicate a more serious problem.

 

Prevention

Most head injuries can be prevented by taking the appropriate precautions.

Motor Vehicles

• Always wear your seat belt. Younger children should be in their child safety seat or a booster seat.

• Never drive under the infl uence of drugs or alcohol.

 

Helmets

• Use helmets when riding a bike, a snowmobile, and an all-terrain vehicle and when skateboarding, snowboarding, skiing, or riding a horse.

• Wear a helmet when playing contact sports such as football and ice hockey and also when playing baseball, softball, and lacrosse.

• Set a good example for your children by wearing a helmet when you ride a bicycle or partake in activities that may lead to head injuries.

 

Playgrounds

Playgrounds should have shock-absorbing surfaces such as mulch, sand, or rubber.

 

Firearms

Keep firearms away from children!

 

Falls from Heights

• Never leave your infant unattended on a changing table.

• Do not put your child in a mobile walker—these walkers have a tendency to make their way to the nearest staircase and descend rapidly!

• Keep house and apartment windows fastened.

• Do not let children play on balconies.

 

 

 

CAUTION

Never shake your baby!

Treatment

• If the skin is broken, clean the abrasion gently with soap and warm water. If your child has a laceration that is bleeding, apply fi rm pressure with a handkerchief, tissue, or gauze until the bleeding has stopped. The scalp is very vascular, and it may take some minutes and fi rm pressure to control the bleeding. If he has a laceration with gaping wound edges, however, he needs medical attention.

• An older child with a swelling on his head may be willing to hold an ice pack against the swelling. Wrap a plastic bag of ice (or a bag of frozen vegetables) in a cloth or towel and apply this to the wound. It is probably not worth trying to do this if you are dealing with an uncooperative toddler!

• Do not give your child ibuprofen (Advil or Motrin) or aspirin. You may administer a dose of acetaminophen (Tylenol) if you feel this is necessary.

• If your child is sleepy, let him sleep. You don’t have to keep your child awake, but you do need to keep a close watch on him. If it is nighttime, wake him when you go to bed and then every four hours or so to determine whether he is behaving normally:

– Does he make good eye contact and appear to be totally “with it?”

–  If he has learned to walk, can he walk normally?

– If he is an older child who has learned to talk, is he talking normally? Ask him a few simple questions and assess his response.

– Are his pupils (the dark spot in the center of the eyes) the same size? If you shine a fl ashlight into his eyes, do the pupils constrict equally?

If you are unsure or concerned about any of the answers to these questions, call your physician. Usually, by the following day, your child will have recovered, but you will have a few more gray hairs! Occasionally it may be necessary to watch your child more closely for another day or night.

 

When to Seek Medical Attention

• If your child has a laceration with gaping wound edges.

• If your child is two years of age or younger and has any detectable abnormality of his skull, even if it is just a bruise or a localize swelling (an “egg”).

• If your child vomits more than two times.

• If it is difficult to rouse your child, or if he becomes unconscious.

• If your child has a headache that lasts longer than just a few hours, or if he has a headache that is increasing in severity.

• If an older child is not behaving, walking, or talking normally. If she seems confused or has slurred speech, persisting dizziness, clumsiness, or difficulty walking, seek immediate medical care.

• If your child’s pupils are unequal in size.

• If your child has blurred vision, or if he sees double.

• If your child remains fussy, irritable, and inconsolable. These symptoms, as well as changes in eating or nursing, may be the only signs of a problem in a younger child. Most children do not cry for longer than 10 minutes after a minor head injury.

• If your child has blood or watery fl uid coming out of one or both ears or his nose.

• If your child has a seizure.

• If, over the following days, your child loses balance easily, seems to regress, or loses interest in favorite toys or activities, or if his schoolwork deteriorates.

• If your child has a preexisting brain condition.

• If your child has any bleeding disorder or is on blood thinners.

 

RISK FACTORS FOR BRAIN INJURY

• Children two years of age and younger, especially those in the fi rst year of life. The younger the child, the more vulnerable the brain.

• Falls from 3 feet and higher.

• The harder the surface, the more severe the injury. Falls onto a concrete fl oor are likely to be more traumatic than those onto a carpeted floor. Bumps over the temple or the back of the head have a higher chance of being associated with underlying damage. (Bumps on the forehead are the least likely to lead to underlying brain injury.)

• Children with blood clotting problems or who are on blood thinners.

• Children with preexisting neurological (brain) problems.

 

Remember, any child  under two years of age who has had a fall and has signs of a

skull injury (an abrasion, a bruise, a swelling, or a laceration) should be discussed

with a physician.