Accidents happen! Head injuries can be scary and in this blog I’ll discuss prevention, step by step what to do in the moment, what to monitor and when to seek medical attention. The reality is, kids can get hurt. We try our best, but injuries happen.
Check out this PedsDocTalk YouTube Video for more details on head injuries in kids — including what to assess for, what to monitor for, a chart of symptoms to monitor, other symptoms for kids under 2 years, and management of minor head injuries at home.
First, let’s talk about how we can minimize injuries
- Changing tables/beds: Most injuries are “rolling over injuries” when a baby rolls off a bed or changing table. Remember that babies will always roll when you least expect it! Even newborns are capable of rolling on their side and can get enough momentum to roll. So, watch these higher places. You have to make sure your child is not unattended when they are on these surfaces.
- Childproofing: Please remember to put gates on stairs and mount furniture that can topple down. Consider corners of tables. Look at places they can fall from or sharp edges they can fall onto. Remember, we reduce these risks as much as possible but accidents still happen.
A step by step guide on what to do in the case of a head injury
Head injuries can happen for many reason, but for this post I will use the example of falling on the playground and hitting head on concrete.
- Take a breath. Your child fell and that can be traumatizing to you just as much as them. Try to center yourself as much as you can to attend to them. I know sometimes its hard to be strong, but when they’re hurt, try to hold it together. And then you can go cry in a room later (trust me, I’ve done that). But in the moment, they need you.
- You need to assess your child. If the child is unconscious, you need to call 9/11 and seek medical attention. This is very important. If they lose consciousness and become alert, you still need to have them evaluated in an ER setting. For any loss of consciousness, please go to the ER.
- If your child is crying/alert, after consoling them/bringing them to a safe area, assess them for any obvious visible injuries like cuts and bruises. If you notice a laceration on the face that is gaping, meaning you have to push the wound edges together for it to close, your child should be evaluated as they may need glue, stitches or staples.
- Glue/dermabond is possible in most areas, but we usually tend to not do it near the eye, joints and places that would require a lot of movement. Stitches are useful in many places and can provide better cosmetic recovery. Staples are used on scalps. For a gaping wound, have it evaluated so a clinician can determine what “closure” (if any) is needed.
- When checking for bruises, check for bruises behind the ears, or under the eyes (or if these develop) OR if child is draining clear fluid from nose that is not snot (looks like a faucet) – this can indicate internal injury.
- As part of the assessment, if they are unable to move their neck or can’t feel their fingers or hands, it’s important to seek medical attention as this may indicate a neck injury.
If your child cried and has no open injuries, monitor for the following
- A constant headache, particularly one that gets worse
- Dizziness that does not go away or happens repeatedly
- Vomiting more than 2 or 3 times
- Difficulty walking, talking or communicating at baseline
- Complaining of visual changes or hearing changes
- Seizure-like activity
- Drowsy and not interested in feedings/hydration
- Inconsolable even with consoling and changing locations
If your child has any of these lingering symptoms, it’s best to seek medical attention.
Why you should care about head injuries
Most head injuries are minor, but if any of the above symptoms are occurring, we want an evaluation to see if the child needs imaging—namely a CT scan to assess for internal injuries such as brain bleeds. We use something called Pecarn Guidelines to determine if head injuries require a CT. CTs do have small amounts of radiation so we like to assess benefit vs. risk for these images. If your child has a hematoma on back of head (excluding frontal area) let your clinician know. If your child is under three months old, let clinician know. It’s best to evaluate since they are small.
Concussions can occur with these mild head injuries—it’s basically a “bruise” and just like bruises we get on body, they do heal. Many head injuries can lead to concussions and they heal. If your child is experiencing any prolonged symptoms of headache, irritability, dehydration, and you feel symptoms are not improving, speak to a clinician. We want to know 48 hours after an injury if things aren’t seeming to improve. Imaging is not necessary for a concussion, but it will be indicated if a child is not acting at baseline, there is loss of consciousness or vomiting.
How to monitor at home
For older children than one, put an ice pack on the injured area and monitor for 24 hours. They can sleep and you can visually check in. No need to wake them up from sleep unless directed by a clinician. Give them pain meds if need be. Speak to clinician at any time you are concerned. If your child isn’t acting right, healthcare is accessible 24 hours a day (ER/doctors office for you!).