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Head Injury

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Definition

  • Injuries to the head
  • Includes the scalp, skull and brain

Types of Head Injuries

  • Scalp Injury. Most head injuries only damage the scalp. Examples are a cut, scrape, bruise or swelling. It is common for children to fall and hit their head while growing up. This is especially common when a child is learning to walk. Big lumps (bruises) can occur with minor injuries. This is because there is a large blood supply to the scalp. For the same reason, small cuts on the head may bleed a lot. Bruises on the forehead sometimes cause black eyes 1 to 3 days later. This is caused by blood spreading downward by gravity.
  • Skull Fracture. Only 1% to 2% of children with head injuries will get a skull fracture. Most often, there are no other symptoms except for a headache. The headache occurs at the site where the head was hit. Most skull fractures occur without any injury to the brain. They heal easily.
  • Concussion. A head injury that changes how the brain normally works. It is usually caused by a sudden blow or jolt to the head. Most children bump or hit their heads without causing a concussion. The most common signs are a brief period of confusion or memory loss. This happens after the injury. Other signs of a concussion can include a headache or vomiting. Dizziness or acting dazed can also be signs. A person does not need to be knocked out to have had a concussion. Following a concussion, some children have ongoing symptoms. These can include headaches, dizziness or thinking difficulties. School problems or emotional changes can occur. These symptoms can last for several weeks.
  • Brain Injuries (Serious) are uncommon. This includes bleeding, bruises or swelling within the brain. They are suspected by the symptoms listed below:
  • Hard to wake up or keep awake or
  • Acts or talks confused or
  • Slurred speech or
  • Weakness of arms or legs or
  • Walking is not steady.
  • These symptoms are an emergency. If they happen, call 911.

Concussion Treatment

  • Treating a concussion requires both Physical Rest and Brain Rest.
  • Brain rest means a gradual return to full studying and school attendance.
  • Physical rest means a gradual return to normal activity, work and gym class.
  • If symptoms occur (like a headache), the child needs to return to the previous level of physical and mental activity. In 24 hours, they can try again to take it to the next level.
  • Athletes involved in sports need to have a stepwise plan for "return to play." Progressing through stages should be supervised by a doctor or athletic trainer.

Pain Scale

  • Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
  • Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
  • Severe: the pain is very bad. It keeps your child from doing all normal activities.
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When To Call

Call 911 Now

  • Seizure occurred
  • Knocked out (unconscious) for more than 1 minute
  • Not moving neck normally. Caution: protect the neck from any movement.
  • Hard to wake up
  • Acts or talks confused or slurred speech present now
  • Walking not steady or weakness of arms/legs present now
  • Major bleeding that can't be stopped
  • You think your child has a life-threatening emergency

Go to ER Now

  • Mild concussion suspected (awake but not alert, not focused, slow to respond)
  • Neck pain after head injury
  • Had confused talking, slurred speech, unsteady walking or weakness of arms/legs but fine now
  • Blurred vision lasted more than 5 minutes
  • Injury caused by high speed (car crash)
  • Vomited 2 or more times
  • Severe headache or crying that won't stop
  • Can't remember what happened or store new memories
  • Large deep cut that will need many stitches

Call Doctor or Seek Care Now

  • Age less than 1 year old
  • Knocked out (unconscious) for less than 1 minute
  • Skin is split open or gaping and may need stitches
  • Bleeding that won't stop after 10 minutes of direct pressure
  • Large swelling (larger than 1 inch or 2.5 cm)
  • Large dent in skull
  • Blow from hard object (such as a golf club)
  • Fall from a dangerous height
  • You think your child has a serious injury
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Headache lasts more than 24 hours
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Dirty cut and no tetanus shot in more than 5 years
  • Clean cut and no tetanus shot in more than 10 years
  • You have other questions or concerns

Self Care at Home

  • Minor head injury
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Care Advice

  1. What You Should Know About Mild Head Injuries:
    • Most head injuries only cause a swelling or bruise to the scalp.
    • The main symptom is pain.
    • Swelling of the scalp does not mean there is any swelling of the brain. The scalp and brain are not connected. They are separated by the skull bone.
    • The skull bone protects the brain from getting injured.
    • Big lumps or bruising can occur with minor injuries to the scalp. This is normal. Reason: the scalp has a large blood supply.
    • The mildest brain injury is a concussion. Most of those also turn out fine.
    • Here is some care advice that should help.
  2. Wound Care:
    • If there is a scrape or cut, wash it off with soap and water.
    • For any bleeding, put direct pressure on the wound. Use a gauze pad or clean cloth. Press for 10 minutes or until the bleeding has stopped.
  3. Cold Pack For Swelling:
    • Use a cold pack or ice bag wrapped in a wet cloth. Put it on any swelling. Do this for 20 minutes.
    • Reason: Prevent big lumps ("goose eggs"). Also, helps with the pain.
    • Repeat in 1 hour, then as needed.
  4. Watch Your Child Closely for 2 Hours:
    • Watch your child closely during the first 2 hours after the injury.
    • Have your child lie down and rest until all symptoms have cleared. Note: mild headache, mild dizziness and nausea are common.
    • Allow your child to sleep if he wants to, but keep him nearby.
    • Wake him up after 2 hours of sleeping. Check that he is alert and knows who you are. Also, check that he can talk and walk normally.
  5. Diet - Start With Clear Fluids:
    • Offer only clear fluids to drink, in case he vomits.
    • Allow a regular diet after 2 hours.
    • Exception: babies can continue breastfeeding or formula.
  6. Pain Medicine:
    • To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed.
    • Exception: Do not give until 2 hours have passed from injury without any vomiting.
    • Caution: Never give aspirin to children and teens. Reason: Always increases risk of bleeding.
  7. Special Precautions For 1 Night:
    • Mainly, sleep in same room as your child for the first night.
    • Reason: If a problem occurs, you will recognize it if you are close by. Problems include a bad headache, vomiting or confusion. Also, look for any change in your child's normal behavior.
    • Option: If you are worried, wake your child once during the night. Check how he walks and talks.
    • After 24 hours, return to a normal sleep routine.
  8. What to Expect:
    • Most head trauma only causes a scalp injury.
    • The deep headache usually clears in 24 hours.
    • The scalp pain at the site of impact may last 3 days.
    • The swelling may take a week to go away.
  9. Call Your Doctor If:
    • Pain or crying becomes severe
    • Vomits 2 or more times
    • Your child becomes hard to wake up or confused
    • Walking or talking is not normal
    • Headache lasts more than 24 hours
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

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Photos

Laceration - Scalp

This scalp laceration (cut) is gaping open. It will require closure with sutures or medical staples.

First Aid Care Advice:

  • Apply direct pressure for 10 minutes to stop any bleeding.
  • Wash the cut with soap and water.

Source: Health Navigator, Inc.
Copyright 2000-2019. Health Navigator, LLC. Used by Permission.

Laceration - Scalp (After Staples)

This photo shows a scalp laceration after it has been closed with 4 metal medical staples.

Source: Health Navigator, Inc.
Copyright 2000-2019. Health Navigator, LLC. Used by Permission.

Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.
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Related Information

© Copyright 2009 American Academy of Pediatrics. All rights reserved.