Head Injury

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 cut and No past tetanus shots. Note: tetanus is the "T" in DTaP, TdaP, or Td vaccines.
• 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

Contact Doctor Within 24 Hours

• Headache lasts more than 24 hours
• Dirty cut or hard to clean and no tetanus shot in more than 5 years
• Clean cut and no tetanus shot in more than 10 years
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Minor head injury

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.

Photos

First Aid - Bleeding Head

• Apply direct pressure to the entire wound with a sterile gauze dressing or a clean cloth. Once the bleeding has stopped, cover with an adhesive bandage or gauze.

Source: Self Care Decisions, LLC
Used with Permission from Schmitt Pediatric Guidelines LLC.

Laceration - Scalp (After Staples)

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

Source: Self Care Decisions, LLC
Used with Permission from Schmitt Pediatric Guidelines LLC.

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: Self Care Decisions, LLC
Used with Permission from Schmitt Pediatric Guidelines LLC.