Head Injury

HEAD INJURY

Injury Definition

  • Injuries to the head.

Types of Head Injuries

  • SCALP INJURY: Most head injuries only damage the scalp (a cut, scrape, bruise or swelling).  It is common for children to fall and hit their head at some point while growing up.  This is especially common when a child is learning to walk. Big lumps (bruises) can occur with minor injuries 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 because the blood spreads downward by gravity. 
  • SKULL FRACTURE: Only 1% to 2% of children with head injuries will get a skull fracture.  Usually there are no other symptoms except for a headache at the site where the head was hit.  Most skull fractures occur without any injury to the brain and they heal easily.
  • CONCUSSION: A concussion is a mild injury to the brain that changes how the brain normally works.  It is usually caused by a sudden blow or jolt to the head.  Many children bump or hit their heads without causing a concussion.  The most common signs of a concussion are a brief period of confusion or memory loss following the injury. Other signs of a concussion can include a headache, vomiting, dizziness, acting dazed, or being knocked out.  A person does NOT need to be knocked out (lose consciousness) to have had a concussion. Following a concussion, some children have ongoing symptoms such as mild headaches, dizziness, thinking difficulties, school problems or emotional changes for several days to weeks. 
  • BRAIN INJURIES are rare but are recognized by the presence of the following symptoms:
    (1) Difficult to awaken, or keep awake OR (2) confused thinking and talking, OR (3) slurred speech, OR (4) weakness of arms or legs OR (5) unsteady walking.

Scalp Laceration
Scalp Laceration

This scalp laceration (cut) is gaping open. It required closure with medical staples.

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WHEN TO CALL YOUR DOCTOR

Call 911 now (your child may need an ambulance) if:

  • A seizure (convulsion) occurred.
  • Knocked unconscious for more than 1 minute.
  • Not moving neck normally (caution: protect the neck from any movement).
  • Difficult to awaken.
  • Confused thinking, slurred speech, unsteady walking OR weakness of arms present now.
  • Major bleeding that can't be stopped.

Call your doctor now (night or day) if:

  • You think your child has a serious injury.
  • Age less than 1 year old.
  • Neck pain.  
  • Knocked unconscious for less than 1 minute.  
  • Had confused thinking, slurred speech, unsteady walking OR weakness of arms BUT fine now.
  • Blurred vision persists for more than 5 minutes.
  • 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.  
  • Injury caused by high speed (e.g. auto accident), great height(e.g. twice the child's height) or blow from hard object (eg. golf club).
  • Vomited 2 or more times within 3 days of injury.
  • Watery fluid dripping from the nose or ear while child not crying.
  • Severe headache or crying.
  • Can't remember what happened.

Call your doctor within 24 hours (between 9am and 4pm) if:

  • You think your child needs to be seen.
  • Headache persists for more than 3 days.

Call your doctor during weekday office hours if:

  • You have other questions or concerns.
  • No tetanus shot in over 5 years for DIRTY cuts (over 10 years for CLEAN cuts).

Parent care at home if:

  • Minor head injury and you don't think your child needs to be seen
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HOME CARE ADVICE

  1. Wound Care:  If there is a scrape or cut, wash it off with soap and water. Then apply pressure with a sterile gauze for 10 minutes to stop any bleeding.
  2. Local Cold:  Apply a cold pack or ice bag wrapped in a wet cloth to any swelling for 20 minutes. (Big lumps are common)
  3. Observation:  Observe your child closely during the first 2 hours following the injury.
    • Encourage your child to 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.
    • Awaken after 2 hours of sleeping to check the ability to walk and talk.
  4. Diet:  Offer only clear fluids to drink, in case he vomits.  Regular diet OK after 2 hours.
  5. Avoid Pain Medicines:  If the headache is that bad, he needs to be examined.
  6. Special Precautions at Night:
    • Awaken your child at your bedtime and again 4 hours later for 2 nights. Check the ability to walk and talk.
    • Sleep in same room as your child for 2 nights.
    • After 48 hours, return to a normal routine.
  7. Expected Course:  Most head impact only causes a scalp injury.  The swelling may take a week to resolve.  The local headache at the site of impact usually clears in 2 to 3 days.
  8. Call Your Doctor If:
    • Pain becomes severe
    • Your child becomes worse

And remember, contact your doctor if your child becomes worse or develops any of the "Call Your Doctor" symptoms.

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REFERENCES

  1. Aitken ME, Herrerias CT, Davis R, Bell HS, Coombs JB, Kleinman LC, Homer CJ Minor head injury in children. Arch Pediatr Adolesc Med. 1998;152:1176-1180.
  2. American Academy of Pediatrics Committee on Quality Improvement, Commission on Clinical Policies and Research. The management of closed head injury in children. Pediatrics.1999;104:1407-1415.
  3. Coombs JB and Davis RL. A synopsis of the American Academy of Pediatrics' Practice Parameter on the management of minor closed head injury in children. Pediatr Rev. 2000;21:413-415.
  4. Dunning J, Daly P, Lomas J, et.al. Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child. 2006;21:885-891.
  5. Gedeit R. Head injury. Pediatr Rev. 2001;22:118-123.
  6. Goldstein B and Powers K. Head trauma in children. Pediatr Rev. 1994;15:213-219.
  7. Greenes DS and Schutzman SA. Clinical indicators of intracranial injury in head-injured infants. Pediatrics. 1999;104:861-867.
  8. Greenes DS. Decisionmaking in pediatric minor head trauma. Ann Emerg Med. 2003;42:515-518.
  9. Gruskin KD, Schutzman SA. Head trauma in children younger than 2 years. Arch Pediatr Adolesc Med. 1999;153:15-20.
  10. Haydel MJ, Shembekar AD. Prediction of intracranial injury in children aged five years and older with loss of consciousness after minor head injury due to nontrivial mechanisms. Ann Emerg Med. 2003;42(4):507-510.
  11. Kelly JR and Rosenberg JH. Diagnosis and management of concussion in sports. Neurology. 1997; 48:575-580.
  12. Lallier M, Bouchard S, St-Vil D, et al. Falls from heights among children: a retrospective review. J Pediatr Surg. 1999;34:1060-1063.
  13. Palchak MJ, Holmes JF, Vance CW, et al. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med. 2003;42:492-506.
  14. Palchak MJ, Holmes JF, Vance CW, et al. Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma? Pediatrics. 2004;113:e507-e513.
  15. Patel D. Managing concussion in a young athlete. Contemp Pediatr. 2006;23(11):62-69.
  16. Quality Standards Subcommittee of the American Academy of Neurology. The management of concussion in sports (practice parameters). Neurology. 1997; 48:581-585.
  17. Quayle KS. Minor head injury in the pediatric patient. Pediatr Clin North Am. 1999;46(6):1189-1199.
  18. Schutzman SA, Barnes P, Duhaime A et al. Evaluation and management of children younger than two years old with apparently minor head trauma: Proposed guidelines. Pediatrics. 2001;107:983-993.
  19. Thiessen ML, Woolridge D. Pediatric minor closed head injury. Pediatr Clin North Am. 2006;53(1):1-26.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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