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Head Injury

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 mild brain injury 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 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, acting dazed, or being knocked out 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 mild headaches, dizziness or thinking difficulties. School problems or emotional changes can occur. These symptoms can last for several weeks. 
  • Brain Injuries are uncommon. They are recognized 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.

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.

FIRST AID for Bleeding:

  • Put a gauze pad or clean cloth on top of the wound.
  • Press down firmly on the place that is bleeding.
  • This is called direct pressure. It is the best way to stop bleeding.
  • Keep using pressure until the bleeding stops.
  • If bleeding does not stop, press on a slightly different spot.

FIRST AID for Suspected Spinal Cord Injury:

  • Do not move your child until a spine board is put on.

When to Call Us for Head Injury

Call 911 Now (your child may need an ambulance) If

  • Seizure occurred
  • Knocked out 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 (See FIRST AID)
  • You think your child has a life-threatening emergency

Call Us Now (night or day) If

  • You think your child has a serious injury
  • Age less than 1 year old
  • Neck pain after head injury
  • Knocked out for less than 1 minute
  • Had confused talking, slurred speech, unsteady walking OR weakness of arms/legs BUT fine now
  • Blurred vision lasted more than 5 minutes
  • Skin is split open or gaping and may need stitches
  • Bleeding 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 (car crash)
  • Blow from hard object (such as a golf club)
  • Fall from a dangerous height
  • Vomited 2 or more times
  • Severe headache or crying that won't stop
  • Can't remember what happened
  • You think your child needs to be seen urgently

Call Us During Weekday Office Hours If

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

Parent Care at Home If

  • Minor head injury

CARE ADVICE FOR SCALP INJURIES

What You Should Know:
  • Most head injuries only cause a swelling or bruise to the scalp.
  • The skull bone protects the brain from getting injured.
  • The mildest brain injury is a concussion. Most of those also turn out fine.
  • Here is some care advice that should help.
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.
Cold Pack:
  • 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.
Watch Your Child:  
  • 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. Then, check how he walks and talks.
Diet:
  • Offer only clear fluids to drink, in case he vomits. Allow a regular diet after 2 hours.
Pain:
  • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed. See Dose Table.
  • Exception: Do not give until 2 hours have passed from injury without any vomiting.
  • Never give aspirin to children and teens. Reason: Always increases risk of bleeding.
Special Precautions at Night:
  • Mainly, sleep in same room as your child for 2 nights.
  • 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 48 hours, return to a normal sleep routine.
What to Expect:
  • Most head impact only causes a scalp injury.
  • The swelling may take a week to go away.
  • The headache at the site of impact usually clears in 2 to 3 days.
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
  • Your child becomes worse
First Aid - Bleeding Head

Laceration - Scalp

Laceration - Scalp (After Staples)



And remember, contact us if your child develops any of the "Call Us" symptoms.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Copyright 1994-2013 Barton D. Schmitt, M.D.

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