Head Injuries

Head injuries are common in childhood, especially during the early developmental years. Most are not serious and result in no noticeable injury to the head. More forceful blows to the head may result in an abrasion, a deep cut or a lump on the scalp due to broken blood vessels under the skin. Most attention, however, must be focused upon the child’s mental and neurological state. The following guidelines will help in assessment and treatment of a head injury.

  1. Is the skin broken? Most bleeding is controllable with direct pressure over the wound for 10 minutes. Wash small cuts or abrasions with soap and water. Deep or gaping cuts may need suturing for proper healing. (See Topic 15 sheet).
  2. How did the injury happen? The greater the force behind the injury, the greater the concern. An automobile accident, a long fall (as from a roof), and an impact from a heavy object (as from a baseball bat) are examples of significant force.
  3. Was there any loss of consciousness? Either being “knocked out” or having a seizure is indicative of loss of consciousness. Any loss of consciousness, however brief, may signal a dangerous head injury and requires immediate medical evaluation of the child.
  4. Does the child have a headache of increasing intensity? Headaches are common after a head injury, but generally improve fairly rapidly. A headache that is becoming more severe requires immediate medical attention.
  5. Has the child vomited? One or two episodes of vomiting are common immediately following a head injury. Any vomiting more than two hours after the accident is reason for concern, especially if it is associated with a headache.
  6. How is the child acting? Confusion, disorientation, excessive sleepiness, blurred or doubled vision, unsteady walk, weakness in arms or legs, and difficulty speaking are indications deserving immediate medical attention.

Home Management of a Mild Head Injury

Once the child has been evaluated, or determined to have sustained only a mild head injury, the following steps should be followed:

  1. If sleepy immediately after the head injury, allow the child to rest or sleep. Sleepiness is common due to exhaustion from the pain and agitation of the accident. Wake the child in one hour to access his alertness.
  2. Give only clear fluids (no solid foods) until the child has gone six hours without vomiting.
  3. Don’t give the child any medication that may cause drowsiness, such as antihistamines. Acetaminophen (Tempra, Tylenol) or ibuprofen (Advil, Motrin) are acceptable for pain relief.
  4. Observe the child closely for 48 hours. Awaken him three times during the night: once at your bedtime, at 1:00 a.m. and at 4:00 a.m. More frequent checks may be necessary if advised. Arouse him until he is walking and talking normally.
  5. Call back if:
  • The headache worsens.
  • The child has any vomiting two hours after the accident.
  • The child is difficult to arouse, acts confused or is unable to walk.
  • If there are any unusual symptoms, such as neck stiffness, vision problems, speech difficulty or fluid drainage from the ear or nose.

Posted in: Pediatric Topics