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Quick reference medical handouts used by Pediatric offices

When to Worry About a Head Injury


Anybody watching children playing will know that they are constantly banging their heads, often in seemingly frightening circumstances. Fortunately severe injury to the brain is unusual and most bumps on the head, even large ones, are not serious. 

Injury to the skull Causes lacerations and bleeding of the scalp, producing large swellings ("goose egg") on the skin
Injury to the brain Concussion: The brain is not a tight fit in the skull and can shake around within it. When the head is struck the softer brain  hits up against the hard skull. Usually, but not always, associated with a loss of consciousness. 
Bleeding.  Broken blood vessels produce bleeding either between the skull and the brain or within the brain itself. This causes the brain to be compressed producing signs of brain injury.


When to worry after a head injury and seek medical attention

When to worry less after a head injury

Your parental intuition tells you something is wrong Your child is alert and walking, talking, playing, and acting like she/he was before the fall
Loss of consciousness or appearing not to respond to speech or touch No loss of consciousness or "blacks out" for less than 5 seconds, then  is easily aroused by a loud voice or a little touch. 
Vomits three or more times Vomits once or twice3
Mental status altered - child is confused and disoriented, will not focus on you or respond to questions or commands.   Child is dazed but recognizes you or familiar objects (security blankets, etc). The child fights you when you attempt to put ice on the injury
There is a decreasing level of consciousness, from awake to drowsy, to lethargic, and then to unconsciousness. Note: a child may show extreme restlessness prior to loss of consciousness.  There is an improving level of consciousness, from lethargic to drowsy to full awake status. Child may want to fall asleep (especially if injury occurred around nap time) but is easily aroused.4
Unable to walk without falling. May have weakness, numbness, or tingling of a part of the body, usually on the same side of the body. Slurred speech  
Prolonged and excessive crying lasting over an hour Child is able to be comforted and soothed in a short period of time
Severe, unremitting headache2 Child complains of headache only when asked and does not seem bothered by it
Eye changes- pupils are different size or eyes appear crossed. A dilating (getting larger) pupil following a head injury is an important danger sign. The child complains of blurred or double vision.1 Pupils are the same size and eyes appear normal; child does not complain of blurred or double vision
Bleeding or clear fluid discharge from the ears. After the child jas stopped crying, there is a clear discharge from the nose. No bleeding or discharge from the ears or nose.
Convulsions or seizures after the injury No convulsions or seizures
Non-stop bleeding from the scalp Even small head cuts can be quite bloody, but steady pressure should stop small cuts within 5 to 10 minutes. 
Your child has had a previous concussion in the last year There is no history of previous serious head injury
The child has another medical condition, such as a bleeding disorder, congenital abnormality, leukemia, or a heart disorder that will make the head injury more dangerous The child does not have any medical condition that would make the head injury potentially more dangerous. 
1Note: a small difference in pupil size is  frequently found in many normal children. Futhermore, it is not necessary to check the child's pupils to make sure they  become smaller when you shine a flashlight on them. This test is difficult to perform with uncooperative children and is a late sign of brain injury. 

2Check with your doctor concerning the use of acetominophen or ibuprofen for headache. Some phyisicans prefer you not to give medicine for pain since they feel iIf the headache is bad enough to need acetaminophen or ibuprofen.  your child should be checked. 

3As a precaution, feed only clear liquids to the child who has hit their head. Okay to breast feed. 

4Check with you doctor to find out whether or not you should wake your baby up. Some physicians prefer that you simply check your child for color (pink, not pale or blue) and breathing pattern (regular breathing, rather than shallow or irregular breathing) 


When to Worry after 24 hours

Your child.......
  • changes in sleep patterns
  • becomes restless or fussy
  • doesn't pay attention
  • forgets things
  • gets mixed up about time and places
  • takes longer to get things done
  • doesn't act the same
  • acts without thinking
  • becomes easily upset
  • loses his or her temper a lot
  • tires easily or needs extra sleep
  • doesn't see or hear as well
  • drops things or trips a lot
  • develops problems with words or sentences
  • has a harder time learning.

Will my Child Need a Skull X-ray?

Skull x-rays are seldom helpful. It is therefore usually not necessary to take an otherwise normal, active child who has sustained a head injury to an ER for skull x-rays.  If neurological signs call for a x-ray, then a CAT scan will give physicians more information than a skull x-ray. A CAT scan, which is a series of cross-sectional x-rays of the brain, will show bleeding and swelling of the brain, which is what is really important to know.



As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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