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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
|Injury to the skull
||Causes lacerations and bleeding of the scalp, producing large
swellings ("goose egg") on the skin
|Injury to the brain
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
||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
||No convulsions or seizures
|Non-stop bleeding from the
||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
||The child does not have any
medical condition that would make the head injury potentially more
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
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
When to Worry after 24 hours
- 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 childs pediatrician.
Please read our full disclaimer.