It is rare for a child to reach adulthood without
having injured their head at least once. Infants roll off the bed when their parents are
distracted for a second, toddlers are unsteady on their feet, school-aged children collide
with each other while playing, and older children frequently get separated from their
bicycle. While head injuries are common, it is unusual for the trauma to produce any
serious neurological problems.
When a child does fall, a parents first thought is
to call "911" or take their child immediately to the nearest emergency room.
Does the child need only a reassuring hug or a skull x-ray and "CAT" scan? How
do parents know what to do after that inevitable head injury?
A child who sustains a high impact injury, such as
an auto accident, a fall from a high tree, or being struck by a heavy object should
probably be evaluated by their physician or a hospital emergency room. Fortunately, most
head injuries in children are mild and parents can determine for themselves whether or not
to seek medical attention.
Your child should definitely be evaluated by a
physician if the injury is severe enough to cause a temporary loss of consciousness--
known medically as a concussion. If a small child cries immediately after they hit their
head, then parents can assume that they were not unconscious With older children, many
times no one was around to witness the fall, but if the child remembers the entire
incident, than a concussion probably did not occur. An injured child does not have a
concussion unless there is a temporary loss of consciousness, seems confused or
disoriented, or has no memory of the accident.
Once a parent has determined that their child did
not have a concussion, carefully check the site of the injury. If there is a deep cut and
the bleeding cannot be controlled with simple pressure, stitches may be required. It is
very common for parents to find swelling over the site of the injury, caused by bleeding
from broken blood vessels under the skin. The size of this "goose egg" concerns
parents, but its presence does not mean that there is bleeding into the brain or that
there is something wrong with their child’s blood. "Goose eggs," or
hematomas, may turn black and blue and take up to two weeks to disappear. Forehead
injuries frequently produce "shiners" around the eyes from blood drifting down
under the skin. If your child allows it (and most of the time they don’t), ice can be
applied to reduce the amount of swelling.
Following any head injury, a parents biggest fear
is that their child has suffered damage to their nervous system. While this does occur, it
is the exception rather than the rule, since the brain is well protected and cushioned by
the skull. If significant injury is to occur, it will do so in the first eight to twelve
hours after the injury. During this time, parents should observe their child for any
unusual behavior or symptoms.
It has always been suggested that parents should
keep their child awake after an accident. Actually, most children are usually sleepy after
hitting their head, so it is okay to allow them to go to sleep. It is a good idea,
however. to check they every couple hours for the next twelve hours, just to be safe. The
infant should try to resist being aroused and be able to ,move both arms and legs. The
older child may act a little confused (who would not if they were awaken from sleep every
two hours) but be able to walk across the room or talk to you.
Headache and vomiting are extremely common
following any head injury in children. A mild headache can be relieved with acetaminophen
and the vomiting is best treated by offering your child only clear liquids (ones you can
see through). Avoid a big meal-- there is no need to have your child vomit up lunch or
dinner! Parents should report a severe, unresolving headache, or reoccurring vomiting by
calling their child’s doctor .
In addition to the above, if the answer to any of
the following questions is yes, the injured child should be evaluated by a physician as
soon as possible.
* Did the child become extremely drowsy or so
sleepy that you are unable to awake them hours after the injury? Does the child seem
confused, disoriented, or different to you in any other way?
* Is the child able to move only one side of the
body, one arm or one leg?
* Did the child have a seizure after the injury?
* Is there any blood or fluid leaking from the
nose or ears?
* Does the child have any other medical
conditions? Some conditions warranting concern following head trauma include bleeding
disorders, heart failure, congenital abnormalities, and leukemia.
* Does the older child complain of double vision
or do the eyes appear crossed?
* Is the child’s speech slurred?
The most common problem following a head injury is the guilt most
adults feel after the fall. Frequently a parent will blame the babysitter for not watching
their child better, or a father will be critical of his wife’s parenting ability. The
person who was with the child at the time of the fall feels bad enough, and sure,
sometimes the fall was preventable. But instead of wasting energy being overly critical or
feeling guilty, use the injury as a learning experience to prevent future accidents. When
your child does fall, try to stay calm. Remember, falls happen to all children in spite of
the best of care.