Head injuries fall into two categories:
- external (usually scalp) injuries
- internal head injuries, which may involve the skull, the blood vessels within the skull, or the brain
Fortunately, most childhood falls or blows to the head cause injury to the scalp only, which is usually more frightening than threatening. An internal head injury could be more serious because it may cause bleeding or bruising of the brain.
External (Scalp) Injuries
The scalp is rich with blood vessels, so even a minor cut there can bleed a lot. Sometimes the scalp’s veins leak fluid or blood into (and under) the scalp. This appears as a "goose egg" or swelling on the head. It may take days or even a week to disappear.
What to look for and what to do:
- Call the doctor if your child is an infant; has lost consciousness, even briefly; or if a child of any age has any of these symptoms:
- won't stop crying
- complains of head and neck pain (younger or nonverbal children may be more fussy)
- vomits several times
- won't awaken easily
- becomes hard to console
- isn't walking or talking normally
- If your child is not an infant, has not lost consciousness, and is alert and behaving normally after the fall or blow:
- Apply an ice pack or instant cold pack to the injured area for 20 minutes every 3 to 4 hours. If you use ice, always wrap it in a washcloth or sock; ice applied directly to bare skin can injure it.
- Watch your child carefully for the next 24 hours. If you notice any of the signs of internal injury, call your doctor right away.
- If the incident happens close to bedtime or naptime and your child falls asleep soon afterward, check in a few times while he or she sleeps.
- If color and breathing are normal, and you don't sense a problem, let your child sleep (unless the doctor has advised otherwise). There's no need to keep a child awake after a head injury.
- Trust your instincts. If you aren't comfortable with your child's appearance, partly awaken your child by sitting him or her up. Your child should fuss a bit and attempt to resettle. If he or she still seems very drowsy, try to awaken your child fully. If your child can't be awakened or shows any signs of internal injury, call the doctor or 911 for an ambulance.
Cerebrospinal fluid (CSF) is a clear fluid that cushions the brain from damage. But a severe blow to the head can still knock the brain into the side of the skull or tear blood vessels.
Some internal head injuries can be serious and possibly life-threatening. These include a broken skull bone, torn blood vessels, or damage to the brain itself.
It can be hard to know how serious a head injury is, so it's always wise to call your doctor.
Symptoms and What to Do
Call 911 if your child shows any of these symptoms after a head injury:
- unconsciousness for more than a few seconds
- abnormal breathing
- obvious serious wound
- bleeding or clear fluid from the nose, ear, or mouth
- disturbance of speech or vision
- pupils of unequal size
- weakness or paralysis
- neck pain or stiffness
If your child is unconscious:
- Do not try to move your child in case there is a neck or spine injury.
- Call for help.
- Turn a child who is vomiting or having a seizure onto his or her side while trying to keep the head and neck straight. This will help prevent choking and provide protection in case of neck and spine injury.
If your child is conscious:
- Do your best to keep your child calm and still.
- If there's bleeding, apply a clean or sterile bandage.
- Do not attempt to cleanse the wound, which can make bleeding worse and/or cause serious complications if the skull is fractured.
- Do not apply direct pressure to the wound if you suspect the skull is fractured.
- Do not remove any object that's stuck in the wound.
Concussions — the temporary loss of normal brain function due to an injury — are also a type of internal head injury. Repeated concussions can permanently damage the brain.
In many cases, a concussion is mild and won't cause long-term damage. Kids who get a concussion usually recover within a week or two without lasting health problems by following certain precautions and taking a break from sports and other activities that make symptoms worse.
Playing sports is one of the most common causes of concussions. To help protect your kids, make sure that they wear the proper protective gear, and don't let them continue to play if they've had a head injury.
If your child sustains an injury to the head, watch for these signs of a possible concussion:
- "seeing stars" and feeling dazed, dizzy, or lightheaded
- memory loss, such as trouble remembering what happened right before and after the injury
- blurred vision and sensitivity to light
- slurred speech or saying things that don't make sense
- problems concentrating, thinking, or making decisions
- difficulty with coordination or balance (such as being unable to catch a ball or other easy tasks)
- feeling anxious or irritable for no apparent reason
If you suspect a concussion, call your doctor right away.
Preventing Head Injuries
It's impossible to prevent kids from ever being injured, but there are ways to help prevent head blows.
Make sure that:
- your home is childproofed to prevent household accidents
- your kids always wear the proper headgear and safety equipment when biking, in-line skating, skateboarding, snowboarding or skiing, and playing contact sports
- kids always use a seatbelt or child safety seat
- your child takes it easy after a head injury, especially if there is a concussion
- your child doesn't go back to rough play or sports until the doctor says it's OK. If your child reinjures the brain while it's still healing, it will take even longer to completely heal.
Reviewed by: Rupal Christine Gupta, MD
Date reviewed: January 2015