Children's Hospital Colorado

Head Injury

Urgent or Emergency Care?

If you believe your child needs immediate attention and you have concerns for a life-threatening emergency, call 911. Not sure what counts as urgent and what's an emergency when your child is sick or injured? When it can't wait, know where to take your kids.

Help Me Decide

  • Injuries to the head
  • Includes the scalp, skull and brain

Types of Head Injuries

  • Scalp Injury. Most head injuries only damage the scalp. Examples are a cut, scrape, bruise or swelling. It is common for children to fall and hit their head while growing up. This is especially common when a child is learning to walk. Big lumps (bruises) can occur with minor injuries. This is because there is a large blood supply to the scalp. For the same reason, small cuts on the head may bleed a lot. Bruises on the forehead sometimes cause black eyes 1 to 3 days later. This is caused by blood spreading downward by gravity.
  • Skull Fracture. Only 1% to 2% of children with head injuries will get a skull fracture. Most often, there are no other symptoms except for a headache. The headache occurs at the site where the head was hit. Most skull fractures occur without any injury to the brain. They heal easily.
  • Concussion. A head injury that changes how the brain normally works. It is usually caused by a sudden blow or jolt to the head. Most children bump or hit their heads without causing a concussion. The most common signs are a brief period of confusion or memory loss. This happens after the injury. Other signs of a concussion can include a headache or vomiting. Dizziness or acting dazed can also be signs. A person does not need to be knocked out to have had a concussion. Following a concussion, some children have ongoing symptoms. These can include headaches, dizziness or thinking difficulties. School problems or emotional changes can occur. These symptoms can last for several weeks.
  • Brain Injuries (Serious) are uncommon. This includes bleeding, bruises or swelling within the brain. They are suspected by the symptoms listed below:
  • Hard to wake up or keep awake or
  • Acts or talks confused or
  • Slurred speech or
  • Weakness of arms or legs or
  • Walking is not steady.
  • These symptoms are an emergency. If they happen, call 911.

Concussion Treatment

  • Treating a concussion requires both Physical Rest and Brain Rest.
  • Brain rest means a gradual return to full studying and school attendance.
  • Physical rest means a gradual return to normal activity, work and gym class.
  • If symptoms occur (like a headache), the child needs to return to the previous level of physical and mental activity. In 24 hours, they can try again to take it to the next level.
  • Athletes involved in sports need to have a stepwise plan for "return to play." Progressing through stages should be supervised by a doctor or athletic trainer.

Pain Scale

  • Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
  • Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
  • Severe: The pain is very bad. It keeps your child from doing all normal activities.

Call 911 Now

  • Seizure occurred
  • Knocked out (unconscious) for more than 1 minute
  • Not moving neck normally (Caution: protect the neck from any movement)
  • Hard to wake up
  • Acts or talks confused or slurred speech present now
  • Walking not steady or weakness of arms/legs present now
  • Major bleeding that can't be stopped
  • You think your child has a life-threatening emergency

Go to ER Now

  • Mild concussion suspected (awake but not alert, not focused, slow to respond)
  • Neck pain after head injury
  • Had confused talking, slurred speech, unsteady walking or weakness of arms/legs but fine now
  • Blurred vision lasted more than 5 minutes
  • Injury caused by high speed (car crash)
  • Vomited 2 or more times
  • Severe headache or crying that won't stop
  • Can't remember what happened or store new memories
  • Large deep cut that will need many stitches

Call Doctor or Seek Care Now

  • Age less than 1 year old
  • Knocked out (unconscious) for less than 1 minute
  • Skin is split open or gaping and may need stitches
  • Bleeding that won't stop after 10 minutes of direct pressure
  • Large swelling (larger than 1 inch or 2.5 cm)
  • Large dent in skull
  • Blow from hard object (such as a golf club)
  • Fall from a dangerous height
  • You think your child has a serious injury
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Headache lasts more than 24 hours
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Dirty cut and no tetanus shot in more than 5 years
  • Clean cut and no tetanus shot in more than 10 years
  • You have other questions or concerns

Self Care at Home

  • Minor head injury

Care Advice for Head Injuries

  1. What You Should Know About Mild Head Injuries:
    • Most head injuries only cause a swelling or bruise to the scalp.
    • The main symptom is pain.
    • Swelling of the scalp does not mean there is any swelling of the brain. The scalp and brain are not connected. They are separated by the skull bone.
    • The skull bone protects the brain from getting injured.
    • The mildest brain injury is a concussion. Most of those also turn out fine.
    • Here is some care advice that should help.
  2. Wound Care:
    • If there is a scrape or cut, wash it off with soap and water.
    • For any bleeding, put direct pressure on the wound. Use a gauze pad or clean cloth. Press for 10 minutes or until the bleeding has stopped.
  3. Cold Pack For Swelling:
    • Use a cold pack or ice bag wrapped in a wet cloth. Put it on any swelling. Do this for 20 minutes.
    • Reason: Prevent big lumps ("goose eggs"). Also, helps with the pain.
    • Repeat in 1 hour, then as needed.
  4. Watch Your Child Closely for 2 Hours:
    • Watch your child closely during the first 2 hours after the injury.
    • Have your child lie down and rest until all symptoms have cleared. Note: mild headache, mild dizziness and nausea are common.
    • Allow your child to sleep if he wants to, but keep him nearby.
    • Wake him up after 2 hours of sleeping. Check that he is alert and knows who you are. Also, check that he can talk and walk normally.
  5. Diet - Start With Clear Fluids:
    • Offer only clear fluids to drink, in case he vomits. Allow a regular diet after 2 hours.
  6. Pain Medicine:
    • To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed.
    • Exception: Do not give until 2 hours have passed from injury without any vomiting.
    • Caution: Never give aspirin to children and teens. Reason: Always increases risk of bleeding.
  7. Special Precautions For 1 Night:
    • Mainly, sleep in same room as your child for the first night.
    • Reason: If a problem occurs, you will recognize it if you are close by. Problems include a bad headache, vomiting or confusion. Also, look for any change in your child's normal behavior.
    • Option: If you are worried, wake your child once during the night. Check how he walks and talks.
    • After 24 hours, return to a normal sleep routine.
  8. What to Expect:
    • Most head trauma only causes a scalp injury.
    • The deep headache usually clears in 24 hours.
    • The scalp pain at the site of impact may last 3 days.
    • The swelling may take a week to go away.
  9. Call Your Doctor If:
    • Pain or crying becomes severe
    • Vomits 2 or more times
    • Your child becomes hard to wake up or confused
    • Walking or talking is not normal
    • Headache lasts more than 24 hours
    • You think your child needs to be seen
    • Your child becomes worse

Care Advice for Head Injuries

Laceration - Scalp

This scalp laceration (cut) is gaping open. It will require closure with sutures or medical staples.

First Aid Care Advice:

  • Apply direct pressure for 10 minutes to stop any bleeding.
  • Wash the cut with soap and water.
First Aid - Bleeding Head
  • Apply direct pressure to the entire wound with a sterile gauze dressing or a clean cloth. Once the bleeding has stopped, cover with an adhesive bandage or gauze.
Laceration - Scalp

This scalp laceration (cut) is gaping open. It will require closure with sutures or medical staples.

First Aid Care Advice:

  • Apply direct pressure for 10 minutes to stop any bleeding.
  • Wash the cut with soap and water.
Laceration - Scalp (After Staples)

This photo shows a scalp laceration after it has been closed with 4 metal medical staples.

Disclaimer

The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.

  • Not a Substitute - The information and materials in Pediatric HouseCalls Symptom Checker should not be used as a substitute for the care and knowledge that your physician can provide to you.
  • Supplement - The information and materials presented here in Pediatric HouseCalls Symptom Checker are meant to supplement the information that you obtain from your physician. If there is a disagreement between the information presented herein and what your physician has told you -- it is more likely that your physician is correct. He or she has the benefit of knowing your child's medical problems.
  • Limitations - You should recognize that the information and materials presented here in Pediatric HouseCalls Symptom Checker have the following limitations, in comparison to being examined by your own physician:
    • You can have a conversation with your child's doctor.
    • Your child's doctor can perform a physical examination and any necessary tests.
    • Your child could have an underlying medical problem that requires a physician to detect.
    • If your child is taking medications, they could influence how he experiences various symptoms.

If you think that your child is having a medical emergency, call 911 or the number for the local emergency ambulance service NOW!

And when in doubt, call your child's doctor NOW or go to the closest emergency department.

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By using this website, you accept the information provided herein "AS IS." Neither publishers nor the providers of the information contained herein will have any liability to you arising out of your use of the information contained herein or make any expressed or implied warranty regarding the accuracy, content, completeness, reliability, or efficacy of the information contained within this website.

Copyright 2000-2018. Schmitt Pediatric Guidelines LLC.

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