Head Injury

• 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 concussion is a type of brain injury. It causes a change in how the brain works for a short time. 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 or double 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 cut and No past tetanus shots. Note: tetanus is the "T" in DTaP, TdaP, or Td vaccines.
• 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

Contact Doctor Within 24 Hours

• Headache lasts more than 24 hours
• Dirty cut or hard to clean and no tetanus shot in more than 5 years
• Clean cut and no tetanus shot in more than 10 years
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Minor head injury

Care Advice for Head Injuries

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.
• Big lumps or bruising can occur with minor injuries to the scalp. This is normal. Reason: the scalp has a large blood supply.
• The mildest brain injury is a concussion. Most of those also turn out fine.
• Here is some care advice that should help.

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.

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.

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.

Diet - Start With Clear Fluids:

• Offer only clear fluids to drink, in case he vomits.
• Allow a regular diet after 2 hours.
• Exception: babies can continue breastfeeding or formula.

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.

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.

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.

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

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.

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

• 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.