Kids Health Info - Head Injury

Children have many bangs to the head and it can be difficult to tell whether they are serious or not. If your child has received an injury to the head, you should see a doctor.
A head injury is any knock to the head that causes lumps, bruises, cuts or more severe injuries to your child's head. Many head injuries are not serious and simply result on a bump or bruise. Occasionally head injuries can result in damage to the brain.

Seek medical help immediately if:

• Your child has had a hard bang to the head, such as falling off something high or from a car accident.
• Your child losses consciousness.
• Your child seems unwell and vomits several times after.

Signs and symptoms

The symptoms of head injuries are used to determine how serious it is. Head injuries can be classified into minor, moderate or serious.

A severe head injury is when your child:

• Has lost consciousness for more than 30 seconds.
• Is drowsy and does not respond to your voice.
• Has other significant head injury signs, such as unequal pupils, arm and leg weakness.
• Has something stuck in their head.
• Has a second fit or convulsion, other than a single brief one when the injury happened.

You should call an ambulance immediately if your child has a severe head injury.

A moderate head injury is when your child:

• Has lost consciousness for less than 30 seconds.
• Is alert and responds to your voice.
• Has vomited 2 times or more.
• Has a headache.
• One brief fit may have happened straight after the injury.
• May have a large bruise, lump or cut on the head.

Your child should be watched closely in hospital for at least 4 hours after a moderate head injury.

A minor head injury is when your child:

• Has not lost consciousness.
• Is alert or interacts with you.
• May have vomited, but only once.
• May have bruising or cuts on their head.
• Otherwise normal.

Treatment of minor head injury

Most children with minor head injury make a full recovery. Most small knocks just cause bruising and pain for a short while.

• Apply ice or a cool wash to the area injured to help reduce the swelling.
• If your child has a cut, apply a clean dressing  and press on it for about 5 mins. Cuts to the head will often bleed a lot.

Problems to watch for in the next day or two:

• Headache. Your child may have a headache. Give paracetamol every 4-6 hours if needed to relieve pain
• Vomiting. Your child may have vomited once but if vomiting continues, go back to your doctor. 
• Drowsiness. Immediately after the head injury your child may be sleepy.
  There is no need to keep your child awake if they want to sleep. If your child does go to sleep, wake them every half to one hour to check their condition, and their reaction to familiar things. You should do this until they are no longer drowsy and have been awake and alert for a few hours.
  Some questions you could ask are:
  - Do they know where they are?
  - Do they know familiar people's names?
  - Do they know which day it is?
  - Or if they are very young: Do their reactions seem appropriate? ie. Reaching out for a dummy. Are they interactive and not too irritable?

If you have any difficulty waking your child, take them to the nearest emergency department or call an ambulance.

If your child's behaviour is very different to their normal behaviour, or the pain does not go away, go back to your doctor.  

Follow up

Some problems that may result from a minor head injury can be hard to detect at first. In the next few weeks parents may notice:

• Irritability 
• Mood swings 
• Tiredness 
• Concentration problems in their child
• Behavioural changes.

Talk to your doctor if you are worried about any of these signs.

Go back to your doctor or hospital immediately if your child has:

• Unusual or confused behaviour. 
• Severe or persistent headache which is not relieved by paracetamol (irritability in a baby). 
• Frequent vomiting. 
• Bleeding or discharge from the ear or nose. 
• A fit or convulsion, or spasm of the face or arms or legs. 
• Difficulty in waking up. 
• Difficulty in staying awake. 
• If you are worried for any reason.

Key points to remember

• If your child has received an injury to the head, you should see a doctor.
• Apply ice or a cool wash to the area injured to help reduce the swelling.

* Information extracted from RCH.