Head injuries are very common during the childhood years. Fortunately, the brain is encased in the skull, a very hard covering which prevents most injuries from being serious.
Head injuries may be external or internal. An external injury to the skin and tissues outside the skull is less serious. It often causes a rapid raised swelling (hematoma) resulting from blood trapped in the tissues under the skin. An ice bag applied every 15 to 30 minutes will help reduce the swelling.
Abrasions should be thoroughly cleaned with soap and water and an antibiotic ointment such as Polysporin®, or Mycitracin® should be applied. Lacerations to the head bleed freely. Direct pressure over the cut will help stop the bleeding. Call your doctor's office if the bleeding will not stop, if the laceration is large and deep, or if it is located on the face. Some lacerations need repair.
Signs of Serious (Internal) Injury
"Internal head injuries" refer to injury to the brain and are serious.
It is quite common for a child to have a headache, several episodes of vomiting and some sleepiness lasting for a few hours following the injury. The following are signs of internal head injuries that require prompt attention:
- Loss of consciousness
- A clear or bloody discharge from the ear or nose
- Persistent vomiting (more than three times)
- A headache that persists or increases in intensity or does not respond to acetaminophen
- Persistent drowsiness or trouble waking your child. Be aware that some drowsiness may occur as a result of the injury but should disappear after one or two hours of rest
- Confusion or other changes in behavior or personality
- Blurred or double vision that persists for more than 15 minutes
- Weakness in the arms or legs, clumsy walking or staggering
- Facial asymmetry (drooping of one side of the mouth or face)
- Pupils are not the same size or the eyes are not moving together
Observation When Your Child Experiences a Head Injury
You should observe your child closely for 24 hours. During naps and sleep, wake your child hourly during the first six hours after the injury. Be sure he can identify you and interact appropriately when aroused. For the remainder of the 24 hours, if doing well, continue checking every two to three hours.
Mild head injuries can be managed at home with rest, acetaminophen and observation. He may return to full activity when feeling well and headaches have totally resolved. If headaches worsen with increased activity your child needs to be evaluated for a concussion. Call your doctor's office immediately if symptoms of serious head injury are observed.
Remember, prevention of head injuries is critical. Supervised play and the use of seat belts, bicycle helmets and appropriate sports equipment can prevent the majority of serious head injuries.