How do I know if my child has a serious head injury?

Falls and bumps are common in young children, and many times result in hitting their heads. While most head injuries are not serious, an estimated 432,000 U.S. children do experience a traumatic brain injury each year. The consequences of a head injury can be serious, symptoms can be difficult to assess, and many parents are unsure as to the best course of action when their child hits his head.

The American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) developed guidelines for assessing and treating what they call “minor closed head injury in children.” Here are some strategies: 

• If your child has mild or moderate bleeding, apply pressure. If the bleeding does not stop during 10 minutes of direct pressure, call your child’s doctor immediately.
  
• If your child loses consciousness, call 911 right away. A loss of consciousness, even if for less than one minute, requires a clinical evaluation by a health care provider and potentially a CT scan or other imaging test. 
  
• If your child remains conscious and alert, it’s likely that no tests or x-rays are needed. Comfort your child, apply a cold compress for about 20 minutes to help relieve swelling, and watch him closely. The AAP and AAFP recommend that children be observed for onset of symptoms for at least 24 hours and that parents and caregivers “have a high index of suspicion about any change in the patient’s clinical status for several days after the injury.” Any development of symptoms within several days of injury should be reported to your child’s doctor.
  
• If you notice symptoms, call your child’s doctor immediately. Watch for: 
  
• headache (constant or worsening) 
• continued crying (beyond 10 minutes) 
• confusion 
• trouble recognizing people 
• slurred speech 
• dizziness (prolonged or recurring) 
• persistent ringing in the ears 
• irritability or abnormal behavior 
• vomiting (2–3 times or more) 
• stumbling or difficulty in walking 
• weakness of arms or legs 
• blood from nose or ears 
• moderate to severe swelling of the face or scalp 
• bruising or discoloration around the eyes, behind the ears, or on the scalp
• sleepiness or trouble awakening 
• difference in the size of the pupils at the center of child’s eyes 
• paleness (for longer than an hour) 
• convulsions (seizures) 
• fever 

• If your child is to be monitored at home, he may be able to sleep. Watch for color or breathing changes, or twitching of the arms or legs. If your doctor recommends, you may need to “check him every 2 to 3 hours to make sure he moves normally, wakes to recognize you, and responds to you.” 
  
• If your child is prescribed medicine, give it to him carefully. Do not give him any medication—including acetaminophen (e.g., Tylenol)—while you are watching for symptoms, unless his doctor recommends it.