Head Injury

Pediatric HouseCalls Online

DEFINITION

• Injuries to the head.

Types of Head Injuries

• Scalp injuries (cut, scrape, bruise or swelling).
• Skull injury: bruises, fracture.
• Concussion: brief period of confusion or loss of memory.  Does not require a loss of consciousness.
• Brain injuries are rare but are recognized by the presence of the following symptoms:
  (1) Difficult to awaken, or keep awake OR (2) confused thinking and talking, OR (3) slurred speech, OR (4) weakness of arms or legs, OR (5) unsteady walking.

WHEN TO CALL YOUR DOCTOR

Call 911 Now (your child may need an ambulance) If

• A seizure (convulsion) occurred.
• Knocked unconscious for more than 1 minute.
• Not moving neck normally (caution: protect the neck from any movement).
• Difficult to awaken.
• Confused thinking, slurred speech, unsteady walking OR weakness of arms/legs present now.
• Major bleeding that can't be stopped.

Call Your Doctor Now (night or day) If

• You think your child has a serious injury.
• Age under 1 year old.
• Neck pain.  
• Knocked unconscious for less than 1 minute.  
• Had confused thinking, slurred speech, unsteady walking OR weakness of arms/legs BUT fine now.
• Blurred vision persists for more than 5 minutes.
• 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.  
• Injury caused by high speed (e.g. auto accident), great height (e.g. twice the child's height) or blow from hard object (eg. golf club).
• Vomited 2 or more times since injury.
• Watery fluid dripping from the nose or ear while child not crying.
• Severe headache or crying.
• Can't remember what happened.

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

• You think your child needs to be seen.
• Headache persists over 3 days.

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns.

Parent Care at Home If

• Minor head injury and you don't think your child needs to be seen

HOME CARE ADVICE FOR SCALP INJURIES

1. Wound Care:  If there is a scrape or cut, wash it off with soap and water. Then apply pressure with a sterile gauze for 10 minutes to stop any bleeding.
2. Local Cold:   Apply a cold pack or ice bag wrapped in a wet cloth to any swelling for 20 minutes. (Big lumps are common)
3. Observation:  Observe your child closely during the first 2 hours following the injury.
   • Encourage your child to 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.
   • Awaken after 2 hours of sleeping to check the ability to walk and talk.
4. Diet:  Offer only clear fluids to drink, in case he vomits.  Regular diet OK after 2 hours.
5. Avoid Pain Medicines:  If the headache is that bad, he needs to be examined.
6. Special Precautions at Night:
   • Awaken your child at your bedtime and again 4 hours later for 2 nights. Check the ability to walk and talk.
   • Sleep in same room as your child for 2 nights.
   • After 48 hours, return to a normal routine.
7. Expected Course:  Most head impact only causes a scalp injury.  The swelling may take a week to resolve.  The local headache at the site of impact usually clears in 2 to 3 days.
8. Call Your Doctor If:
   • Pain becomes severe
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

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