Definition

• Injuries to the head
• Includes the scalp, skull and brain

Health Information

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 temporary change in how the brain works. 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, acting dazed, or being knocked out 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 mild headaches, dizziness or thinking difficulties. School problems or emotional changes can occur. These symptoms can last for several weeks.
• Brain Injuries are uncommon, but are an emergency.

Symptoms of a Brain Injury

• 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
• Any of these symptoms are an emergency. If they happen, call 911.

Symptoms of a Minor Head Injury

• The main symptom is pain.
• The scalp may bleed a little or develop a lump.

Prevention

• Careful adult supervision of young children
• Education of older children about high risk behaviors

Care Advice

1. Overview:
   • Most head injuries only cause a swelling or bruise to the scalp. The main symptom is pain where the head was injured.
   • 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.
   • 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 mildest brain injury is a concussion. Most of those also turn out fine.
   • Here is some care advice that should help.
2. 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.
3. Cold Pack:
   • 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.
4. Watch Your Child:
   • 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.
5. Diet:
   • Offer only clear fluids to drink, in case he vomits. Allow a regular diet after 2 hours.
   • Exception: Babies can continue breast feeding or formula.
6. Pain Medicine:
   • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
   • Exception: Do not give until 2 hours have passed from injury without any vomiting.
   • Never give aspirin to children and teens. Reason: increases risk of bleeding.
7. Special Precautions for One 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.
8. What to Expect:
   • Most head trauma only causes an injury to the scalp.
   • The headache at the site of impact gets better in 2 to 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
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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