Head Injuries

Head injuries fall into two categories: external (usually scalp) injuries and internal head injuries, which may involve the skull, the blood vessels within the skull, or the brain.

Fortunately, most childhood falls or blows to the head result in injury to the scalp only, which is usually more frightening than threatening. An internal head injury could have more serious implications because the skull serves as the protective helmet for the delicate brain.

External (Scalp) Injury

The scalp is rich with blood vessels, so even a minor cut to the scalp can bleed profusely. The "goose egg" or swelling that may appear on the scalp after a head blow results from the scalp's veins leaking fluid or blood into (and under) the scalp. It may take days or even weeks to disappear.

What to look for and what to do:

• Call your child's doctor if your child is an infant or has lost consciousness, even momentarily, or if your child of any age does any of the following:
  • won't stop crying
  • complains of head and neck pain
  • becomes difficult to console
  • isn't walking normally

• If your child is not an infant, has not lost consciousness, and is alert and behaving normally after the fall or blow:
  • Apply an ice pack or instant cold pack to the injured area for 20 minutes. If you use ice, always wrap it in a washcloth or sock; ice applied directly to bare skin can cause frostbite damage.
  • Observe your child carefully for the next 24 hours. If he or she shows any of the signs of internal injury (see below), call your child's doctor immediately.
  • If the incident has occurred close to bedtime or naptime and your child falls asleep soon afterward, check him or her every few hours for twitching limbs or disturbances in color or breathing.
• If color and breathing are normal, and you observe or sense no other abnormalities, let your child sleep (unless your child's doctor has advised otherwise). There's no need to keep a child awake after a head injury.
• If color and/or breathing are abnormal, or if you aren't comfortable with your child's appearance (trust your instincts), arouse your child partially by sitting him or her up. Your child should fuss a bit and attempt to resettle. If he or she doesn't protest, try to awaken your child fully. If your child can't be awakened or shows any signs of internal injury (see below), call your child's doctor or an ambulance.

Suspected Internal Injury

The brain is cushioned by cerebrospinal fluid, but a severe blow to the head may knock the brain into the side of the skull or tear blood vessels. Any internal head injury - fractured skull, torn blood vessels, or damage to the brain itself - can be serious and possibly life threatening.

There are different levels of injury that require different levels of concern. It can be difficult to determine the level of injury, so it's always wise to discuss a head injury with your child's doctor. A clear indicator of a more serious injury is when your child loses consciousness or has signs of confusion.

What to look for and what to do:

Call an ambulance if your child shows any of the following symptoms: