Ouch! Head Injuries... When to Worry

“Sandy, we have a situation,” my nanny said in a panicky voice over the phone.  I was at work when I received this call and felt instant fear when I heard her dreaded words. 

“What’s wrong?” I asked, trying to remain calm.  My mind was racing through many horrific scenarios.  What could have happened to my kids?  Were they okay?  Why was she calling?

As it turned out, my oldest son had been climbing up on a structure in our basement and had fallen off of it landing headfirst onto a toy with a sharp edge.  He had cut his head on top pretty badly. The cut had been bleeding a lot and was scaring him and my nanny.  The good news was that he was alert, could talk and remembered what had happened. 

My nanny had done the right thing.  She applied pressure to the wound with a clean towel.  But it took a long time to stop bleeding.  She didn’t know that the scalp is rich with blood vessels.  A cut on the scalp can really bleed impressively.

Because he was alert, acting normally, wasn’t vomiting, and wasn’t bleeding anymore, I asked her to bring him to my office.  He ended up needing seven staples (like metal stitches) for a good-sized laceration on his scalp.  As a kid with a high pain tolerance, he was very calm through the whole procedure.  He was even reading a book when Dr. Dakin was putting the staples in!



Even I was impressed with his tolerance and patience with the whole procedure.  Nonetheless, I think (hope) he learned that climbing up on things in the basement and hanging over the top of them headfirst is generally a bad idea.

Head injuries can be very frightening.  With active children, they are extremely common though.  The horrible sound of your child’s head hitting a surface from a fall is one of the worst in the world.  Most parents can remember those moments quite clearly. 

So, what do you do and when should you worry?

At any age, if your child loses consciousness, is having seizures, or has significant injury/bleeding, call 911 immediately.

If your child seems very drowsy, has multiple episodes of vomiting, or is acting strangely, go to your nearest emergency room.

If your child appears alert, cried immediately at the time of injury, is not vomiting, and is behaving normally, it is reasonable to watch your child closely.  If your child is under age two, call your doctor for guidance.  If you are worried or there is a change in your child’s behavior, you should call your child’s doctor. 

For most minor head injuries without open wounds, you should put ice on the area that was hurt to help reduce swelling. Watch your child closely for the first 24-48 hrs after the head injury.  Avoid giving Tylenol or Motrin so that you don’t mask any symptoms.  You should wake your child at least once that night to make sure that he/she is okay.  Avoid contact sports or any activities that could result in another head injury until your child is completely symptom-free.  If the head injury occurred while playing sports, consult your team doctor or your child’s doctor for when it is safe to return to play.

Symptoms to call your child’s doctor about:
1. Any behavioral changes or changes in alertness
2. More than one episode of vomiting
3. Persistent or severe headache
4. Weakness or loss of strength

Bleeding inside the head is the main worry after a head injury.  Bleeding or swelling inside the head usually takes place during the first 24-48 hours after an injury and can cause life-threatening pressure on the brain.  This pressure results in headaches, irritability, recurrent vomiting, vision/pupil changes, and changes in alertness. 

Most people will check their child’s pupils to see if they are the same size.  While it is fine to do this, unequal pupils usually show up only after there is quite a bit of pressure from an internal brain bleed.  Just because the pupils are the same size early on, it does not mean that all is well. 

Watch for other signs such as the ones mentioned above.  While internal bleeding is rare from mild head injuries, you should watch your child carefully for signs and symptoms. 

My son’s cut has almost completely healed.  He has impressed many of his friends with his staples.  His 3-year old brother has already asked for staples for his boo-boo’s.  Hopefully, I have convinced him that staples are not for all boo-boo’s. (Not to mention that I have put all household staplers high out of reach just in case anyone gets any ideas!)  Kids... always an adventure...