Head Injury

When To Call

Call 911 Now

• Seizure occurred
• Knocked out (unconscious) for more than 1 minute
• Not moving neck normally. Caution: protect the neck from any movement.
• Hard to wake up
• Acts or talks confused or slurred speech present now
• Walking not steady or weakness of arms/legs present now
• Major bleeding that can't be stopped
• You think your child has a life-threatening emergency

Go to ER Now

• Mild concussion suspected (awake but not alert, not focused, slow to respond)
• Neck pain after head injury
• Had confused talking, slurred speech, unsteady walking or weakness of arms/legs but fine now
• Blurred vision lasted more than 5 minutes
• Injury caused by high speed (car crash)
• Vomited 2 or more times
• Severe headache or crying that won't stop
• Can't remember what happened or store new memories
• Large deep cut that will need many stitches

Call Doctor or Seek Care Now

• Age less than 1 year old
• Knocked out (unconscious) for less than 1 minute
• Skin is cut and No past tetanus shots. Note: tetanus is the "T" in DTaP, TdaP, or Td vaccines.
• 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
• Blow from hard object (such as a golf club)
• Fall from a dangerous height
• You think your child has a serious injury
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Headache lasts more than 24 hours
• Dirty cut or hard to clean and no tetanus shot in more than 5 years
• Clean cut and no tetanus shot in more than 10 years
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Minor head injury

Care Advice

What You Should Know About Mild Head Injuries:

• Most head injuries only cause a swelling or bruise to the scalp.
• The main symptom is pain.
• 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 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.
• The mildest brain injury is a concussion. Most of those also turn out fine.
• Here is some care advice that should help.

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.

Cold Pack For Swelling:

• 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.

Watch Your Child Closely for 2 Hours:

• 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.

Diet - Start With Clear Fluids:

• Offer only clear fluids to drink, in case he vomits.
• Allow a regular diet after 2 hours.
• Exception: babies can continue breastfeeding or formula.

Pain Medicine:

• To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed.
• Exception: do not give until 2 hours have passed from injury without any vomiting.
• Caution: never give aspirin to children and teens. Reason: always increases risk of bleeding.

Special Precautions For 1 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.

What to Expect:

• Most head trauma only causes a scalp injury.
• The deep headache usually clears in 24 hours.
• The scalp pain at the site of impact may last 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
• Headache lasts more than 24 hours
• You think your child needs to be seen
• Your child becomes worse

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Photos

Scalp laceration

This scalp laceration (cut) is gaping open. It will require closure with sutures or medical staples.

First Aid Care Advice:

• Apply direct pressure for 10 minutes to stop any bleeding.
• Wash the cut with soap and water.

Source: Self Care Decisions, LLC
Used with Permission from Schmitt Pediatric Guidelines LLC.

FIRST AID Advice - Bleeding Wound of the Head

• Apply direct pressure to the entire wound with a sterile gauze dressing or a clean cloth. Once the bleeding has stopped, cover with an adhesive bandage or gauze.

Source: Self Care Decisions, LLC
Used with Permission from Schmitt Pediatric Guidelines LLC.

Scalp Laceration (After Staples)

This photo shows a scalp laceration after it has been closed with 4 metal medical staples.

Source: Self Care Decisions, LLC
Used with Permission from Schmitt Pediatric Guidelines LLC.