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 or double 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

Remember! Contact your doctor if you or your child develop any "Contact Your Doctor" symptoms.

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.

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.

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.