Head Injuries and Children: When to Take Your Child to the Doctor

A head injury is a common childhood experience that can happen at any age – whether it’s the newly mobile baby rolling off the bed, the elementary school kid falling off the jungle gym, or the teenage athlete colliding with an opposing team member.

“Although your first instinct as a parent is to take your child to the doctor right away after a head injury, you may not need to,” says Cara Barone, M.D., pediatrician at the Palo Alto Medical Foundation.

“If your child was healthy before the head injury, doesn’t lose consciousness, doesn’t have cuts on the head or face, and acts normally afterward, it is probably just a bump on the head. In this situation, the most important thing you can do is carefully observe your child, and should you have concerns, don’t hesitate to follow your instincts and call your doctor.”

Mild Injuries

“It’s normal for a child to cry after a head injury – it hurts and they’re scared – but it shouldn’t last longer than 10 minutes,” Dr. Barone says. 

If your child is alert and responds to you, the head injury is likely mild and a trip to the doctor and tests are not necessary, she says. 

“To help soothe your child, you can apply a cold compress for 20 minutes to help the swelling go down,” Dr. Barone recommends. “For pain, you can give your child Tylenol (acetaminophen), but you should check with your child’s doctor before giving any other medication. You don’t want to mask pain or symptoms that suggest a serious head injury.” 

Dr. Barone says you can let your child go to sleep if it’s naptime or bedtime, but check on him every two to three hours to make sure everything is OK.

Baby Bumps on the Head

It’s exciting watching your child learn to walk but like any skill it requires practice. There will be falls and near misses, and occasionally there may also be some bumps on the head. Fortunately, most baby head bumps are mild. 

“If your daughter does fall and bump her head, but is alert and responds to you, watch her carefully for the next 36 to 48 hours to see if any symptoms develop that could indicate a head injury,” Dr. Barone says. 

Changes to watch for include inconsolable crying or fussiness, vomiting more than once, balancing difficulties when sitting or walking, and being unresponsive.

If your child is exhibiting any of these symptoms, or has any significant swelling over the site of the injury, you should take him to the doctor right away, she says.

Serious Injuries

Head injuries can cause changes in memory, judgment, balance, reaction time, speech and sleep. They can also cause headaches and more sensitivity to light and sound.

If your child loses consciousness or you are worried about your child, you should seek immediate medical attention, Dr. Barone advises.

The American Academy of Pediatrics also recommends taking your child to the doctor right away if he or she has any of the following:

• Unusual paleness that lasts for more than an hour
• Tingling on one side of the body
• Numbness or weakness of arms or legs
• Losing balance, stumbling or trouble walking
• Seizures
• Repeated dizziness or dizziness that doesn’t go away
• Nauseous or vomits more than two or three times
• Persistent ringing in the ears or loss of hearing
• Slurred speech
• Blurry vision, double vision or pupils of unequal size
• Difficulty recognizing familiar faces
• A constant headache, especially if it gets worse
• Extreme sleepiness or difficulty waking up
• Very irritable, confused or other abnormal behavior 

“These symptoms are signs of a more serious head injury, and they may happen hours later and, rarely, even days later,” Dr. Barone says. “That’s why watching your child closely for the first 24 to 48 hours after a head injury is important.” 

Certain accidents are also more likely to cause a serious head injury, she says, including a car accident, falling down a flights of stairs, falling off a bicycle without a helmet, falling from three or more feet off the ground, and higher level competitive contact sports.

CT Scans

According to AAP, CT scans are useful for injuries such as bleeding in the brain or skull fractures, but not helpful for the diagnosis of a concussion. For the majority of childhood head injuries, CT scans of children are not necessary. 

CT scans use radiation, and because children’s brains are still developing and their brain tissue is more sensitive, unnecessary exposure to X-rays may increase their lifetime risk of cancer, according to AAP. 

“A physician should only order a CT scan if he or she feels it is necessary to rule out a brain bleed or serious skull fracture,” Dr. Barone says. 

The doctor should examine your child and ask about specific symptoms, which is a much better indicator of how serious the head injury is and what treatment is best. 

AAP has more recommendations for children and CT scans, available in English or Spanish.

Concussions

Sometimes a head injury can lead to a concussion – a mild traumatic brain injury caused by an impact. Symptoms include dizziness, nausea, fatigue and forgetfulness, which can last anywhere from 15 minutes to a few weeks after the impact.

“Recovery time can vary greatly from one person to the next,” Dr. Barone says. “So it’s possible – although rare – to still experience symptoms of a head injury long after the accident occurred. Children’s and teenagers’ developing brains, in particular, can take at least seven to 10 days to return to normal after a head injury.”

If your child gets a concussion, it’s extremely important for her not to get back to being overly active too soon, Dr. Barone notes. “The best early treatment for concussion is rest from both physical and mental activity for a few days and then a gradual return to activities.”

Getting Back in the Game

All concussions are serious, and all athletes with suspected concussions should not return to play until they see a doctor.

“Your child should never go directly back into a game after she has experienced a head injury,” Dr. Barone says, “and she also shouldn’t return to sports until she is back to her baseline normal health before the injury.”

Usually, a child should have at least one week with no symptoms before going back to sports, and the return to sports should be gradual, according to AAP. Dr. Barone notes this process is best guided by your child’s physician.