Head Injuries in Children: When to See a Doctor

No parent wants to think about their child having a head injury. The good news is that most bumps to the head are minor and can be treated at home. A proportion of them, though, require treatment by a medical professional

When to Go to the ER for a Head Injury

If there is any question about the severity of your child’s injury, take them to the nearest emergency department right away. The American Academy of Pediatrics (AAP) recommends seeking immediate medical care for head injury that is accompanied by the following symptoms:

• Balance problems
• Constant or worsening headache
• Difficulty recognizing familiar faces
• Extreme sleepiness or difficulty waking up
• Neck pain or problems moving their head and neck
• Numbness, weakness or tingling in the body
• Persistent or repeated dizziness
• Persistent ringing in the ears or loss of hearing
• Prolonged nausea or repeated vomiting
• Seizures
• Slurred speech
• Unusual paleness that lasts for more than an hour
• Vision changes
• Very irritable, confused or other abnormal behavior

These symptoms may be signs of a more serious head injury and may evolve over time. Monitor any child that has a head injury — even if minor — for the first 24 to 48 hours. When in doubt, seek medical care.

If your child is otherwise symptom free, you can ease their pain at home by:

• Applying a cold compress for up to 20 minutes
• Giving acetaminophen or ibuprofen
• Offering them water and quiet time

When Are Brain Imaging Tests Necessary?

If your child’s injury or symptoms are more severe, their provider may order brain imaging to check for skull fractures and internal bleeding.

Brain imaging tests, including CT scan and MRI, cannot be used to diagnose minor brain injuries or concussion. And because these tests come with some risk, most head injuries do not result in imaging.

CT scans use radiation, and unnecessary exposure may increase your child’s lifetime risk of cancer, according to the AAP. MRI does not use radiation, but it can take up to 30 minutes and the child must remain still for the entire test. That sometimes requires sedation, which has its own risks. Ultimately, your child’s provider will determine if these tests are necessary to diagnose your child’s injury.

Pediatric Concussion Symptoms

Some head injuries — even ones that seem minor — can lead to concussion, which is a mild traumatic brain injury caused by an impact. Symptoms of concussion include:

• Difficulty concentrating
• Dizziness
• Fatigue
• Feeling more emotional
• Nausea and vomiting

On average, it takes about a month to recover from concussion, though some children and teens will take longer.

Some studies have shown that children who sustain a concussion during sport and continue playing that day may have more severe or prolonged symptoms. It’s important to remove a child from play if they have a head injury.

While your child is recovering from concussion, they are at increased risk for re-injury if they return to contact sports or risky physical activity too early.

Return-to-Play Protocol

Since concussion increases a person’s risk of re-injury, returning to contact sports and risky physical activity should be taken seriously. The standard return-to-play protocol is that any athlete with a suspected concussion should not return to play until they see a doctor.

Your child should not go back into a game after a head injury. They also shouldn’t return to contact sports until their health is back to normal. Your child’s provider will help to guide them in this process.