Head injuries fall into two categories:

1. external (usually scalp) injuries
2. internal head injuries, which may involve the skull, the blood vessels within the skull, or the brain

Fortunately, most childhood falls or blows to the head result in injury to the scalp only, which is usually more frightening than threatening. An internal head injury could have more serious implications because it may result in bleeding or bruising of the brain.

External (Scalp) Injuries

The scalp is rich with blood vessels, so even a minor cut there can bleed profusely. The "goose egg" or swelling that may appear after a head blow is the result of the scalp's veins leaking fluid or blood into (and under) the scalp. It may take days or even a week to disappear.

What to look for and what to do:

• Call the doctor if your child is an infant; has lost consciousness, even momentarily; or if a child of any age has any of these symptoms:
  • won't stop crying
  • complains of head and neck pain
  • vomits repeatedly
  • difficult to awaken
  • becomes difficult to console
  • isn't walking normally
• If your child is not an infant, has not lost consciousness, and is alert and behaving normally after the fall or blow:
  • Apply an ice pack or instant cold pack to the injured area for 20 minutes every 3 to 4 hours. If you use ice, always wrap it in a washcloth or sock; ice applied directly to bare skin can cause cold injury to the skin.
  • Observe your child carefully for the next 24 hours. If you notice any of the signs of internal injury (see below), call your doctor immediately.
  • If the incident has occurred close to bedtime or naptime and your child falls asleep soon afterward, check in once or twice to also check for disturbances in color or breathing.
• If color and breathing are normal, and you observe or sense no other abnormalities, let your child sleep (unless the doctor has advised otherwise). There's no need to keep a child awake after a head injury.
• If you aren't comfortable with your child's appearance (trust your instincts), rouse your child partially by sitting him or her up. Your child should fuss a bit and attempt to resettle. If he or she doesn't protest, try to awaken your child fully. If your child can't be awakened or shows any signs of internal injury (see below), call the doctor or an ambulance.

Suspected Internal Injury

The brain is cushioned by cerebrospinal fluid, but a severe blow to the head may knock the brain into the side of the skull or tear blood vessels. Some internal head injuries — complications of a fractured skull, torn blood vessels, or damage to the brain itself — can be serious and possibly life threatening.

Different levels of injury require different levels of concern. It can be difficult to determine the level of injury, so it's always wise to discuss a head injury with your doctor.

What to Look for and What to Do

Call 911 if your child shows any of these symptoms after a head injury:

• unconsciousness for more than a few minutes
• abnormal breathing
• obvious serious wound
• bleeding or clear fluid from the nose, ear, or mouth
• disturbance of speech or vision
• pupils of unequal size
• weakness or paralysis
• neck pain or stiffness
• seizure

If your child is unconscious:

• Do not try to move your child in case there is a neck or spine injury.
• Call for help.
• Turn a child who is vomiting or having a seizure onto his or her side while trying to keep the head and neck straight. This will help prevent choking and provide protection in case of neck and spine injury.

If your child is conscious:

• Do your best to keep your child calm and still.
• If there's bleeding, apply a clean or sterile bandage.
• Do not attempt to cleanse the wound, which may aggravate bleeding and/or cause serious complications if the skull is fractured.
• Do not apply direct pressure to the wound if you suspect the skull is fractured.
• Do not remove any object that's stuck in the wound.

Concussions

Concussions are also a type of internal head injury. A concussion is the temporary loss of normal brain function due to an injury. Repeated concussions can result in permanent injury to the brain. However, it's possible to get a concussion that's mild and doesn't result in long-term damage.

One of the most common reasons kids get concussions is through sports, so make sure yours wear appropriate protective gear and don't let them continue to play if they've had a head injury.

If your child sustains an injury to the head, watch for these signs of a possible concussion:

• "seeing stars" and feeling dazed, dizzy, or lightheaded
• memory loss, such as trouble remembering what happened right before and after the injury
• vomiting
• headaches
• blurred vision and sensitivity to light
• slurred speech or saying things that don't make sense
• difficulty concentrating, thinking, or making decisions
• difficulty with coordination or balance (such as being unable to catch a ball or other easy tasks)
• feeling anxious or irritable for no apparent reason

If you suspect a concussion, call your doctor for further instructions.

Preventing Head Injuries

It's impossible to prevent kids from ever being injured, but there are ways to help prevent head blows.

Make sure that:

• your home is childproofed to prevent household accidents
• your kids always wear appropriate headgear and safety equipment when biking, in-line skating, skateboarding, snowboarding or skiing, and playing contact sports. Wearing an appropriately fitting bike helmet, for instance, reduces the risk of head injury by about 85%.
• kids always use a seatbelt or child safety seat
• your child takes it easy after a head injury, especially if there is a concussion
• your child doesn't go back to rough play or playing sports until the doctor gives approval. (If your child reinjures the brain while it's still healing, it will take even more time to completely heal.)

Reviewed by: Kate M. Cronan, MD
Date reviewed: January 2011