Head Injury
Head injuries are very common, and in considering how serious one might be, there are several factors that we need to consider. Most bumps, swellings, and bruises are outside the skull and are not indicative of what is going on inside the skull. Someone with an awful looking bump and bruise on the forehead may have absolutely no risk to the brain, while someone with minimal bumps and bruises could be hours away from grave danger. Below are key points to consider.
1. Any fall or head injury in a newborn should be seen immediately. This age group is at much higher risk for bleeds in the brain than older infants and children.
2. The mechanism of injury is important. A fall off a couch (a newborn being the exception) or bumping into a doorknob is unlikely to lead to a serious brain injury, no matter how bad the swelling and bruise. A fall from a balcony, a head injury in a car accident, a baseball pitch or line drive to the head, etc. involve much higher speeds of impact and should be seen immediately.
3. Any infant or child who loses consciousness from a head injury, even for a moment, should be seen immediately. If the child remains unconscious, call 911.
4. If your child is vomiting, he/she should be seen immediately.
5. If there is a progressive decrease in alertness, call 911. A way to distinguish this from just normal sleepiness at a late hour is to see if you can forcibly awaken your child and get him/her to respond appropriately to you. This can be done successfully with even the sleepiest of children, but a child with a bleed inside the skull may not respond. It's always a good idea to awaken your child every 2 to 3 hours after a head injury to make sure he/she is responsive.
6, Checking pupils can be helpful. If one pupil is larger than the other in a child who is losing alertness, call 911.
Of special note is the child athlete (e.g. football player) who takes a hard hit and remains woozy. If he/she lost consciousness at any point, an emergency room visit is warranted. As long as the athlete has any symptoms or signs of aconcussion (headache, dizziness, blank stare, can't remember the details of the injury, can't remember what you just told him/her 2 minutes ago, or nausea), he/she should not return to play. A second head impact could be deadly. The patient should be checked on every 2 to 3 hours, and if symptoms last more than 24 hours, the child should be seen.