Head Injury

DEFINITION

• Injuries to the head

• SCALP INJURY: Most head injuries only damage the scalp (a cut, scrape, bruise or swelling).  It is common for children to fall and hit their head at some point while growing up.  This is especially common when a child is learning to walk. Big lumps (bruises) can occur with minor injuries because there is a large blood supply to the scalp.  For the same reason, small cuts on the head may bleed a lot.  Bruises on the forehead sometimes cause black eyes 1 to 3 days later because the blood spreads downward by gravity. 
• SKULL FRACTURE: Only 1% to 2% of children with head injuries will get a skull fracture.  Usually there are no other symptoms except for a headache at the site where the head was hit.  Most skull fractures occur without any injury to the brain and they heal easily.
• CONCUSSION: A concussion is a mild injury to the brain that changes how the brain normally works.  It is usually caused by a sudden blow or jolt to the head.  Many children bump or hit their heads without causing a concussion.  The most common signs of a concussion are a brief period of confusion or memory loss following the injury. Other signs of a concussion can include a headache, vomiting, dizziness, acting dazed, or being knocked out.  A person does NOT need to be knocked out (lose consciousness) to have had a concussion. Following a concussion, some children have ongoing symptoms such as mild headaches, dizziness, thinking difficulties, school problems or emotional changes for several days to weeks. 
• BRAIN INJURIES are rare but are recognized by the presence of the following symptoms:
  (1) Difficult to awaken, or keep awake OR (2) confused thinking and talking, OR (3) slurred speech, OR (4) weakness of arms or legs OR (5) unsteady walking.

WHEN TO CALL YOUR DOCTOR

HOME CARE ADVICE FOR SCALP INJURIES

1. Wound Care: If there is a scrape or cut, wash it off with soap and water.Then apply pressure with a sterile gauze for 10 minutes to stop any bleeding.
2. Local Cold: Apply a cold pack or ice bag wrapped in a wet cloth to any swelling for 20 minutes. (Big lumps are common).
3. Observation:  Observe your child closely during the first 2 hours following the injury.
   • Encourage your child to 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.
   • Awaken after 2 hours of sleeping to check the ability to walk and talk.
4. Diet: Offer only clear fluids to drink, in case he vomits. Regular diet OK after 2 hours.
5. Avoid Pain Medicines: If the headache is that bad, he needs to be examined.
6. Special Precautions at Night:
   • Awaken your child at your bedtime and again 4 hours later for 2 nights. Check the ability to walk and talk.
   • Sleep in same room as your child for 2 nights.
   • After 48 hours, return to a normal routine.
7. Expected Course: Most head impact only causes a scalp injury. The swelling may take a week to resolve. The local headache at the site of impact usually clears in 2 to 3 days.
8. Call Your Doctor If:
   • Pain becomes severe
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.