Head Injury
By Dr. Brown
When a child hits his head there are many things to consider. Fortunately, most children do fine with just external sings of trauma. When should you be worried? Should you just observe or go to the Emergency Room? Are there cuts that may need stitches or taping to be closed? Did the child black out? This is called Loss of Consciousness. If so, how long was the child out? How is the child acting afterwards? Is their speech or coordination affected? The mechanism of injury is very important to know.
Lacerations:
Cuts can be superficial or deep. The superficial ones are called abrasions, and do not need stitches. Bleeding control will consist of pressure for 5-10 minutes. Deeper cuts may need to be closed for two reasons: bleeding control and/or cosmetic reasons. So, if the cut is on an elbow and is the same length as one on the child’s face, we may do much less for the elbow cut but may even consider having a Plastic Surgeon repair the facial cut. Location is therefore important. Scalp wounds may be superficial and yet bleed intensively due to the rich blood supply.
Loss of consciousness:
"Blacking out" can happen with head injuries. Some episodes are relatively trivial while sometimes there can be injury to the brain or a brain bleed leading to death. Serious head injuries are rare however and mechanism of injury is helpful in understanding what needs to happen next and how quickly.
Observation:
After any injury to the head, observation of the patient is important. Is the person acting usually? Do they know where they are and what happened? How is their recall of names of people in your family or teacher’s names. This can help to determine that they may have sustained a significant injury that may need observation in the hospital. These pieces of information are tough to tell with an infant or young toddler.
Assessment:
If the patient did not lose consciousness and there are no cuts that need stitching and the patient is acting normally there is usually not much to do. They can sleep as usual, eat as usual and there is generally no need to get x-rays of the head or go to the emergency room. They do not need to have their pupils checked for hours afterward or other tests done. If parental observation notes new or changing behavior this warrants a call to us.
It's very important to continue to observe the patient for the next 4-6 hours for any peculiar symptoms.
Reasons for Concern:
Bleeding that does not stop easily in a few minutes from a cut.
Cuts to the face where a scar may be unacceptable.
Any loss of consciousness, even less than a few seconds.
Odd behavior for the person.
Vomiting more than once. This may be a sign of increasing pressure in the head leading quickly to coma and perhaps death. Having said that, many people vomit once in the short period of time after a head injury and will be completely fine.
Other Injuries. Are there other injuries? Can the person move their arms and legs?
Sports injuries. Loss of consciousness during a game happens occasionally. Duration of loss of consciousness is important to know. How long was it until the patient was back to normal behavior? How long did the headache last? Often the recommendation for when to return to sports is dependent on these answers. Call us to discuss during regular hours.
Please also see the section on CONCUSSION on our website for additional info.
If any of these areas are of concern, please call us at the office for our recommendation as to what to do next.
When a child hits his head there are many things to consider. Fortunately, most children do fine with just external sings of trauma. When should you be worried? Should you just observe or go to the Emergency Room? Are there cuts that may need stitches or taping to be closed? Did the child black out? This is called Loss of Consciousness. If so, how long was the child out? How is the child acting afterwards? Is their speech or coordination affected? The mechanism of injury is very important to know.
Lacerations:
Cuts can be superficial or deep. The superficial ones are called abrasions, and do not need stitches. Bleeding control will consist of pressure for 5-10 minutes. Deeper cuts may need to be closed for two reasons: bleeding control and/or cosmetic reasons. So, if the cut is on an elbow and is the same length as one on the child’s face, we may do much less for the elbow cut but may even consider having a Plastic Surgeon repair the facial cut. Location is therefore important. Scalp wounds may be superficial and yet bleed intensively due to the rich blood supply.
Loss of consciousness:
"Blacking out" can happen with head injuries. Some episodes are relatively trivial while sometimes there can be injury to the brain or a brain bleed leading to death. Serious head injuries are rare however and mechanism of injury is helpful in understanding what needs to happen next and how quickly.
Observation:
After any injury to the head, observation of the patient is important. Is the person acting usually? Do they know where they are and what happened? How is their recall of names of people in your family or teacher’s names. This can help to determine that they may have sustained a significant injury that may need observation in the hospital. These pieces of information are tough to tell with an infant or young toddler.
Assessment:
If the patient did not lose consciousness and there are no cuts that need stitching and the patient is acting normally there is usually not much to do. They can sleep as usual, eat as usual and there is generally no need to get x-rays of the head or go to the emergency room. They do not need to have their pupils checked for hours afterward or other tests done. If parental observation notes new or changing behavior this warrants a call to us.
It's very important to continue to observe the patient for the next 4-6 hours for any peculiar symptoms.
Reasons for Concern:
Bleeding that does not stop easily in a few minutes from a cut.
Cuts to the face where a scar may be unacceptable.
Any loss of consciousness, even less than a few seconds.
Odd behavior for the person.
Vomiting more than once. This may be a sign of increasing pressure in the head leading quickly to coma and perhaps death. Having said that, many people vomit once in the short period of time after a head injury and will be completely fine.
Other Injuries. Are there other injuries? Can the person move their arms and legs?
Sports injuries. Loss of consciousness during a game happens occasionally. Duration of loss of consciousness is important to know. How long was it until the patient was back to normal behavior? How long did the headache last? Often the recommendation for when to return to sports is dependent on these answers. Call us to discuss during regular hours.
Please also see the section on CONCUSSION on our website for additional info.
If any of these areas are of concern, please call us at the office for our recommendation as to what to do next.