Friday, March 19, 2010

How do I know if my child's head injury is serious?

This is a VERY common scenerio.

Toddler climbing on everything, parent turns back for a second and BOOM! toddler hits head on floor, table, chair. A goose egg immediately appears on forehead and parents get worried. Meanwhile, kid is running around like nothing happened. When my youngest daughter was 18 months old she climbed out of a shopping cart and landed on her head. I was loading groceries on the belt and saw it was about to happen and couldn't stop it in time.

Another scenerio is kid who is playing sports and gets hit in the head. They are dazed for a second but then feel fine and want to keep playing.

Do these patients need emergency care?

Let me start by saying that I took my 18 month old daughter to the ED when she fell out of the shopping cart. I knew she was ok but I needed someone else to tell me she was ok.

It is always ok to take your child to the emergency department if they hit their head and you are worried. But many times they really don't need to be there.

Toddlers whack their heads all the time. They will swell very fast because the skin on the skull is very tight and there is not a lot of room for a bruise to form. You can put ice on it but in most cases it will go down by itself pretty quickly.

Here is what we worry about:
  • Loss of consciousness
  • Persistent vomiting (not just she was crying so hard she threw up)
  • Lethargy
  • Severe headache
  • Inability to wake up
  • confusion
Most people will order a CT scan on a very small baby with a significant fall (we see falls out of carseats a lot) because these things are difficult to determine in a small baby.

But in an older child who does not have these symptoms observation is usually ok. Most people with serious head injuries start to have symptoms by about 4 hours after the injury. If they develop symptoms they will usually get a CT scan.

We recommend an adult stay with the injured child and wake them up once during the night to make sure they are easily arousable. If they are not then they need to return to the ED.

Kids with head injuries as a result of sports may need additional clearance before being allowed to return to sports. This depends on the individual school district's policies.

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