Definition

• History of a blow to the head
• Scalp trauma (cut, scrape, bruise, or swelling)

Cause

Every child sooner or later strikes his head. Falls are especially common when your child is learning to walk. Most bruises occur on the forehead. Sometimes black eyes appear 3 days later because the bruising spreads downward by gravity.

Expected Course

Most head trauma simply results in a scalp injury. Big lumps can occur with minor injuries because the blood supply to the scalp is so plentiful. For the same reason small cuts here can bleed profusely. Only 1% to 2% of injured children get a skull fracture. Usually there are no associated symptoms except for a headache at the site of impact. Your child has not had a concussion unless there is temporary unconsciousness, confusion, and amnesia.

Home Care

Wound Care

If there is a scrape, wash it off with soap and water. Then apply pressure with a clean cloth (sterile gauze if you have it) for 10 minutes to stop any bleeding. For swelling, apply ice for 20 minutes.

Rest

Encourage your child to lie down and rest until all symptoms are gone (or at least 2 hours). Your child can be allowed to sleep; you don’t have to try to keep him awake. Just have him sleep nearby so you can periodically check on him. Don’t give any pain medicine. If the headache is bad enough to need acetaminophen, your child probably should be checked by a physician.

Diet

Only give clear fluids (ones you can see through) until your child has gone 2 hours without vomiting. Vomiting is common after head injuries, and there is no need to have him vomit up his dinner.

Pain Medicines

Don’t give any pain medicine. If the headache is bad enough to require acetaminophen or aspirin, your child should be checked by a physician.

Special Precautions and Awakening

Although your child is probably fine, close observation for 48 hours will ensure that no serious complication is missed.

• Awakening your child twice during the night: Do this once at your bedtime and once 4 hours later. Awakening him every hour is unnecessary and next to impossible. Arouse him until he is walking and talking normally. Do this for two nights. Sleep in his room or have him sleep in your room for those two nights. If his breathing becomes abnormal or his sleep is otherwise unusual, awaken him to be sure a coma is not developing. After two nights, return to a normal sleep routine.

Call Our Office Immediately if

• The headache becomes severe
• Vomiting occurs three or more times
• Vision becomes blurred or double
• Your child becomes difficult to awaken or confused
• Walking or talking becomes difficult.
• Your child’s neurological condition worsens in any other way