Head Bumps and Bruises: When to Worry About Head Injuries

Sit and watch children at play and you will quickly learn one thing: children are constantly hitting their heads! If your child hits his or her head, how do you know when it is serious enough to seek medical care and when you can relax and stay home?

As one of the St. Louis Children’s Hospital Pediatric Hospitalists, should you come to the emergency room at Missouri Baptist or Progress West Health Center, either I or one of my partners is likely to be your “official greeting party” there to calm your child and hopefully calm your worries by evaluating and caring for your child after a head injury.

But, how do you answer the line to that classic song, “Should I stay or should I go?” Hopefully with a little bit of information and a few tips, you will feel more equipped to do just that!

Every year millions of people have head injuries. The Center for disease Control and Prevention estimates that there are more than 435,000 visits to the emergency room each year for evaluation of head injury in children. Most of these injuries are minor because the skull and cerebrospinal fluid surrounding the brain provide considerable protection for the brain. However, more than half a million head injuries a year are severe enough to require hospitalization. Most of these are due to major head trauma such as high speed impacts from car and bike accidents, falls from great heights or gun shots.

Fortunately, serious injury to the brain from minor head trauma is very rare and most bumps to the head are safe. Symptoms of minor head injuries like bruises or mild headaches go away on their own.

Scalp Injuries

Before we talk about symptoms of serious head injury, let’s talk briefly about injuries to the scalp or external head injuries. Injuries to the scalp often look very scary. The scalp is rich in blood vessels and tightly adherent to the skull, so even minor injuries can bleed a great deal. The common “goose egg” children get after hitting their heads is the result of blood and fluid leaking into the scalp. While “goose eggs” and bleeding can look frightening, if the cut is small and bleeding stops with pressure after 5-10 minutes or the “goose egg” is not accompanied by neurologic changes noted below, you  do not need to seek immediate care. Call your doctor if in doubt.

When to Worry

Now let’s go over worries about the inside of the head. How do you know when to worry and when you can relax and observe at home? Here are some tips:

Seek Immediate Medical Attention if: Worry less if:
Your child losses consciousness or appears confused or drowsy. He does not lose consciousness or has a less than 5 second appearance of being stunned
Eye changes including: changes in pupil size, blurry or double vision, or eyes not moving correctly (one or both eyes do not move appropriately when the child look up down, or to the side Pupils appear normal, eyes move normally and your child doesn’t complain of visual difficulty (double vision, blurred vision, inability to see fully out of one or both eyes)
Weakness on inability to move one or both arms or legs, walks with difficulty or clumsiness Wants to play shortly after injury, no weakness or changes in gait or coordination
Severe headache Mild headache or only complains of headache when you ask
Vomiting more than twice or late onset vomiting Vomiting once or vomiting than begins 3 or more days after the head injury
Clear fluid or blood draining from the nose or ears, constant slow drip of fluid from the nose Runny nose associated with crying, resolves once crying subsides
Bleeding from the scalp that won’t stop Bleeding that stops after 5 to 10 minutes of pressure and a cut less than one centimeter.
Crying that lasts more than an hour, irritability or restlessness Child is able to be consoled, calmed and easily distracted. It is okay if your child wants to be held and or is less active much like when he or she has a minor cold
Something about child just doesn’t seem right Your child is interested in playing, talking and acting just as he or she did before the fall

In addition, seek immediate care if any of the following are present:

  • Convulsions
  • Changes in speech: slurred words or inability to come up with the right words
  • Changes in hearing, smell or taste
  • Breathing that becomes slow or very shallow
  • Neck pain
  • Changes in level of consciousness (from alert to very sleepy or confused)

Different levels of injury require different levels of concern. It can be difficult to determine the level of injury, so if in doubt, discuss the head injury with your doctor.

If your child is not an infant, has not lost consciousness and is alert and behaving normally after a fall or blow to the head:

  1. Apply an ice pack to the injured area. Be careful to cover the pack with cloth to avoid cold injury (frostbite) to the skin
  2. Watch your child carefully for the next 24 hours. If any symptoms described below occur, contact your doctor immediately.
  3. It is okay to let your child sleep if he or she is acting appropriately after an injury. Check on your child every 2 or 3 hours during nap or bed time. Does your child’s color and breathing appear normal? Is their anything else about the child’s appearance that worries you? If you aren’t comfortable with your child’s appearance, arouse your child partially by sitting him or her up. Your child should respond by attempting to resettle or being a bit fussy. If your child doesn’t arouse or responds abnormally, wake him or her up fully and check pupils, arm and leg strength and level of consciousness as described below.

Remember that, if a child begins to run or play immediately after a bump on the head, serious injury is unlikely.

Prevention

While many minor head injuries are not preventable, most major head trauma and some minor head trauma is preventable. Follow these steps to protect your child and yourself from head injury:

  • Always use appropriate safety equipment. Use helmets for biking, skating, skiing, snow boarding, skate boarding, horse back riding and contact sports. Stick to strict rules with your kids on this. “No helmet, no bike.” In other words, if they are found doing an activity that requires a helmet and they don’t have one on, they lose the bike or skateboard for an extended period of time. Lead by example, kids won’t feel helmets are important if the adults in their life are not wearing them.
  • Wear seatbelts and use the appropriate car seat for your child.  Studies show greater than 80% of car seats are installed incorrectly.
  • Complete a home safety check and make changes as needed: cover sharp corners on furniture and fireplaces, when purchasing furniture consider round tables or furniture with rounded corners. Avoid purchasing furniture with glass. Anchor high bookshelves and TVs to the wall.
  • Don’t allow children to operate motorized vehicles like ATVs. Their inexperience and lack of coordination leave them at great risk when combined with speed.
  • Wear light reflective clothing when biking or being active outside after dark.
Kelly Ross, M.D. About Kelly Ross, M.D.

Kelly L. Ross, MD is an assistant professor in the Department of Newborn Medicine at Washington University School of Medicine in St. Louis and a pediatric hospitalist at St. Louis Children’s Hospital. She also serves as Director of Pediatric Hospitalist Medicine at Missouri Baptist Medical Center. As mother of premature triplets, Dr. Ross’ clinical interests include multiple birth, neonatal prematurity especially the late preterm infant and post partum depression, especially as it relates to high risk pregnancies. She is the Medical Director of Mothers of Supertwins (MOST), an international organization that exists to support families who have triplets, quadruplets or more. Dr. Ross is also a member of the MOST professional advisory board. She has co-developed two educational videos about multiple birth families, has been featured in a TLC documentary about a family of quintuplets, interviewed by Newsweek, Pregnancy magazine and various other local news programs and is currently editing a book for couples expecting triplets or more. Dr. Ross is featured on a monthly email from Babycenter.com and along with her hospitalist group, runs a health information discussion group on momslikeme.com. Dr. Ross served as a consultant on a National Institute of Mental Health-funded grant to educate medical professionals about post partum depression.

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Comments

  1. Doesn't Matter says:

    9-10 months ago I wrecked my bike without a helmet. At the time my parents were concerned because there was a huge knot on my head, and I could barely walk/talk any of that for about 20 minutes. At the hospital they told me I had a concussion and to stay off my bike, and not do any sports for 2 weeks, then to make sure to be careful for 6 weeks. Anyway, I went through all the scans they did, and they told me the knot was a pump knot, and it should go away soon. 2 weeks later it was still there and I went back for a check-up and they told me it was fine, and to just give it time. Well here I am 10 months later and I still have a noticeable sized pump knot on my head. When will it go away?

  2. Jackie Ferman says:

    Great question, thanks for posting it!
    Dr. Ross says she hasn’t heard the term “pump knot” but very frequently the bump or knot left on your scalp after you hit your head does take a long time to fully resolve (go away). Without actually seeing your head, she can’t address your specific concerns and would suggest talking to your doctor in person or by phone.
    Dr. Ross does tell me most of the time, the raised area is due to bleeding that occurs under the skin. That blood forms a clot made up of blood products and scar tissue. The body normally slowly absorbs that clot and the bump goes away. This can take many months. Sometimes the scar tissue never fully goes away and a bump remains. This is not dangerous but sometimes the appearance of the bump is bothersome. A plastic surgeon can improve the look but this procedure is normally just to make the area look better and thus is not covered by insurance.

  3. my baby is 2.5yrs old around a month before he had a fall and there was a bump.He did cry ,and didn’t allow me to put an ice pack he later went to sleep. I find his activities to be normal but still there is bump on his head and sometimes he says purple colour to be black and yellow to be blue.
    Please let me know what must I do

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  5. you know, these things are terrible! Two out of my three sweet boys has had one after age two and before age four. And they swell up so darn fast and are such a yucky color your heart skips and you are in panic mode…. It looks so much worse than it actually is, and I know this, but I can’t accept it. And little ones always seem to get them by running right into the corner of a bloody wall. It is something I will never be able to get used to.

  6. I hit my head yesterday on a cabinet. I did not pass out and was stunned for about a moment. There was no server dizziness or nausea that occurred. The bump was small and it is going down. The bump is right on the edge of my hair line and has a small red line that is on the top. I have slept one night and woke up with no issues. The only thing is that my bump is very sensitive to the touch. I have no major head aches or even mild ones. Just the pain of touching the bump and the discomfort afterwards. I know it sounds like I am answering my own question of “is there something wrong” but, you read so much online about the rare cases that I do get a bit nervous. Do you think there is anything to really worry about?

  7. Michael Floyd says:

    our granddaughter has suffered abuse while in her mothers custody. doctors seem to avoid answering the question, and it seems one of liability.

    the mother receives the child and gives bath in morning and not a mark on the baby, no claim of anything wrong.

    the mother and step grandmother have stated that during the second bath of the day at supper time, they noticed multiple goose eggs on the top of the head and along the front hairline. they claim they are skin colored.

    when we pick the baby(18 months) up roughly 36 hours after the suppertime bath. all the goose eggs have turned to bruises, and their are 2 black eyes. Medical professions claim they cannot give any time frame on the bruises, not even by coloring.

    when we picked her up, we immediately took her to the hospital which was roughly 45 mins. the mother is claiming that the black eye was received sometime after we picked her up and there were 2 of us picking up the baby to protect ourselves……

    any time frames i can use…….this one of four events……please give me info or send me to the right spot

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