Safety • Mar 29, 2010

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.


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.


  • Doesn’t Matter

    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?

  • Jackie Ferman

    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.

  • shivani

    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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  • Li

    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.

  • Dominique

    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?

  • Michael Floyd

    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

  • First off I want to say wonderful blog! I had a quick question
    which I’d like to ask if you don’t mind. Iwas curious to know
    how you center yourself and clear your head prio
    to writing. I have had a difficult time clearing my thoughts in getting my ideas out there.
    I do enjoy writimg but it just seems like the first 10 to 15 minutes are lost simply just trying to
    figure out hhow to begin. Any ideas or tips? Manny thanks!

  • joy

    i banged my head with i tap it was a bit painful for 5 mins then the pain disappeared . within 24 hours had mild headache for 2 hours then it was gone do you think i should see a doctor. or its just anxiety ?

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  • Seanese

    My son is 22 months old and he bumped his head almost a week ago playing with his sister. He did cry for about 2-5 minutes but he was so anxious to go back to playing but now he has a knot that hasnt gone down yet i mean it has some but its still a knot and its hard i been putting ice on it but of course he doesnt wont me to touch it but he doesnt complain about pain when i touch it

  • angela

    My grandson is 2.5yrs old. He has been getting bumps on his forehead since he started to walk. He seems to have this “perpetual” lump above his right eye. And everytime he gets hurt, whether he falls or bumps into something, it’s always in that spot. His behavior has changed – for the worse, and he is getting more out of control. Is it possible his behavior is related to this constant bruising on his forehead? How can I be certain? Should I take him to a neurologist?

  • curious

    My now 18m child fell off the couch, about 8 months ago and bumped his head on hardwood flooring. He had a nice goose eggon his forehead for a few weeks. But then about 3 months ago he bumped his head on the corner of the wall in the same spot. The lump is still visible, especially when he raises his eyebrows. He seems like a normal kid. He is developing quite well. But will the lump ever go away or is he “permanently scarred? “

  • Brenda

    my sister hit her head on the sink in May which cause a bump and swelling she had a brain scan which turned out fine
    Now this spot is swollen and sore do u think this may be what they call a pump knot

  • Devan

    Hi. My daughter who is 2 feel and got a pretty good size goose egg on the right side if her forehead. I was freaking out she cried less then 3 minutes her goose egg did not show up until I took her into the other room where i freaked out and her dad had to take her from me. No bleeding, she let me hold ice on and off for an hour. She was up watching cops with her dad as she calls it , “bad boys”. She was responding just fine also laughing abd being silly. I would say maybe a week after she was running at school wasn’t looking and ran into the pool. Mind you when she got her goose egg there was no bruise, after her incident with the pool it was a little green skin colored bruise. She is sleeping now and I notice i can fill a slight bump where her goose egg was a few weeks ago when the rest of her forehead is smooth. As a first time mother I don’t know if I should take her to urgent care? I am worried. I have pictures of her goose egg before and after icing for an hour.

  • Rob

    About 7hrs ago i was on the swing with my brother we were spinning around and then we hit eachother on the side of of our heads. We hit pretty hard. I have little pain right now, i just wanted to know if i should worry about it.

  • I hurt my head very badly and it’s time to go to bed a had a couple of concussions in just a year and I heard that it would be more easy to get another one much worse and I domt know if I should go to bed or not.?

  • Tonya

    My 2 yr fail of one of the toys at a play ground and hit a metal pole a few days ago and at first it was a big knot and with in an hour the knot went down should I be concerned because it went down so quickly …

  • Scared

    My brother hit his head and has a huge bump on his head and wants to go to the hospital. It looks bad but not like super bad. I am scared and so is he.

  • Aisling

    My 7 year old took a bad fall headfirst of her bike the noise of the bang is haunting she didnt cry afterwards she looked shocked there was blood on her forehead and coming from her nose im not sure if she hit her face aswell and that caused the nosebleed? Brought her to hospital she had paper stitches in her forehead and tests done on her eyes,blood pressure, reflexes,ect i asked about a cat scan but they said she didnt need one im so worried anyone any suggestions or advise tia

  • Lee Harding

    My 4yr old fell off his bike hit his head no bump but like red little dots in a circle, not sure if he was out or not ,said was OK cried, now 6hours later in bed was sick once should I take him to hospital

  • classified4926@gmail

    Can i see the pictures?

  • classified4926@gmail

    That’s exactly what I’d call a pump knot I don’t know about you Brenda! Hah

  • classified4926@gmail

    Dear Quincy please google
    I’m sure this is exactly what your looking for!

  • Breyanna Scott

    My daughter hit her head about two weeks ago and the bump is still on her forehead is that normal

  • Sierra Nichols

    My son hit is head a few minutes ago. He cried and what not and screamed. He is 7mo ths old. There is a goose egg on the side of his head right were there is an indentation where his skull bones aren’t fused together. He ate a bottle and dosed for five minutes. I got nervous and woke him . He is now playing in his walker but I am a first time mom and I worry about it being so close the sent.

  • Cerise

    Hi, how is your son? I’m looking for other experiences and outcomes. My 6 month old hit her head on our wood floor last night. The swelling has went down. However, it looks like there is an indentation on the left side of the skull. I was ready to take her to ER. Her Dad said just watch her behavior over night. What’s your experience?

  • Sierra Nichols

    He is fine. The dent in his skull was where the bones haven’t fused. Did she cry when it happened?

  • Cerise

    It’s good that your son is doing better. I’m sure that’s a big relief. Yes she did cry. The next day as well. She’s still her smiling happy self. But has cried hear and there. I’m off work now and taking her to be seen

  • Sierra Nichols

    I hope all goes well.

  • Cerise

    Thank you

  • Tony

    My 2yr old son was playing with the dog this morning outside my dad left the bed box spring on the wall and the baby was walking by and fell on him and hit him in the head he has a big soft lump in the injury and looks like it’s spreading.

  • Chad Thompson

    This is a ridiculous post. We’re only here because there’s been an incident and need some quick insight, NO ONE wants to read your prose or musing on Clash songs.

  • Paulo Cercado

    Hi! My son bumped his forehead in the a table’s edge about 6 months ago.what worries me is that the bruise is still visible (slightly purple).should i be worried?thanks!

  • Jennie Humphreys

    Some people may find it informative or helpful so if it wasn’t for u ok and move on don’t put it down and insult it. At least it’s was trying to help parents and be informative to ease some’ worries and or possibly prevent an unnecessary visits wasting your time and worry !

  • Jennie Humphreys

    My 3 month old son while balancing himself in a positioning setting up strengthening set wabbled back and hit the back of his head on it, and immediately let out a loud cry I pulled him out And soothed him to ok . But since then been worried. He’s only three months old and hit the back of his head on it ? Haven’t noticed anything out of ordinary ,other than he’s slept on and off a lot since this. He didn’t sleep much during day before other than small naps either so not sure if it’s anything to be alarmed over or if I should take him to be checked or not ?

  • Tania Ng

    Hi Tony,
    My son, 1 yr fell down too. Incidentally slipped by his own pee. His head now soft too. Same with your son experience. How long will the soft head turn to normal again? Did your son go for CT Scan? I am terrible worry now. He seems normal just like before.

  • Oddfella

    I believed you should get him check out since there a change in behavior it’s best to be safe since he so small.

  • Tikur Smith

    My 2yr old fell and hit his head too, but he is taking playing and all but he got a goose egg on the back of his head , he fellow again on that same spot and now I’m worried even though I wasn’t before,it is big and soft, I’m using ice but he is screening whenever I use there any other solutions for it??

  • Tasha Benson

    You’re an idiot, if you don’t want to read it then don’t, some of us do.

  • Aiman Asad

    My 2.5 year old baby girl get hurt by the tap ,while takeing bath and I found bump on his forehead, as she got hurt she got shocked but after few sec she was normal. I wanna know is it fine or I should take her to doctor

  • Netta Knapper

    My 4 year old did a back flip and hit his head on the side of the pool and a has a big goose egg. This was very helpful thank you

  • Bob Loblah

    25Jun17…..Why not something about ‘ adults ‘……!!!!!!!!!!!!!!……in this topics. Adults are just as important as kids just as ants are just as important as elephants in the grand scheme of God’s creation of course. Adults suffer all kinds of bruises such as BobLoblah his his head ( or bumped as you people call it ) on the end of an ‘ upper ‘ bed in BobLoblah’s motorhome. BobLoblah being just human continued working inside and in the course of 3 – 4 hours bumped BobLoblah’s head again…..’ in the same spot on the head. ‘
    Now, its 3 weeks later and it still pains like hell. After completely shaving the area where the bump occurred, a bruise is well noticed and very painful. BobLoblah continued to put some ‘ Deep Heat ‘ ( a soothing muscle relaxant ) on the spot. It pained a whole lot, but at this moment is simmering downwards.
    What about OLD people who bump their heads for a million reasons…..!!!!!!!!!!!……Isn’t there anyone herein who can even mention what for these human beings to do. A very high percentage of them no longer drive vehicles and a lot of them live in the urban areas and countryside. They usually think that the bruise is ‘ nothing ‘ but later on regret having done nothing about it. Besides, they think that having an ambulance come for them is a waste of taxPayers money as the ambulances these days arrive with all kinds of ‘ overkill ‘ when it comes to expenses to operate it. ( Make no wonder the country is 19 trillion bucks in debt ). Then there are the lame, the blind, and the insane who don’t have a clue what to do when they get a bruise……other than drink the pain away and you know what that means…they eventually end up in the hospital for a long-time stay at YOUR expense.
    Remember, there’s more than kids in the WholeWideworld……YES…

  • RivkaMaria

    Bloggers and the like often weave what they think is entertaining quips into their writing. As a former EMT, I’m with you. Just the facts, ma’am.

  • RivkaMaria

    Hahaha. Just Google ‘adult head injuries’ and you’ll have a zillion sources to read. Methinks you’re a bit of a troll, Booblah Bob.

  • RivkaMaria

    I’m just impressed your four year old can do a back flip!

  • Jesse James

    Wow really? When it comes to my child being sick and not knowing what to do ill read the entire encyclopedia! Front to back as many times as possible to understand whats happened… some people ill tell yah!!! Yes should i stay or should i go… very helpful because im wondering do i take my child to the hospital or is she ok am i over reacting or not….

  • Jesse James

    My child just turned 4 she fell at soccer fell head first into the goal post 3 weeks ago now. I took her to the hospital immediately she got 3 stitches. A week later got the stitches out. Right away the next day she was clumsy said she had a headache. I gave her tyelonal made her rest. When she got the stitches out the doctors office said oh shes fine without really checking her.. its just 3weeks now since it happened she was clumsy today she seems irritated she said tonight her head hurts. She hasent said anything about not feeling well until today shes been playing like normal. Tonight her ears are sensitive to noise. I dont know if i should take her baxk to the hospital and have her examined i really want to but im wondering could she be over tired will making her rest/sleep help.?So this post was helpful . When she wakes up in the morning ill decide if i take her to the hospital if she still has the headache. It was really scary this happened and im so so woŕried about a head injury. I thought she was good playing like normal not saying anything about it hurting becauae i put cream on the scar everyday. But ive read it may take a few weeks for the concussion to set in… im a single mom 27 years old. Played soccer my entire life i never seen this happen to anyone so im really sad it happened to my baby girl i wont ever let her play soccer again. And the worst part is it was a make up game we didnt even need to be there that day infact my little girl didnt wanna play i was like lets go home then she decide to play and boom it happened. Im really sad about it especially if she has a head injury shes so little she still cant communicate exactly how she feels. I really hope shes just been playing to hard to much ipad not enough sleep cuz i know the doctors gonna tell me to make her sleep. Its better to be safe then sorry so i might just take her back to the hosptial anyways this friday will be 3 weeks exactly since it happened.

  • Megan

    My one year old just went to jump out of my arms and they had a chair right behind me so the end result is a little centimeter or less, lump on his temple on the left side. Should I go to the ER? He was tired before, so he is falling asleep while trying to feed him but pupils look OK and he isn’t acting different besides being sleepy.

  • John N Michelle Jerrell

    In the moment when something tragic like this happens. Like a few mins ago for our 5 year old…running into my room and smashed side of her head into my open dresser drawer as i put clothes away . instant greenish goose egg continueing to grow. They need a summary at the top of the important info so u can quickly get what you need then when things have calmed and you feel a little better, then you can read the rest. But during a panic, woukd have been nice to find answers fast. Thanks for the info. Both much calmer

  • Eleni Thayer

    The website is also called children’ So it is clearly going to be advice about children. If you need medical attention, go see your doctor or visit wedmd or an adult health site. But no reason to know a children’s health site for writing about children.

  • Bob Loblah

    22Sep17…..and you rivkamaria are fulla schidt to the eyeballs. Ps: Have you gotten out of your schidthole yet…..!!!…..Go figure…..Hahahahahhahahaahhaahhaahhahahahahaahhahahahahahaah……You are not only a ‘ troll ‘ but also a ‘ trollop ‘…………Go figure this one toooooooooooooooo……

  • Bob Loblah

    22Sep17…..Just ‘ google ‘ childrens’ head injuries and you’ll have a qadZillion sources to read. BobLoblah thinks that you have less brains than what is found in a bottle of wadda……….Go figure…

  • Bob Loblah

    22Se17…..BobLoblah is a dummy at the best of times. Ps: What’s ‘ wedmd ‘ for those others who are just ad dumb as BobLoblah…….Much Obliged……BobLoblalh…