Head injury in children

Safety • Mar 29, 2010

Head Injuries in Children | When Should Parents Worry?


All parents have hard and fast rules for their kids. In our house, we have some pretty clear rules about helmets. As a pediatric orthopedist, I’ve seen enough head injuries to know I’d rather prevent them.

But as much as we’d love to wrap our kids in bubble wrap and protect them from every tumble, we know we can’t (and bubble wrap has its own set of hazards). Babies fall. Soccer players take some pretty tough headers. Cross country runners can trip. Here are my thoughts on when to watch a head injury and when to seek help immediately

What to Watch for After Head Injuries

If your child takes a hit to the head, cries for a minute, but then goes right back to playing, you can probably breathe easy. Even if that knock results in a goose egg, you’re usually okay. Those goose eggs are really just big bruises. In those instances, you want to pay attention to how the injury feels to the touch. Goose eggs can be hard or soft, depending on the surface the child hit, and can resolve within a matter of minutes. If it starts to feel squishy, you move into the next category: seek help.

When Should You Seek Immediate Medical Attention?

Kids will show you signs if there’s something wrong. They won’t act like themselves, they’ll be sleepy. They might vomit or refuse to eat or drink. If your child experiences any of those symptoms, loses consciousness or complains of a persistent or worsening headache, go to the emergency department.

When Should You Call Your Pediatrician?

Your child isn’t displaying the symptoms that would suggest a trip to the ER is necessary, but you feel like something is off. In that case, call your pediatrician. They will help you determine the best course of action, whether it’s a matter of keeping an eye on your child for a few hours or getting the injury checked out.


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

Sleeping with a Pediatric Head Injury

If your child was behaving normally after the injury, let him sleep normally. Don’t wake him up. Waking a sleeping child will make him more irritable and more tired. I tell parents if you feel like you have to check in on your child, you should take him to the hospital.

Preventing Head Injuries in Children

Back to our household rule on helmets. We require our children to wear helmets when they’re on anything with wheels, whether they’re riding the tricycle or in the carrier mom or dad is pulling behind an adult bike.

Make an appointment at Safety Stop to ensure your child’s helmet fits properly. At Safety Stop, they also sell helmets, offer home safety consultations and low-cost materials to help baby-proof your house, which will help soften those corners right at your child’s eye (and head bumping) level.

Disclaimer: This post was updated on 5/9/2018 to reflect current recommendations.