What to watch for with a head injury

Head injuries are common in children and teens. They can hurt the scalp, skull, brain, or blood vessels.

Head injuries can be mild, like a bump on the head, or more serious, like a concussion. In kids, most are mild and don't injure the brain.

What Causes Head Injuries?

Most head injuries in childhood are due to falls. They also happen from:

What Are the Types of Head Injuries?

Head injuries can be: 

  • external and involve the scalp
  • internal and involve the skull, brain, or blood vessels

An injury can cause a concussion, contusion, fracture, or bleeding:

  • A concussion is a type of mild traumatic brain injury. It happens when a blow to the head or another injury moves the head back and forth with a lot of force. This causes chemical changes in the brain and sometimes damages brain cells.
  • A contusion (bruise) happens when a blow to the head injures the skin and the soft tissue under it. Blood from small blood vessels leaks, causing red or purple marks on the skin. Contusions often happen on the scalp or forehead. More serious head injuries can cause a brain contusion.
  • A skull fracture is a break in the skull bone. Skull fractures can happen in different parts of the skull.
  • Bleeding can happen on and under the scalp and in or around the brain. 

What Are the Signs & Symptoms of a Head Injury?

A child with a head injury might:

  • Have a swollen scalp: This is common because the scalp has many small blood vessels that can leak.
  • Have a headache: About half of children with a head injury get a headache.
  • Lose consciousness (pass out): This isn't common.
  • Vomit once or twice: This happens in some children after a head injury.

How Are Head Injuries Diagnosed?

Doctors diagnose head injuries by asking questions about how the injury happened and doing a careful exam of the head. They'll also check to see how the nerves are working.

Most children with a mild brain injury don't need medical tests. Doctors often do a CAT scan of the head if the injury is more serious.

Signs that the injury could be serious include:

  • loss of consciousness for more than a few minutes
  • continued vomiting
  • confusion
  • seizures
  • a headache that gets worse

What Should I Do When a Child Has a Head Injury?

Call your health care provider right away if your child had a head injury and:

  • is an infant
  • lost consciousness, even for a moment
  • has any of these symptoms:
    • won't stop crying
    • complains of head and neck pain (younger children who aren't talking yet may be more fussy)
    • vomits more than one time
    • won't awaken easily
    • becomes hard to comfort
    • isn't walking or talking normally

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

  • Put an ice pack or instant cold pack on the injured area for 20 minutes every 3–4 hours. If you use ice, always wrap it in a washcloth or sock. Ice placed right on bare skin can injure it.
  • Watch your child carefully for the next 24 hours. If the injury happens close to bedtime or naptime and your child falls asleep soon afterward, check in a few times while they sleep.

If your child's skin color and breathing are normal, and you don't sense a problem, let your child sleep unless the doctor tells you otherwise. There's no need to keep a child awake after a head injury.

Trust your instincts. If you think your child doesn't look or seem right, partly awaken your child by sitting them up. They should fuss a bit and attempt to resettle. If your child still seems very drowsy, try to awaken them fully. If you can't wake your child, call your health care provider or 911 for an ambulance.

What Should I Do if a Child Is Unconscious After a Head Injury?

  • Don't move the child in case there is a neck or spine injury.
  • Call for help. If you have a phone with you, call 911.
  • If the child is vomiting or having a seizure, turn them onto their side while trying to keep the head and neck straight. This will help prevent choking and protect the neck and spine.

Can Head Injuries Be Prevented?

It's impossible to protect kids from every injury. But you can help prevent head blows. Most important, childproof your home to prevent household accidents.

A concussion is a traumatic brain injury that affects your brain function. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination.

Concussions are usually caused by a blow to the head. Violently shaking of the head and upper body also can cause concussions.

Some concussions cause you to lose consciousness, but most do not.

Falls are the most common cause of concussion. Concussions are also common if you play a contact sport, such as football or soccer. Most people usually recover fully after a concussion.

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Symptoms

The signs and symptoms of a concussion can be subtle and may not show up immediately. Symptoms can last for days, weeks or even longer.

Common symptoms after a concussive traumatic brain injury are headache, loss of memory (amnesia) and confusion. The amnesia usually involves forgetting the event that caused the concussion.

Physical signs and symptoms of a concussion may include:

  • Headache
  • Ringing in the ears
  • Nausea
  • Vomiting
  • Fatigue or drowsiness
  • Blurry vision

Other signs and symptoms of a concussion include:

  • Confusion or feeling as if in a fog
  • Amnesia surrounding the traumatic event
  • Dizziness or "seeing stars"

A witness may observe these signs and symptoms in the concussed person:

  • Temporary loss of consciousness (though this doesn't always occur)
  • Slurred speech
  • Delayed response to questions
  • Dazed appearance
  • Forgetfulness, such as repeatedly asking the same question

You may have some symptoms of concussions immediately, and some can occur for days after the injury, such as:

  • Concentration and memory complaints
  • Irritability and other personality changes
  • Sensitivity to light and noise
  • Sleep disturbances
  • Psychological adjustment problems and depression
  • Disorders of taste and smell

Symptoms in children

Head trauma is very common in young children. But concussions can be difficult to recognize in infants and toddlers because they can't describe how they feel. Concussion clues may include:

  • Dazed appearance
  • Listlessness and tiring easily
  • Irritability and crankiness
  • Loss of balance and unsteady walking
  • Excessive crying
  • Change in eating or sleeping patterns
  • Lack of interest in favorite toys
  • Vomiting
  • Seizures

When to see a doctor

See a doctor within 1 to 2 days if:

  • You or your child experiences a head injury, even if emergency care isn't required

If your child doesn't have signs of a serious head injury, remains alert, moves normally and responds to you, the injury is probably mild and usually doesn't need further testing.

In this case, if your child wants to nap, it's OK to let him or her sleep. If worrisome signs develop later, seek emergency care.

Seek emergency care for an adult or child who experiences a head injury and signs and symptoms such as:

  • Repeated vomiting or nausea
  • A loss of consciousness lasting longer than 30 seconds
  • A headache that gets worse over time
  • Fluid or blood draining from the nose or ears
  • Vision or eye disturbances, such as pupils that are bigger than normal (dilated pupils) or pupils of unequal sizes
  • Ringing in the ears that doesn't go away
  • Weakness in the arms or legs
  • Appearing very pale for longer than an hour
  • Changes in behavior
  • Confusion or disorientation, such as difficulty recognizing people or places
  • Slurred speech or other changes in speech
  • Obvious difficulty with mental function or physical coordination
  • Changes in physical coordination, such as stumbling or clumsiness
  • Seizures or convulsions
  • Lasting or recurrent dizziness
  • Symptoms that worsen over time
  • Large head bumps or bruises on areas other than the forehead in children, especially in infants under 12 months of age

Athletes

Never return to play or vigorous activity while signs or symptoms of a concussion are present.

Experts recommend that an athlete with a suspected concussion not return to activities that are associated with a higher risk of another concussion while still showing concussion symptoms.

Children and adolescents should be evaluated by a health care professional trained in evaluating and managing pediatric concussions.

Experts also recommend that adult, child and adolescent athletes with concussions not return to play on the same day as the injury.

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How can I tell if a head injury is mild or severe?

Symptoms may include: Mild head injury: Raised, swollen area from a bump or a bruise..
Loss of consciousness..
Severe headache that does not go away..
Repeated nausea and vomiting..

How do I know if my head injury is serious?

Danger signs in adults.
Have a headache that gets worse and does not go away..
Experience weakness, numbness, decreased coordination, convulsions, or seizures..
Vomit repeatedly..
Have slurred speech or unusual behavior..
Have one pupil (the black part in the middle of the eye) larger than the other..

What should I watch for after hitting my head?

What to look out for.
unconsciousness – either brief (concussion) or for a longer period of time..
fits or seizures..
problems with the senses – such as hearing loss or double vision..
repeated vomiting..
blood or clear fluid coming from the ears or nose..
memory loss (amnesia).

How long should I worry after a head injury?

See a provider within 1 to 2 days of a significant head injury with ongoing symptoms, even if emergency care isn't required. Seek emergency medical attention if your child experiences: Unconsciousness, confusion or disorientation after a head injury.