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  • Head Injury

    Definition

    • Injuries to the head
    • Includes the scalp, skull and brain

    FIRST AID for Bleeding:

    • Put a gauze pad or clean cloth on top of the wound.
    • Press down firmly on the place that is bleeding.
    • This is called direct pressure. It is the best way to stop bleeding.
    • Keep using pressure until the bleeding stops.
    • If bleeding does not stop, press on a slightly different spot.

    FIRST AID for Suspected Spinal Cord Injury:

    • Do not move your child until a spine board is put on.

    Types of Head Injuries

    • Scalp Injury. Most head injuries only damage the scalp. Examples are a cut, scrape, bruise or swelling. It is common for children to fall and hit their head while growing up. This is especially common when a child is learning to walk. Big lumps (bruises) can occur with minor injuries. This is because there is a large blood supply to the scalp. For the same reason, small cuts on the head may bleed a lot. Bruises on the forehead sometimes cause black eyes 1 to 3 days later. This is caused by blood spreading downward by gravity.
    • Skull Fracture. Only 1% to 2% of children with head injuries will get a skull fracture. Most often, there are no other symptoms except for a headache. The headache occurs at the site where the head was hit. Most skull fractures occur without any injury to the brain. They heal easily.
    • Concussion. A mild brain injury that changes how the brain normally works. It is usually caused by a sudden blow or jolt to the head. Many children bump or hit their heads without causing a concussion. The most common signs are a brief period of confusion or memory loss. This happens after the injury. Other signs of a concussion can include a headache or vomiting. Dizziness, acting dazed, or being knocked out can also be signs. A person does NOT need to be knocked out to have had a concussion. Following a concussion, some children have ongoing symptoms. These can include mild headaches, dizziness or thinking difficulties. School problems or emotional changes can occur. These symptoms can last for several weeks.
    • Brain Injuries are uncommon. They are recognized by the symptoms listed below:
      • Hard to wake up or keep awake OR
      • Acts or talks confused OR
      • Slurred speech OR
      • Weakness of arms or legs OR
      • Walking is not steady.

    Pain Scale

    • Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
    • Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
    • Severe: The pain is very bad. It keeps your child from doing all normal activities.

    When to Call Us for Head Injury

    Call 911 Now (your child may need an ambulance) If:

    • Seizure occurred
    • Knocked out for more than 1 minute
    • Not moving neck normally (Caution: protect the neck from any movement)
    • Hard to wake up
    • Acts or talks confused OR slurred speech present now
    • Walking not steady OR weakness of arms/legs present now
    • Major bleeding that can’t be stopped (See FIRST AID
    • You think your child has a life-threatening emergency

    Call Us Now (night or day) If:

    • You think your child has a serious injury
    • Age less than 1 year old
    • Neck pain after head injury
    • Knocked out for less than 1 minute
    • Had confused talking, slurred speech, unsteady walking OR weakness of arms/legs BUT fine now
    • Blurred vision lasted more than 5 minutes
    • Skin is split open or gaping and may need stitches
    • Bleeding won’t stop after 10 minutes of direct pressure
    • Large swelling (larger than 1 inch or 2.5 cm)
    • Large dent in skull
    • Injury caused by high speed (car crash)
    • Blow from hard object (such as a golf club)
    • Fall from a dangerous height
    • Vomited 2 or more times
    • Severe headache or crying that won’t stop
    • Can’t remember what happened
    • You think your child needs to be seen urgently

    Call Us Within 24 Hours (between 9 am and 4 pm) If:

    • You think your child needs to be seen, but not urgently
    • Headache lasts more than 3 days

    Call Us During Weekday Office Hours If:

    • You have other questions or concerns
    • No tetanus shot in over 5 years for DIRTY cuts
    • No tetanus shot in over 10 years for CLEAN cuts

    Parent Care at Home If:

    • Minor head injury

    Care Advice for Scalp Injuries

    What You Should Know:

    • Most head injuries only cause a swelling or bruise to the scalp.
    • The skull bone protects the brain from getting injured.
    • The mildest brain injury is a concussion. Most of those also turn out fine.
    • Here is some care advice that should help.

    Wound Care:

    • If there is a scrape or cut, wash it off with soap and water.
    • For any bleeding, put direct pressure on the wound. Use a gauze pad or clean cloth. Press for 10 minutes or until the bleeding has stopped.

    Cold Pack:

    • Use a cold pack or ice bag wrapped in a wet cloth. Put it on any swelling. Do this for 20 minutes.
    • Reason: Prevent big lumps (“goose eggs”). Also, helps with the pain.
    • Repeat in 1 hour, then as needed.

    Watch Your Child:

    • Watch your child closely during the first 2 hours after the injury.
    • Have your child lie down and rest until all symptoms have cleared. (Note: Mild headache, mild dizziness and nausea are common)
    • Allow your child to sleep if he wants to, but keep him nearby.
    • Wake him up after 2 hours of sleeping. Then, check how he walks and talks.

    Diet:

    • Offer only clear fluids to drink, in case he vomits. Allow a regular diet after 2 hours.

    Pain:

    • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed. See Dose Table.
    • Exception: Do not give until 2 hours have passed from injury without any vomiting.
    • Never give aspirin to children and teens. Reason: Always increases risk of bleeding.

    Special Precautions at Night:

    • Mainly, sleep in same room as your child for 2 nights.
    • Reason: If a problem occurs, you will recognize it if you are close by. Problems include a bad headache, vomiting or confusion. Also, look for any change in your child’s normal behavior.
    • Option: If you are worried, wake your child once during the night. Check how he walks and talks.
    • After 48 hours, return to a normal sleep routine.

    What to Expect:

    • Most head impact only causes a scalp injury.
    • The swelling may take a week to go away.
    • The headache at the site of impact usually clears in 2 to 3 days.

    Call Your Doctor If:

    • Pain becomes severe
    • Vomits 2 or more times
    • Your child becomes hard to wake up or confused
    • Walking or talking is not normal
    • Your child becomes worse

    Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

    Author and Senior Reviewer: Barton D. Schmitt, M.D.
    Copyright 1994-2013 Barton D. Schmitt, M.D.

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