Falls & Head Trauma

Kids fall and bump their heads commonly, and luckily the vast majority of these injuries are minor. A child’s skull is more flexible than an adult, and can therefore tolerate more of a bump without developing a fracture.

All head injuries are potentially serious however, due to the possibility of internal bleeding in the brain (read more about concussion). Sometimes this may not start until many hours after the event, so a child who looks fine even to a medical provider may suddenly deteriorate later. Because of this children deserve careful watching by their parents after a bump on the head of any sort – the longer they remain well the less likely anything bad will occur. Generally head injuries which are sustained while moving on/in a vehicle (auto, bicycle, sled, skis, skateboard, skates) or in a fall from some height (window, stairs, porch) are far more likely to be significant than those that occur while running or just “horsing around”. A child will surely need to be examined if there is any immediate loss of consciousness, seizure (convulsion).

A child who has difficulty with memory for the event or the period just before or after, a severe headache, repeated episodes of vomiting, change in behavior, any weakness or numbness should also be evaluated. Otherwise it is safe for a parent to keep the child quiet and observe for the following:

  • repeated vomiting
  • lethargy, disorientation
  • visual disturbance, unequal pupils
  • profuse watery nasal drainage (not present before)
  • bleeding from ears
  • stiffness or convulsions
  • dizziness or clumsiness
  • weakness or numbness
  • stiff neck

Should any of the above occur you should call us immediately. While it is OK to let a child go to sleep (a child who is sleepy and oriented is probably OK), you should wake them every 2-3 hours and check for these things.

Finally, it is normal for a large bump to appear on the head quite rapidly after a fall.  This will be tender to touch and appear bruised. It should feel hard initially. This should not concern you too much. If the bump or bruise feels soft or has ‘give’ to it, or if there appears to be more of a “dent” than a bump, you should call.  Bumps on the forehead will often lead to a black eye and swelling around the eye several days later. If the black eye appears on the first day however you should call our office.

The American Academy of Pediatrics provides helpful information on this topic through their website www.healthychildren.org.

One very simple way to protect your child is to buy a bicycle helmet and insist he/she use it.  Broken bones will mend, but a serious head injury is the one potential disaster that could happen on a bike or skateboard.  Helmets are cheap and effective and ought to be law.  No motorized vehicle is ever safe for a child below 16, and then an automobile is the safest by far.

Have you been at the top of a slide or jungle gym lately?  The old fashioned metal kinds are scary – they rely on the child’s own strength and coordination only to prevent a fall.  Newer wooden designs are doing a somewhat better job of enclosing high play spaces but even they are not perfect.  Use caution!  Know where your child is playing.  Scrutinize the equipment there with a suspicious eye and supervise where appropriate.

Another good idea is to install protective bars across second story and certainly all third story or higher windows.  This has become law in some cities such as NY with preponderance of tall residential buildings, where “skydivers” are common.  While less frequent in our surroundings, it still can and does occur.

Finally, a word about infant walkers.  These devices are a major contributor to both head trauma and poisoning/choking in young infants.  They allow mobility and exploratory behavior before the child is developmentally ready and they are prone to going down stairs and tipping over.  Their use is to be strongly discouraged, and is actually now illegal in Canada!  Alternatives such as swings, playpens, jumpers, etc. are much safer.  If you must use one, be sure the infant is closely supervised for every second he is in it.