Head Injuries

What Are Head Injuries?

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:

• car crashes
• bike accidents
• sports injuries
• child abuse

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.

Kids should:

• Always wear a bike helmet that fits well and is approved by the U.S. Consumer Product Safety Commission for biking.
• Use the proper sports equipment for inline skating, skateboarding, snowboarding, skiing, and contact sports.
• Use a child safety seat or seatbelt every time they're in the car.
• Take it easy after a head injury, especially if they had a concussion.
• Wait until the doctor says it's OK before returning to rough play or sports. If the brain gets injured again while it's still healing, it will take even longer to completely heal.