When the baby takes a nose dive off the park bench, when your toddler runs into the doorframe while playing hide and seek, when your teen takes a hard hit playing football - these are all situations requiring you to decide if a blow to the head warrants medical attention.
Laurence Kleiner, MD, director of neurosurgery at Dayton Children’s, has seen many children come into the Soin Regional Pediatric Trauma and Emergency Center with accidental head injuries. Whether the child has a concussion or just a bad "bonk," there are certain things parents can do to care for their child with a head injury.
"Most of the head injuries we see are not concussions, but we always check for certain symptoms and may keep a child for observation if he or she comes to the emergency department with a head injury," Dr. Kleiner explains.
Whether at the emergency department or the urgent care, Dayton Children’s doctors will check your child’s eyes, ears, reflexes and ability to respond appropriately. Your child may be kept for observation to check for any worsening of symptoms. If the doctor feels it is necessary, a CT (computed tomography) scan may be ordered for your child.
But when should you seek medical attention?
With many head injuries, the worst thing that happens is that your child cries and develops a bump on the head. Soon the child is back to normal. In these situations, calling the doctor or visiting the urgent care is not needed.
If, however, your child does not return to normal soon and develops certain symptoms that get worse or don’t go away, be sure to call your child’s doctor or visit Dayton Children’s Urgent Care or the emergency department.
What symptoms should I watch for?
- Unusual sleepiness. It is okay to let your child sleep, but be sure to check on your child every two to four hours for the first 12 hours after the injury. Your child should wake easily and act normally. (If your child acts normally when you wake him or her at night, it is okay to let the child go right back to sleep).
- Memory loss, confusion or trouble concentrating, or other changes in personality such as becoming impulsive, reckless, aggressive or showing abnormal behavior.
- Increasing headache
- Stiff neck
- Nausea or vomiting (two or more times of vomiting in the 12 hours after the injury)
- Bleeding or clear drainage from the nose or ears
- Trouble hearing
- Dizziness, blurred or double vision (children close one eye to try to correct this), unequal pupil size
- Weakness, numbness or tingling of the arms and legs.
- Usually after a trip to the emergency department or urgent care, children can be sent home for you to continue any observation or treatment.
What will I be instructed to do?
- Wake your child every two to four hours (or as instructed by the doctor) for the first 24 hours after the injury. Your child should awaken easily and stay awake for a few minutes.
- In a dark room shine a flashlight into your child’s eyes. Your child’s pupils (small black areas in the middle of the eye) should get smaller and quickly be about the same size.
- Make sure your child is moving his or her arms and legs normally.
- Give only acetaminophen (Tylenol) for pain relief. Use heat or cold packs for comfort.
- The treatment for a head injury is rest. As your child’s symptoms go away, he or she can slowly return to their usual routine. Avoid any activities that risk re-injury. Your child’s health care provider will tell you when it is safe to return to normal activities.
- Notify your child’s doctor if your child doesn’t wake easily, can’t move arms or legs normally and/or pupils don’t change with light or aren’t the same size.
- Call your child’s doctor if your child’s headache lasts for more than seven days or is not relieved by acetaminophen (Tylenol).
Some symptoms of a head injury can occur days, weeks, or months after the initial injury:
- Headache - not relieved by acetaminophen (Tylenol) that gets worse or lasts more than a day
- Difficulty concentrating or loss of memory
- Depression, fatigue, poor school performance
- Behavioral changes
- Loss of consciousness (passing out)
- Nausea or vomiting (two or more times in the 12 hours after injury
- Fits or convulsions (seizures - twitching or jerking movements of parts of the body, may look stiff)
If any of these changes in your child’s condition develop or if at any time you are concerned about your child, call your child’s doctor or return to the emergency department.
When can my child go to gym class or play sports?
- Your child should not participate until all symptoms - headaches, dizziness, nausea, etc - are gone, both at rest and if running or playing.
- Clearance for return-to-participation occurs when your child no longer has a headache. If you have any questions about return to normal activities, please talk to your child’s primary health care provider or doctor.
How can I prevent a head injury?
No all bonks on the head can be prevented when you have active children, but there are things you can do to minimize the risk. Teach your children how to play safely on playground equipment to minimize falls. Always use age-appropriate infant child safety seats and seat belts. Using the correct safety equipment for sporting activities such as helmets for football, baseball, bicycling and skateboarding is important. Appropriate training techniques and having adult supervision when playing any sport are also important.
"Concussions are a widely recognized sports injury, and are more common and subtle than people think," says Dr. Kleiner.
Children and teens at the greatest risk are those who play contact sports such as football, hockey, rugby, soccer and lacrosse. Active children are also at risk when skateboarding, biking and skating.
According to Dr. Kleiner, recent scientific studies show that even the most minor concussions may damage a child’s concentration, memory, reaction time and affect emotions.
Post-concussive syndrome is the name of the debilitating condition that can affect children and adolescents who have had one or more concussions.
10 common signs to watch for:
- Memory difficulties
- Slowed thinking
- Tiredness, changes in sleep
- Ringing in ears
- Sensitivity to light or sounds
- Mood changes
- Blurred vision
Even if the child did not lose consciousness, he or she may have still suffered a concussion. Returning to play - whether organized sports or recreational activities - too soon after a concussion can result in serious brain injury. Be sure to talk to your child’s doctor and seek medical treatment if you believe your child has suffered a concussion.
If you are a coach or trainer and want more information on concussion, contact the neurosurgery department at Dayton Children’s - 937-641-3461.
About our expert
Laurence Kleiner, MD, is director of the department of neurosurgery at The Children’s Medical Center of Dayton. Dr. Kleiner received his medical degree from Temple University. He completed his fellowship in pediatric neurosurgery/CFS physiology at Brown University School of Medicine. His specialty interests include brain tumors and endoscopy with hydrocephalus.