PAMF Health Blog

Be Well, Be Well Informed

A Bump on The Head? When to Take Your Child to the Doctor

Posted on Mar 27, 2012

Lauren Brave, M.D., Pediatrician, Palo Alto Medical Foundation Pediatric Urgent Care

A bump on the head is one of those painful yet common childhood experiences that can happen at any age – whether it’s the newly mobile baby rolling off the bed, the elementary school kid falling off the jungle gym, or the teenage athlete colliding with an opposing team member during a high school football game. Pretty scary stuff for parents – should you rush straight to the emergency room? If your child loses consciousness, even briefly, you should seek immediate medical attention. For many minor head bumps, however, careful observation of your child for the first 36 to 48 hours is the most important thing you can do. If you are at all in doubt, don’t hesitate to follow your instincts and consult your doctor.

My 13-month-old daughter has just started walking and has been close to falling and bumping her head a couple of times. If she falls and hits her head should I take her to the doctor?

New walkers, teetering near the sharpest corners of your furniture or on a hard concrete sidewalk, can be real heart-stoppers for parents. Fortunately, most baby head bumps are benign and your little walker will soon become steadier on her feet.

If your daughter does fall and bump her head, but is alert and responds to you, watch her carefully for the next 36 to 48 hours to see if any symptoms develop that could indicate a head injury. Changes to watch for include:

  • Inconsolable crying
  • Vomiting more than once
  • Unable to respond to you
  • Balance difficulties when trying to sit or walk

As children get older, they may be able to share or you may notice the following symptoms:

  • A sustained headache
  • Slurred speech or confusion
  • Dizziness
  • Numbness or weakness in the arms or legs
  • Amnesia from the event

If your child is exhibiting any of these symptoms, or has any significant swelling over the site of the injury, you should take her to the doctor.

If it is nap or bedtime and your daughter has none of these described symptoms, you can let her sleep, but check on her every two to three hours to make sure all is well. It’s also best not to give her any pain medication so that any pain or other symptoms are not masked.

My daughter fell off her bike and hit her head. Should she get a CT scan?

Getting a CT (computerized tomography) scan may seem like the best way to see what’s really going on inside your daughter’s head but it not always advisable as this does involve a dose of radiation which might not actually be necessary. Instead, your doctor will examine your daughter and ask about the specific symptoms she has. This is a much better indicator of how serious her head injury is and what treatment is best for her. CT scans are usually only administered for patients who are displaying symptoms that indicate a serious head injury.

My son hit his head on the goal post during a soccer game a couple of weeks ago. He’s still complaining of a headache. Is that normal?

Most likely, after this head injury, your son experienced a concussion. A concussion is actually a mild traumatic brain injury caused by an impact and the symptoms reflect this. Symptoms may include dizziness, nausea, fatigue and forgetfulness which can last anywhere from 15 minutes to a couple of weeks.

Recovery time from a head injury can vary greatly for each individual, so it is possible to still experience symptoms of a head injury long after the accident occurred. Children’s and teenagers’ developing brains, in particular, can take seven to ten days (or more) longer than an adult to return to normal after a head injury. Other possible head injury symptoms that can linger include being a little more tired than usual, more sensitive to lights, more emotional, or having trouble concentrating in class. Make sure that your son does not return to soccer before he is completely back to normal. After any significant concussion, a child should be examined by a doctor before returning to sports.

Although it is not possible to prevent all head injuries, there are several ways you can reduce the risk, including always having your child wear the correct protective gear (such as helmets and mouth guards) and knowing and adhering to the rules of the sport.

My 15-year-old son suffered from concussion when he collided with another player during a lacrosse game a couple of weeks ago – now the coach wants him back in the game. When is it safe for him to return?

It’s extremely important for him not to go back too soon and risk another head injury that could result in much more serious damage or, although rare, death. Just remember, ‘when in doubt, sit it out!’ The best treatment for concussion is rest from both physical and mental activity.

A child should never go directly back into the game after he or she has experienced a head injury and your son also shouldn’t return to sports until he is back to his baseline (his normal health before the injury). A five-day step-by-step progressive return to sports is now recommended by the American Academy of Pediatrics after any head injury. When your son is feeling completely back to normal and has no symptoms, he can increase his level activity, day-by-day in the following way:

  • Day 1: light aerobic exercise such as walking or using a stationary bike
  • Day 2: sport-specific drills and running drills
  • Day 3: add drills that involve resistance
  • Day 4: return to practice
  • Day 5: return to game and full participation

Your son will need to complete each step without experiencing any symptoms before he can move on to the next step. If symptoms persist beyond 48 to 72 hours, he should be assessed by a doctor.

This blog post is contributed by Lauren Brave, M.D., a board-certified pediatrician in the Palo Alto Medical Foundation’s Pediatric Urgent Care Department.