Ask the Doc: Head Trauma

head trauma head trauma

Approved by the What’s Up Moms Medical Advisory Board

My toddler is a daredevil and he’s had a few falls that freak me out. When should I worry or take him to the ED?” 

There probably isn’t a parent alive who hasn’t had their heart stop at least once from the sound of their little one taking a big tumble. Toddlers are especially prone to falls since their heads are proportionally larger than their bodies and they’re still learning how to navigate those bodies—often with a reckless lack of fear. Thankfully, this is an area in which children are remarkably resilient. It helps that younger kids have a bit of a softer skull so they can cushion a blow more easily. Mother Nature knew that the only way anyone can learn is by falling and getting up… over and over again.

So the good news is that if your child seems perfectly fine, they probably are. In other words, if he/she hasn’t had any vomiting or loss of consciousness, goes back to acting normally, isn’t excessively tired or fussy or complaining of severe headache, and there’s no obvious trauma to the head (swelling, bruising, bleeding), your child is probably perfectly fine and can generally be observed at home.

The exception for this is a fall from a height of three feet or more (in which a baby or child lands on his/her head), which warrants evaluation by a physician. Falls from changing tables or high chairs are notorious for being associated with skull fractures. (This a good time to remind parents never leave a baby unstrapped in the high chair or move away from the changing table for even seconds… babies love to show off their rolling skills at the worst times!). Likewise, any head injury sustained during a motor vehicle accident deserves prompt evaluation.

So how should you respond to signs of trauma? 

Swelling on the skull – With the exception of the forehead, any time there’s swelling on the head, it’s good to contact your pediatrician and ideally be seen for evaluation. The forehead happens to be a location in which swelling is rarely associated with more serious injuries, so it’s actually the “best” place to get a goose egg. Ice makes the swelling go down more quickly, although I’ll be honest, I’ve generally given up on ice with my kids since it just seems to aggravate them more. The swelling will go down on it’s own, it just takes a bit longer.

Bleeding – Scrapes can be cleaned with soap and water. Add a little antibiotic ointment to help prevent infection and let it air out. If there’s a laceration (an area in which there’s a gap between the tissue), it’s best to have it checked out to see if stitches are needed. Hydrogen peroxide or rubbing alcohol are not recommended for cleaning wounds, especially lacerations; though they kill bacteria, they can also damage healthy tissue and lead to poor healing. Skull lacerations tend to bleed a lot since there’s lots of blood flow to the scalp, so your child might look like something out of a horror movie scene. Applying pressure to the site helps stop the bleeding, and then a trip to the ED/urgent care is generally in order to get some stitches placed.

And what if your child isn’t acting normally?

Take your child in for evaluation. The most common reason for behavioral changes after head trauma is a concussion, but other injuries need to be ruled out first. Typically a concussion in toddlers shows up with behavioral changes, fussiness, lethargy, vomiting, “fogginess” or dizziness. Symptoms can show up right away or hours or days after a head injury. Thankfully, the treatment is rest and time, and toddlers generally recover more quickly than older kids.

One of the most common questions I’m asked…

Do children need to be woken up throughout the night after a head trauma?

As a general rule, most kids do not. If you’re able to get in four hours of observation after the injury and there are none of the above-mentioned red flags, you can let your child sleep throughout the night. If your child has a minor head injury just before bedtime, I recommend keeping them up for just a little while to observe their behavior and make sure they’re acting like their usual selves, and then letting them stick to their typical routine. You can check up on them a couple of times during the night (make sure that their color is normal and their breathing is normal), but unless you’re instructed otherwise by your healthcare provider, you don’t typically need to wake them up. And hopefully, mom and child will both be able to sleep easy overnight.

Dr. Hovav is a board-certified Pediatrician in CA and Fellow of the American Academy of Pediatrics. She lives in Sherman Oaks with her husband and three young children, boy/girl twins and their wanna-be-a-triplet little brother. She can be found caring for patients in Studio City at Beverly Hills Pediatrics -The Valley.