Head Injury

Is this your child's symptom?

  • Injuries to the head

  • Includes the scalp, skull and brain


Types of Head Injuries

  • Scalp Injury. Most head injuries only damage the scalp. Examples are a cut, scrape, bruise or swelling. It is common for children to fall and hit their head while growing up. This is especially common when a child is learning to walk. Big lumps (bruises) can occur with minor injuries. This is because there is a large blood supply to the scalp. For the same reason, small cuts on the head may bleed a lot. Bruises on the forehead sometimes cause black eyes 1 to 3 days later. This is caused by blood spreading downward by gravity.

  • Skull Fracture. Only 1% to 2% of children with head injuries will get a skull fracture. Most often, there are no other symptoms except for a headache. The headache occurs at the site where the head was hit. Most skull fractures occur without any injury to the brain. They heal easily.

  • Concussion. A mild brain injury that changes how the brain normally works. It is usually caused by a sudden blow or jolt to the head. Most children bump or hit their heads without causing a concussion. The most common signs are a brief period of confusion or memory loss. This happens after the injury. Other signs of a concussion can include a headache or vomiting. Dizziness or acting dazed can also be signs. A person does not need to be knocked out to have had a concussion. Following a concussion, some children have ongoing symptoms. These can include headaches, dizziness or thinking difficulties. School problems or emotional changes can occur. These symptoms can last for several weeks.

  • Brain Injuries (Serious) are uncommon. This includes bleeding, bruises or swelling within the brain. They are suspected by the symptoms listed below:

  • Hard to wake up or keep awake or

  • Acts or talks confused or

  • Slurred speech or

  • Weakness of arms or legs or

  • Walking is not steady.

  • These symptoms are an emergency. If they happen, call 911.

Concussion Treatment

  • Treating a concussion requires both Physical Rest and Brain Rest.

  • Brain rest means a gradual return to full studying and school attendance.

  • Physical rest means a gradual return to normal activity, work and gym class.

  • If symptoms occur (like a headache), the child needs to return to the previous level of physical and mental activity. In 24 hours, they can try again to take it to the next level.

  • Athletes involved in sports need to have a stepwise plan for "return to play." Progressing through stages should be supervised by a doctor or athletic trainer.

Pain Scale

  • Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.

  • Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.

  • Severe: The pain is very bad. It keeps your child from doing all normal activities.


Call 911 Now

  • Seizure occurred

  • Knocked out for more than 1 minute

  • Not moving neck normally (Caution: protect the neck from any movement)

  • Hard to wake up

  • Acts or talks confused or slurred speech present now

  • Walking not steady or weakness of arms/legs present now

  • Major bleeding that can't be stopped

  • You think your child has a life-threatening emergency

Call Doctor Now or Go to ER

  • Age less than 1 year old

  • Knocked out for less than 1 minute

  • Skin is split open or gaping and may need stitches

  • Bleeding won't stop after 10 minutes of direct pressure

  • Large swelling (larger than 1 inch or 2.5 cm)

  • Large dent in skull

  • Blow from hard object (such as a golf club)

  • Fall from a dangerous height

  • You think your child has a serious injury

  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Headache lasts more than 24 hours

  • You think your child needs to be seen, but the problem is not urgent


Call Doctor During Office Hours

  • Dirty cut and no tetanus shot in over 5 years

  • Clean cut and no tetanus shot in over 10 years

  • You have other questions or concerns

Self Care at Home

  • Minor head injury

Care Advice for Head Injuries


  1. What You Should Know About Mild Head Injuries:

    • Most head injuries only cause a swelling or bruise to the scalp.

    • The main symptom is pain.

    • Swelling of the scalp does not mean there is any swelling of the brain. The scalp and brain are not connected. They are separated by the skull bone.

    • The skull bone protects the brain from getting injured.

    • The mildest brain injury is a concussion. Most of those also turn out fine.

    • Here is some care advice that should help.

  2. Wound Care:

    • If there is a scrape or cut, wash it off with soap and water.

    • For any bleeding, put direct pressure on the wound. Use a gauze pad or clean cloth. Press for 10 minutes or until the bleeding has stopped.

  3. Cold Pack For Swelling:

    • Use a cold pack or ice bag wrapped in a wet cloth. Put it on any swelling. Do this for 20 minutes.

    • Reason: Prevent big lumps ("goose eggs"). Also, helps with the pain.

    • Repeat in 1 hour, then as needed.

  4. Watch Your Child Closely for 2 Hours:

    • Watch your child closely during the first 2 hours after the injury.

    • Have your child lie down and rest until all symptoms have cleared. (Note: Mild headache, mild dizziness and nausea are common)

    • Allow your child to sleep if he wants to, but keep him nearby.

    • Wake him up after 2 hours of sleeping. Then, check how he walks and talks.

  5. Diet - Start With Clear Fluids:

    • Offer only clear fluids to drink, in case he vomits. Allow a regular diet after 2 hours.

  6. Pain Medicine:

    • To help with the pain, give an acetaminophen product (such as Tylenol). Another choice is an ibuprofen product (such as Advil). Use as needed.

    • Exception: Do not give until 2 hours have passed from injury without any vomiting.

    • Never give aspirin to children and teens. Reason: Always increases risk of bleeding.

  7. Special Precautions For 2 Nights:

    • Mainly, sleep in same room as your child for 2 nights.

    • Reason: If a problem occurs, you will recognize it if you are close by. Problems include a bad headache, vomiting or confusion. Also, look for any change in your child's normal behavior.

    • Option: If you are worried, wake your child once during the night. Check how he walks and talks.

    • After 48 hours, return to a normal sleep routine.

  8. What to Expect:

    • Most head trauma only causes a scalp injury.

    • The deep headache usually clears in 24 hours.

    • The scalp pain at the site of impact may last 3 days.

    • The swelling may take a week to go away.

  9. Call Your Doctor If:

    • Pain or crying becomes severe

    • Vomits 2 or more times

    • Your child becomes hard to wake up or confused

    • Walking or talking is not normal

    • Headache lasts more than 24 hours

    • You think your child needs to be seen

    • Your child becomes worse


And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Copyright 1994-2017 Schmitt Pediatric Guidelines LLC. All rights reserved.