A Bump on the Noggin
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 in a high school football game.
It’s pretty scary stuff for parents. But should you rush straight to the emergency room? If your child loses consciousness, even briefly, the answer is yes. For many minor head bumps, however, careful observation of your child for the first 36 to 48 hours is the most important thing to do. When in doubt, don’t hesitate to follow your instincts and consult your doctor.
Q: 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?
A: Most baby head bumps are benign. As long as she is alert and responsive, you just need to watch her carefully for the next 36 to 48 hours to see if any symptoms develop that could indicate a head injury. Symptoms include:
- Inconsolable crying
- Vomiting more than once
- Unable to respond to you
- Balance difficulties when trying to sit or walk
If your child exhibits any of those, or develops significant swelling over the site of the injury, you should take her to the doctor. If it is nap or bedtime and she has none of these symptoms, you can let her sleep. But check on her every two to three hours. It’s also best not to give her any pain medication so that pain and other symptoms are not masked.
Q: My daughter fell off her bike and hit her head. Should she get a CT scan?
A: Getting a CT (computerized tomography) scan may seem like a good idea but it’s not necessarily advisable, since it involves a dose of radiation. Instead, your doctor will examine your daughter and ask about specific symptoms – a much better indicator of serious injury and appropriate treatment. CT scans are typically administered for patients who display symptoms of a serious injury.
Q: 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?
A: He likely experienced a concussion, which is a mild traumatic brain injury caused by an impact. Symptoms may include dizziness, nausea, fatigue and forgetfulness which can last anywhere from 15 minutes to a couple of weeks.
Recovery time can vary greatly, so it is possible to still experience symptoms long after the accident occurred. Children’s and teenagers’ developing brains, in particular, can take 10 days or longer, 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.
Q: My 15-year-old son suffered a concussion when he collided with another player during a lacrosse game a couple of weeks ago. The coach now wants him back in the game. When is it safe for him to return?
A: 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 even death. Just remember, ‘when in doubt, sit it out!’ The best treatment for concussion is rest from both physical and mental activity.
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 of 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. If symptoms persist beyond 48 to 72 hours, he should be assessed by a doctor.
Lauren Brave, M.D., is a board-certified pediatrician in the Palo Alto Medical Foundation’s Pediatric Urgent Care Department at the Palo Alto Center. Advice is not intended to take the place of an exam or diagnosis by a physician.