BUMPS-A-DAISY
First Aid – Dr Samantha Mitchell answers questions on what to do when your child suffers a head injury
It is not surprising that minor injuries in
children are common. Our kids have
endless amounts of energy, they love
to explore and they have little sense of
danger. Most head injuries are mild and
rarely result in serious complications or
brain damage. Mild symptoms such as
a bruise, a lump or some nausea are
common. So how do we know when to be
concerned about a head injury in a child?
Do I need to get my child checked after a head injury?
A low force injury such as being hit by a ball or soft toy
producing common symptoms such as a short term
mild headache, nausea or a small bump or bruise,
will not always need any specific treatment and it can
be entirely appropriate to observe your child closely at
home for the next 48 hours (see box). In comparison,
injuries of high force e.g. a fall from a high slide or a
car accident have a higher risk of brain injury.
If you are at all concerned about a head injury, it is
important to get your child assessed by a healthcare
professional as soon as possible. This is particularly
important in a child under one year of age, if there
is a deep cut or any obvious signs of damage, or if
you think your child may have lost consciousness
even for a brief period of time. This assessment
can be performed in an Accident and Emergency
Department. A same-day appointment with the GP
or phone call to NHS direct are also other options.
What should I expect when my child is checked?
A healthcare professional will take a detailed story
about the circumstances of the accident. In a fall from
a slide, for example, the height of the slide will be
relevant in determining the likely degree of damage.
It is normal for a doctor to direct questions both to
you and your child – unfortunately there are cases of
injuries in children caused by abuse and therefore the
doctor will always consider this in their assessment
and you should not feel as though you are being
accused of any maltreatment. Next, your child will be
examined, looking for any signs of brain injury, a skull
fracture or a neck injury.
What should I look out for in the next 48 hours?
If any of the following symptoms should occur
you should seek medical attention:
• Increasing headache: it is normal to have a
mild headache after an injury and some simple
pain killers such as paracetamol can be used
but it is more concerning if the headache is
gradually worsening.
• Drowsiness: it can be normal for your child
to feel like a nap after the injury but they should
sleep normally and wake up fully. If you are
concerned your child seems unusually drowsy
and they have difficulty staying awake when they
would normally be awake, seek medical advice.
• Vomiting: your child vomits twice or continues
to vomit 2-6 hours after the injury.
• Confusion, irritability or strange behaviour:
this includes any problems with reading,
writing, understanding or speaking compared
to usual.
• Dizziness, loss of balance or convulsions (fits).
• Any visual problems: such as double or
blurred vision.
• New deafness: in one or both ears.
• Blood, or clear fluid, leaking from the nose
or ear: Clear fluid might represent cerebrospinal
fluid which surrounds the brain.
• Weakness or pins and needles in an arm
or leg.
Doctors will use clinical judgment and national
guidelines to decide if any test such as a CT
head scan is needed. The doctor will not want to
expose your child to radiation unnecessarily and
most children will not require imaging. Following
assessment, it is most likely your child will be sent
home and you will be given some written advice on
how to monitor your child over the 48 hours following
the injury. Close observation is important because
symptoms of bleeding around the brain or other
damage may not develop immediately after an injury.
When can my child return to normal activities?
It is a good idea to allow your child plenty of rest
following a head injury, avoiding any contact sports
or rough play. Light meals are thought less likely to
contribute to nausea. Your child should not return to
nursery, school or college until you feel they are back
to their normal self or following medical advice.
It is unrealistic to think we can predict or prevent
accidents particularly in children. However, it is
worth thinking about ways to keep your environment
as safe as possible to reduce the risk. One of the
most valuable interventions is to ensure your child
wears a properly fitting helmet for cycling as this will
significantly reduce the risk of serious complications
in the event of an accident.
Dr Samantha C Mitchell, MB ChB nMRCGP
is a GP at St Mary’s Surgery, Bath