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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


The Royal Society for the Prevention of Accidents:

Safe Kids: NHS Advice: Pages/Symptoms.aspx

Great Ormond Street Hospital information sheet: information_sheets/head_injury/head_injury_ families.html#children