So, we were hanging out at home tonight....I was sitting at the computer and Philip was right next to me on the floor playing with his cars. Well, he went to stand up and lost his balance and fell forward (about a foot) and bust his head on the edge of the bricks of the fireplace. I saw it as it happened and he started screaming immediately. So, I picked him up and there was an immediate purple mark and a huge goose egg. The deal is...I'm a registered nurse. I've been a nurse for 13 years. But head injuries make me a nervous wreck!!!! Especially after Philip already had to stay overnight last year with his skull fractures. I've been down that road...don't want to do it again. (I will say - the "look" of this bump was way worse than that of his skull fracture - for some reason, the skull fracture didn't swell or anything.) Anyway...so I had to call Matt on his cell phone so he could help me make sense of stuff I already know - but I forget in the instance that I stop becoming a nurse and start becoming a scared mommy!! Thankfully, Philip stopped crying, let me put ice on his head and then returned to his normal state of "being Philip". :) When he had his skull fracture - there was a difference. As soon as he stopped crying then he started to lose consciousness and wanted to sleep, and then he started throwing up as we walked into the E.R. Anyway - people ask me a lot about head injuries and when they are "serious". So, I found some really good info online that I thought I would share....
HEAD INJURY SYMPTOMS
A child's behavior and symptoms after a head injury depend upon the type and extent of the injury. The most common signs and symptoms include:
•Scalp swelling — Scalp swelling is common because there are many blood vessels in the scalp. If the skin is not broken, it is common to develop a large lump from bleeding or swelling under the skin.
•Loss of consciousness — Only about 5 percent of children/adolescents with a mild head injury pass out (lose consciousness), usually just for a brief period (less than one minute).
•Headache — Headache occurs in about 20 percent of children/adolescents after head injury. In children who are too young to speak, irritability may be an indication of headache or other discomfort. (See "Patient information: Headache in children".)
•Vomiting — Approximately 10 percent of children/adolescents have at least one episode of vomiting after a head injury. Children who vomit after a head injury do not necessarily have a serious brain injury.
•Seizures — Less than one percent of children/adolescents have a seizure immediately after a head injury. A few of these children have a serious head injury. A CT scan of the head is usually recommended in this situation. (See 'Imaging tests' below.)
•Concussion — The term concussion is used to describe a mild form of traumatic brain injury. Common symptoms of a concussion include confusion, amnesia (not being able to remember events around the time of the injury), headache, vomiting, and dizziness. Loss of consciousness does not always occur.
HEAD INJURY TESTS
Many parents wonder if their child/adolescent needs medical attention after a head injury. The American Academy of Pediatrics recommends that parents contact their child's healthcare provider for advice for anything more than a light bump on the head.
Children with any of the following symptoms need to be evaluated by a healthcare provider since these symptoms may indicate a higher risk of complications. Depending upon the particular circumstances, this may be done over the phone, at the pediatrician's office, or in an emergency department:
•If the child has recurrent vomiting
•If the child has a seizure (convulsion)
•If the child loses consciousness after the injury
•If the child develops a headache that is severe or worsens with time
•If there are changes in the child's behavior (eg, lethargic, difficult to wake, extremely irritable, or exhibiting other abnormal behavior)
•If the child stumbles, or difficulty walking, clumsiness, or lack of coordination
•If the child is confused or has slurred speech
•If the child has dizziness that does not resolve or recurs repeatedly
•If blood or watery fluid oozes from the nose or ears
•If the child is younger than six months of age
•If a cut will not stop bleeding after applying pressure for 10 minutes
•If the child fell from a height greater than five feet, was hit with a high speed object, or was hit with great force
•If the parent/caregiver is concerned about how the child is acting
The goal of the evaluation is to determine if there is serious brain injury. The evaluation can also determine if the child needs immediate treatment, close follow up, or further testing (eg, CT scanning).
HEAD INJURY TREATMENT AT HOME
If the child/adolescent's injury is mild and there are no worrisome signs or symptoms, he or she can be treated and monitored at home. However, if there is any evidence that the injury is more serious, the child should be evaluated in their doctor's office or an emergency department. (See 'Head injury tests' above.)
Rest — Encourage the child to lie down or choose a quiet activity. Allow the child to sleep if desired. It is not dangerous to sleep after a minor head injury (especially if it is nap time), although the parent should monitor the child. (See 'Monitoring after a head injury' below.)
A mild headache, nausea, and dizziness are common, especially during the first few hours after the injury. If the child is nauseous or has vomited, try offering clear liquids (eg, soda, clear juice, gelatin).
Bleeding — If the head is bleeding, clean the area with soap and water and apply pressure to the area with a clean cloth (sterile gauze, if available). Bleeding should stop within 10 minutes. If bleeding does not stop or the cut is large, the child should be evaluated to determine if stitches are needed.
Swelling — Swelling (a large lump or "goose egg") is also common after a head injury. To reduce swelling, an ice or a cold pack can be applied to the area for 20 minutes. Swelling usually begins to improve within a few hours, but may take one week to completely resolve.
Pain — Acetaminophen (eg, Tylenol®) may be given for a headache (table 1). If the child's headache is severe or worsens, the child should be evaluated by a healthcare provider.
MONITORING AFTER A HEAD INJURY
Parents of a child with a head injury are usually instructed to observe their child at home for signs of worsening injury. The parent(s) should call the pediatrician and/or take the child to the emergency department immediately if the child does any of the following:
•Vomits twice or continues to vomit four to six hours after the injury
•Develops a severe or worsening headache
•Becomes more and more drowsy or is hard to awaken
•Is confused or not acting normally
•Has a hard time walking, talking, or seeing
•Develops a stiff neck
•Has a seizure (convulsion) or any abnormal movements or behaviors that worry you
•Cannot stop crying or looks sicker
•Has weakness or numbness involving any part of the body
Waking from sleep — It is not usually necessary to wake the child/adolescent from sleep after a minor head injury. If the healthcare provider recommends waking the child, he or she should be able to wake up and recognize his or her surroundings and parent/caretaker.
Follow up visit — Most healthcare providers recommend a follow up visit or phone call within 24 hours after the injury. This is to ensure that the child is behaving normally, feeling well, and that there are no signs of brain injury.
Return to play — Children and adolescents who have sustained a concussion are at risk for a serious or even fatal complication if they have a second head injury within a short time after the first injury [3]. This is called second impact syndrome.
Any child/adolescent who is suspected of having a concussion should be removed from play (eg, if playing a team sport) and monitored for signs of brain injury [4]. (See 'Head injury symptoms' above.) The child should follow up with a physician before returning to play.
Postconcussion syndrome — A child/adolescent who has a concussion may develop a group of symptoms called "postconcussion syndrome" in the first few days after the injury. Symptoms can include headaches, personality changes (anxiety, irritability), dizziness, or impaired memory and concentration. In 85 to 90 percent of cases, these symptoms resolve within a few weeks to a few months after the injury. There is no specific treatment for postconcussion syndrome.
In a minority of cases, the symptoms may persist for one year or longer. Prolonged symptoms can affect the child or adolescent's school performance and may lead to depression. Thus, it is important that the child's medical team and teachers are aware of the injury and understand that changes in behavior or performance may occur.
FULL ARTICLE: http://www.uptodate.com/patients/content/topic.do?topicKey=~vEAPHNqmCOJqF1t
