Dr. Reddy's Pediatric Office on the WebTM

Head Injury

If you are reading this because your child has injured his/her head, READ THIS PART FIRST. If your child: CALL YOUR DOCTOR OR TAKE YOUR CHILD TO THE NEAREST EMERGENCY ROOM NOW.

Children who have bumped their heads -- in whatever way, and for whatever reason -- are among the most common visitors to pediatricians' office, after-hours clinics, and emergency rooms. In some cases the resulting head injury is serious, and the child needs immediate treatment. In others, a child may have to be observed in the emergency room or the hospital for a while to make sure that there will be no late-appearing problems. In some cases, though, you as parents can watch the child at home, as long as you know what signs to watch for that indicate that your child needs to be seen by the doctor. The safest thing to do if your child has bumped his/her head is to call your doctor and describe the injury and how your child is acting. Your doctor can then give you more specific advice on what to do and what to watch for.

Open Head Injuries

Common sense should tell you what to do here. An injury that has damaged the skin of the scalp, whether or not the skull has been damaged, should be examined in the emergency room. Small tears in the skin may not need any more treatment than a bandage, but large lacerations may need to be sutured. (Actually, many of us close scalp lacerations with "super glue" -- which was developed as a way to close lacerations without needles, not to hang trucks from helicopters. Surgical staples, which are easier and faster to put in and easier and faster to take out than stiches, are also often used. The staples tend to leave more of a scar than stitches, but under a full head of hair the scar doesn't matter. And no, the staples do not go into the skull...)

Closed Head Injuries

When the skin has not been broken by the injury, it's a little harder to decide how bad the injury is. In these cases, unless the description of the injury makes me believe that the injury is minor and the child is acting completely normally, I tend to err on the side of caution and ask the parents to bring the child in to be seen, either in the office or in an After-Hours Clinic. The questions I ask when I'm deciding whether to see the patient include:

When I examine a child whose head has been injured, I usually pay attention to the signs I've listed above. I do a complete neurological exam as well, to look for other signs of brain injury. We probably do far more CT scans on children who have bumped their heads than we should be doing; a study published in The Lancet, on September 15, 2009, suggests that a child (younger than age 18 years) with a head injury, who is less than 2 years old and

or is 2 years old or older and does NOT need a CT scan. If the child is behaving normally, remembers the injury, and shows none of the signs I've mentioned, I will usually send him/her home -- with these instructions for Mom and Dad:

This sounds -- and is -- pretty time-consuming, but it may be a lot better than spending 24 hours in the hospital. Usually, if there are no problems in the first 24 hours after an injury, the child will be fine. Occasionally, there may be a problem that crops up later, but keeping an eye on your child and calling your doctor if any changes occur should guard against any late effects of the injury.

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PLEASE NOTE: As with all of this Web site, I try to give general answers to common questions my patients and their parents ask me in my (real) office. If you have specific questions about your child you must ask your child's regular doctor. No doctor can give completely accurate advice about a particular child without knowing and examining that child. I will be happy to try and answer general questions about children's health, but unless your child is a regular patient of mine I cannot give you specific advice.

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Copyright © 1998, 1999, 2000, 2005, 2007, 2009, 2013 Vinay N. Reddy, M.D. All rights reserved.
Written 04/12/98; last revised 09/12/13 counter