Clinical Reference Systems: Pediatric Advisor 10.0
Spanish version

DESCRIPTION

• history of a blow to the head
• scalp trauma (cut, scrape, bruise, or swelling)

CAUSE

Every child sooner or later strikes his head. Falls are especially common when your child is learning to walk. Most bruises occur on the forehead. Sometimes black eyes appear 3 days later because the bruising spreads downward by gravity.

EXPECTED COURSE

Most head trauma results simply in a scalp injury. Big lumps can occur with minor injuries because the blood supply to the scalp is so plentiful. For the same reason small cuts on the head may bleed profusely. Only 1 to 2 percent of injured children get a skull fracture. Usually there are no associated symptoms except for a headache at the site of impact. Your child has not had a concussion unless there is temporary unconsciousness, confusion, and amnesia.

HOME CARE

1. Wound care

   If there is a scrape, wash it off with soap and water. Then apply pressure with a clean cloth (sterile gauze if you have it) for 10 minutes to stop any bleeding. For swelling, apply ice for 20 minutes.

2. Rest

   Encourage your child to lie down and rest until all symptoms have cleared (or at least 2 hours). Your child can be allowed to sleep; trying to keep your child awake continuously is unnecessary. Just have him sleep near by so you can periodically check on him.

3. Diet

   Only give clear fluids (ones you can see through) until your child has gone 2 hours without vomiting. (Vomiting is common after head injuries.)

4. Pain medicines

   Don't give any pain medicine. If the headache is bad enough to need acetaminophen or aspirin, your child should be checked by a physician.

5. Special precautions and awakening

   Although your child is probably fine, close observation for 48 hours will ensure that no serious complication is missed.

   Awaken your child twice during the night. Do this once at your bedtime and once 4 hours later. Awakening him every hour is unnecessary and next to impossible. Arouse him until he is walking and talking normally. Do this for two nights. Sleep in his room or have him sleep in your room for those two nights. If his breathing becomes abnormal or his sleep is otherwise unusual, awaken him to be sure a coma is not developing. If you can't awaken your child, call your physician immediately. If your child does fine for 48 hours, return to a normal routine.

   It is not necessary to check your child's pupils to make sure they are equal in size and become smaller when you shine a flashlight on them. Unequal pupils are never seen before other symptoms such as confusion and difficulty walking. In addition, this test is difficult to perform with uncooperative children or dark-colored irises.

CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:

• The skin is split open and might need stitches.
• The headache becomes severe.
• Vomiting occurs three or more times.
• Your child's vision becomes blurred or double.
• Your child becomes difficult to awaken or confused.
• Walking or talking becomes difficult.
• Your child's neurological condition worsens in any other way.