Clinical Reference Systems: Pediatric Advisor 10.0
- history of a blow to the head
- scalp trauma (cut, scrape, bruise, or swelling)
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
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.
- 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.
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.
Only give clear fluids (ones you can see through) until
your child has gone 2 hours without vomiting. (Vomiting
is common after head injuries.)
- 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.
- Special precautions and awakening
Although your child is probably fine, close observation
for 48 hours will ensure that no serious complication is
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
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