2Head injuries

Active children can fall and have many bangs to the head, but it can often be hard to know whether they are serious or not.

Many head injuries are not serious and simply result in a bump, bruise or small cut.  More serious head injuries can cause brain damage and need to be carefully treated.

Seek urgent medical help immediately if:

• There has been a hard bang to the head, such as falling off something high or at high speed, like a car accident
• Altered consciousness, dizziness, confusion
• Nausea or vomiting after the incident
• Deep wounds or profuse bleeding
• Clear fluid leaking from the eyes or nose, black eyes
• Bruises behind the ears and vision changes
• Obvious swelling or disfigurement
• Difficulty breathing, walking, talking or balancing

Signs and symptoms

The symptoms of head injuries are used to determine how serious it is.  Head injuries can be classified into minor, moderate or serious.

Minor injuries

A minor head injury is when a person:

• Has not lost consciousness
• Is alert or interacts with you
• May have minimal bruising or cuts on their head
• Has normal reactions and behaviour
• Feels mild to moderate pain from the injury

Most children with minor head injury make a full recovery. Most small knocks just cause bruising and pain for a short while.

Treatment of a minor head injury:

• Apply ice or a cool wash to the area injured to help reduce the swelling
• If a child has a minor cut or abrasion, apply a clean dressing  and press on it for about 5 minutes to stop bleeding

Moderate head injuries

• Loss of consciousness for less than 30 seconds
• Not alert and responsive to voice
• Vomiting twice or more
• Headache
• Seizures that may have happened straight after the injury
• Large bruise, lump or cut on the head
• A cut that does not stop bleeding after applying pressure for 5 minutes

Cuts to the head will often bleed a lot but only need medical attention if they don’t stop bleeding, are deep, or in a location that may cause a scarring concern – on the face, for example.

It is recommended to take someone with a moderate head injury to the hospital to be monitored.

After a head injury: the first day or two

• Monitor if the child has a headache. They may just need paracetamol (with parents’ permission) or it may be the sign of something more serious.
• Vomiting: the child may have vomited once but if vomiting continues, go see a doctor.
• Drowsiness.  It is likely the child will be more drowsy and want to sleep after a head injury. It is not necessary to keep them awake if you are confident there is no serious injury sustained. However, be sure wake them every half to one hour until they are no longer drowsy, making sure they have a normal reaction to familiar things.  Ask them the name of their favourite toy, what they ate for breakfast, etc. to see that they have regular brain function.

After a head injury: the next couple of weeks

Head injury symptoms are not always immediate. In fact, in many cases, the effects can be present from internal bleeding for up to a couple of weeks after the head injury is sustained.

Make sure you watch for the following signs and seek urgent medical treatment if any of the following signs are present.

• Any difficulty waking
• Differences in behaviour
• Continued pain
• Irritability and mood swings
• Tiredness
• Lack of concentration

Severe head injuries

• Loss of consciousness for more than 30 seconds
• Is disorientated and does not respond to your voice
• Multiple fits or convulsions at the time of the injury
• Has other significant head injury signs, such as unequal pupils, arm and leg weakness
• Something stuck or protruding from their head
• Bleeding or discharge from the nose or ear
• Unusual or confused behaviour
• Difficulty talking, walking or balancing
• Frequent vomiting
• A persistent headache that is not relieved by paracetamol
• Constant crying in the case of a young child a baby

You should always call an ambulance by dialling 000 immediately if a child in your care has a severe head injury.

Treatment of a moderate or severe head injury

Follow DRSABCD action plan

Make sure you:

• Control bleeding of the head, but do not apply pressure if you suspect a skull fracture
• If you see blood or clear fluid coming from the ear, cover with a sterile dressing and turn patient on their side to drain the ear

If the patient is conscious:

rest in a comfortable position with elevated head and shoulders

If the patient is unconscious:

• Place in the recovery position, lying on their side
• Support head and neck during movement to the recovery position
• Monitor airway and breathing
• If the face is injured or swollen, ensure the breathing airway is open by slightly lifting the chin

Watch this video for more info on managing head injuries

Video provided courtesy of Premium Health