When should your child see a doctor for a bump on the head?

From a countertop at just the right height to a fall on the playground, there are all kinds of ways children can take a bump to the head, especially toddlers. Goose eggs, a knot on the head, bruises and complaints of a headache leave parents wondering if that bump on the head is worthy of a call to the doctor.

Dawn D. Johnson, M.D., Medical Director of Children's Health℠ Pediatric Group says it's good for parents to be aware that a bump on the head could result in a concussion or other head injury. However, in most cases and especially in toddlers, it doesn't.

"Head bumps due to falls are most common in preschool-aged children. This is because they have a disproportionately large head, are developing muscle coordination and have an inadequate sense of what is a potentially dangerous activity" she explains. "Fortunately, their falls are also the least likely to cause serious head or brain injury."

School-aged children and adolescents are more likely to have head trauma related to higher impact activities such as sports; bicycle, skateboard or all-terrain vehicle accidents; and motor vehicle or motor vehicle/pedestrian accidents than toddlers. These accidents are more likely to cause serious and even life-threatening brain injuries.

Whether your child is a curious toddler or an active adolescent, it’s important to take steps to prevent head injuries and recognize when a bump on the head requires medical evaluation.

When to see a doctor for a bump on the head

When your child bumps their head, there are signs to watch for to determine when to worry and call the doctor. Remember that young children can't communicate well, so if in doubt, trust your instincts and call the doctor. For babies under 1, consider calling the physician if there is:

• A bulging soft spot on the top of the head
• More than expected swelling or bruising
• More fussiness or sleepiness than normal
• Vomiting
• Loss of consciousness or ‘fainting’ immediately after hitting their head

Red flags to watch for in older children include:

• Loss of consciousness or fainting after bumping their head
• Confusion, such as not knowing where they are
• Memory loss 
• Persistent or increasing dizziness
• Nausea or vomiting
• Sleepiness that is beyond expected
• A change in behavior – this may be subtle, your child is just not acting normally
• Persistent head or neck pain 

"Signs that should prompt you to seek medical advice usually develop in the first 24 hours after the injury, but rarely symptoms can occur as much as 72 hours after head trauma," Dr. Johnson explains. “So, it is important to watch for warning signs that may indicate a serious injury.”

For any fall, monitor the child carefully for the next 24 hours. It's okay to wake the child once or twice during the night or during a nap to make sure that he or she wakes easily and is acting normally. However, it is not necessary to prevent a child from taking a nap or falling asleep after a head injury.

Preventing bumps on the head

You can't prevent every accident, but you can reduce the risk of them happening, starting with age-appropriate adult supervision. You can reduce the risk of accidents for infants and toddlers by:

• Using appropriate-sized crib and bed
• Removing things they can climb on
• Childproofing edges and corners around your home
• Blocking off or keeping kids away from stairs and steps
• Not leaving them alone on couches or beds
• Properly installing appropriately sized car seats

Older kids should be educated about safety precautions and appropriately supervised when crossing the road and in parking lots. They should use age-appropriate restraints in vehicles and helmets when riding bikes or playing sports and demonstrate understanding of good driving habits before being allowed to drive alone. If they are involved in organized sports, be sure that the coaches, school or sport club has a well-defined concussion protocol. If there are any signs of a serious head injury or concussion, it is important that your child is evaluated by a medical professional.   

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