Parents' guide to head injuries

October 30, 2019 by Dr Sophie Genoni

About the author: Sophie is a General Practitioner who has previously worked with Night Doctor and now based in the South West, WA. She has an interest in women’s and children’s health and has completed additional training in obstetrics and gynaecology, sexual health and skin cancer surgery. Aside from her clinical work she also teaches medical students at the University of Notre Dame, was formerly a co-opted member of the RACGP WA Faculty Board, and is a current delegate for the RACGP Future Leaders Program.

Artist: @ellieloomes

What is a head injury?

Any knock to the head is considered a head injury.⁹

Head injuries are common in children. In fact, children under 3 years of age have the highest rates of head injury compared to any other age group. Most head injuries in young children are caused by falls (from a bed, couch, pram, change table or stairs), and are usually mild.¹¹ Older children are more likely to have a head injury from sports or car accidents. Mild injuries caused by a bump to the head can include a concussion, bruises or small cuts. More serious injuries include skull fractures, bleeding in the brain or inside the skull, neck injuries, and bigger/deeper cuts.^1,9

What is a concussion?

A concussion is any mild head injury that temporarily alters the way the brain functions.⁹ We do not know exactly why a concussion happens, but it is thought that the impact of a head injury affects how the brain cells (called neurons) communicate with each other.⁶ It is more common in children and adolescents, with 1 in 5 children experiencing a concussion by the age of 10.¹ The symptoms of a concussion vary widely, and they can change over time. Most concussion symptoms will get better on their own over several days, but can take weeks or months to completely resolve in some children.⁹

Common symptoms of a concussion include:²

Body

Headache
Dizziness
Trouble sleeping
Tiredness/fatigue
Balance problems
Nausea
Blurred vision
Lack of appetite

Brain

Slower thinking
Trouble paying attention
Trouble concentrating
Memory problems

Behaviour

Irritability
Depression
Anxiety
Trouble regulating emotions
Personality changes

What do I do if my child hits their head?

If you see your child hit their head, or you think that they may have hit their head, you should take some simple first aid steps:

Check if they are conscious by calling their name or squeezing their shoulders
Call for help or an ambulance
If they are not conscious, check their ABC (airway, breathing, circulation)
If they are lying down, do not move them unless absolutely necessary³

Read this HealthDirect guide to learn more about basic First Aid.

If your child does not lose consciousness and is moving around and acting like their normal self after a knock to the head, they may just have a mild head injury. Treatment for a mild head injury may include:

Observing your child closely
Paracetamol for any headache (do not give your child ibuprofen as it may increase the risk of bleeding).⁹ Learn more about giving your child Paracetamol or Ibuprofen in our Parents guide to Paracetamol and Ibuprofen blog.
Using an ice pack over any swollen or sore areas
Resting from activity³

It is important that you observe your child at home for the first 24-48 hours after a head injury, in case they get worse.⁷

When should I see a doctor if my child hurts their head?

It is common for parents to ask when they should take their child to a doctor after a bump to the head. Most head injuries are mild and often don’t need specific medical attention. However, if you have any worries or concerns about your child’s head injury, or they have any of the features below, you should get them seen by a doctor.

YOU SHOULD SEEK IMMEDIATE MEDICAL ATTENTION BY CALLING AN AMBULANCE if your child has any of the following risk factors or symptoms that could indicate a more serious head injury:

A fall from higher than 1m above the ground
A motor vehicle accident
An assault
They were hit by a projectile (such as a golf ball or cricket ball)
An injury that was not seen by anyone
Loss of consciousness (blackout)^2,3

Unusual or confused behaviour
Severe or persistent headache that does not settle with simple pain relief
Vomiting more than once
Blood or fluid from their ears or nose
Fits or seizures, or spasm of their body parts
Difficulty waking up from sleep, or difficulty staying awake
Neck stiffness
Numbness or tingling in their body parts
Slurred speech
Blurred or double vision^2,3

Even if your child has already been checked by a doctor, these symptoms should prompt you to get them checked again.

Can my child go to sleep after a head injury?

Your child may be a little sleepy after a head injury and want to go to bed. There is no need to keep your child awake if they want to sleep.⁷ If it is their normal bedtime, there is no need to wake them up from their sleep unless you are told to by a doctor.⁹ If they are wanting to sleep outside their normal bedtime, you can gently wake them every 2 hours and check that they respond normally when they are woken.⁷ If you are worried by how sleepy or drowsy your child is after a head injury, or they do not respond normally when you try to wake them, you should take them to a doctor.

What do I need to watch out for in my child after a head injury?

You should remain with your child for the first 24-48 hours after a head injury and watch them closely.⁷ A handy way to remember what to look out for in your child is with the mnemonic HEADBUMPS. If you notice any of these symptoms in your child you should seek urgent medical attention:¹

H - Headache

E - Eye trouble

A - Abnormal behaviour

D - Dizziness

B - Balance problems

U - Unsteadiness

M - Memory problems

P - Poor concentration

S - Something is not quite right

Are children’s head injuries different to adults?

Children and adults have differences in their head and brain anatomy, which makes the injuries they can receive from a head bump different. This is why the advice doctors may give about your child’s head injury may be different to what an adult might be told.

The important differences include:

Their skull bones are thinner, which means they provide less protection to the brain and can fracture more easily.
Their head is heavier for their size, and their neck muscles are weaker, which increases the chance of a neck injury.
Their brain is not fully developed, which means it is more susceptible to being injured.
Their brain has a higher water content which can mean a higher risk of brain swelling from a head injury.
They can lose larger volumes of their blood if they bleed from a head injury.¹¹

When can my child return to school or sport after a head injury?

This is one of the most frequent questions we get asked by parents whose child has had a knock to the head. It is also an important part of managing their symptoms after a head injury, and making sure your child is not put at risk of further injury. Rest from both physical and mental activities is the initial treatment. However, this rest should not be overdone and your child should return to activities as their symptoms improve.¹

Returning to School

Cognitive fatigue is common after a head injury as your child’s brain has to work harder to do activities it can usually do easily. Your child may experience slower thinking, problems concentrating, difficulties with memory, or be slow to understand or respond.⁹ Your child should return gradually to normal school days by following the stages below.¹⁰ They should remain at each stage for at least 48 hours, or until they can complete the activities listed in the stage without their symptoms returning.

1. Rest

Resting at home for brain and body
Only walking as required around the house
No TV, books, mobile phone or iPad

2. Home based activities

Only simple activities such as reading books
Gentle walking around the house

3. School activities at home

Activities such as homework or reading

4. Return to school part-time

Shorter days with increased breaks
Delay school tests or exams

5. Return to school full-time

Gradually increase school activities to a full day

Returning to Sport

It is important to ensure your child is fully recovered from their concussion before returning to sporting games. This is because their concussion can cause slower thinking and delayed reaction times, which can put them at risk of another injury.⁷ If your child has another head injury before they have fully recovered, it may be worse than the first head injury,³ and may put them at risk of long-term cognitive problems.¹ Your child should return gradually to normal sporting activities by following the stages below.¹⁰ They should remain at each stage for at least 48 hours, or until they can complete the activities listed in the stage without their symptoms returning.

1. Rest

Rest at home for brain and body
Only walking as required around the house

2. Home based activities

Gentle walking around the house

3. Light aerobic exercise

Gradually introduce walking, swimming or stationary cycling at low to medium pace
No resistance training or sporting drills

4. Sport specific exercise

Running, warm-up drills and practicing ball skills
No activities that involve head contact

5. Non-contact training activities

Harder training drills
No activities that involve head contact

6. Full training activities

Requires medical clearance to return to full contact training activities

7. Return to sport

Requires medical clearance to return to games

It is important to get medical clearance from a doctor before returning to full contact training and games.

Below is a list of risky activities that your child should avoid while they have a concussion:

Sports that involve tackling or head contact
Sports where you could be hit on the head with a ball
Horse riding
Bike riding (motorbike or BMX)
Skiing, snowboarding or surfing
Scooter, skateboard or rollerblading
Trampoline
Climbing trees or other high structures¹⁰

When should my child follow-up with their GP after a head injury?

If you think your child has a concussion, you should see your GP. They will be able to check your child to make sure it is a concussion and not a more serious problem, and give you advice on their recovery. Your GP may recommend to follow up with them again 1-2 weeks after their head injury to ensure they are recovering.² If your child is not recovering within the timeframe you have been told to expect, you should see your GP again.

References

Australian Family Physician, 2016. Concussive head injury in children and adolescents
Australian Family Physician, 2010. Minor head injuries in children: An approach to management
Better Health Channel, 2018. Head injuries and concussion
New South Wales Department of Health, 2011. Infants and children: Acute management of Head Injury
Perth Children’s Hospital, 2018. Emergency Department Guidelines: Head injury
Queensland Brain Institute, 2018. What is concussion?
Queensland Health, 2019. Emergency Department fact sheets: Minor Head Injury in Children
The Royal Children’s Hospital Melbourne, 2018. Clinical Practice Guidelines: Head injury
The Royal Children’s Hospital Melbourne, 2018. Kids Health Info: Head injury - general advice
The Royal Children’s Hospital Melbourne, 2018. Kids Health Info: Head injury - return to school and sport
The Royal Children’s Hospital Melbourne, 2018. Trauma Service: Head injury

This information is general and may not apply to you or another person. If you have any concerns about your health or the health and wellbeing of a child, consult a doctor or other healthcare professional. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.