Child Falls on His Head- What to Do?

By "his" head I mean 'his' and 'her' too- just couldn't afford the headline to be too long.

Okay, so anyone who has a kid in the house knows how alert you have to be to prevent them from hurting themselves.

It's a 24X7 job.

They run, they jump, they trip- and eventually, they fall!

These falls are very frequent and mostly minor.

Even if they get seriously hurt, we know that it will not be fatal- UNLESS they hurt that one organ that controls all other organs- the BRAIN.

This is exactly why head injuries cause immense panic reactions in parents of kids.

In most instances, the fall is not from a very big height- most commonly being fall from bed, fall from lap while standing, or fall from stairs.

Older children do not hurt the insides of their brains much with such falls, but brain injuries can occur in children less than 1 year age.

95% of kids who visit hospital emergencies after a fall have few minor symptoms like bruise and pain at the injured site- the rest 5% have serious symptoms and life-threatening bleed inside the skull.

If managed timely the incidence of death in head-injury cases attending the emergency department is only 0.2%.

Unfortunately, child abuse is also a common cause of head injuries in children especially age less than 2 years as such small kids cannot resist any force.

When to see a doctor?

Ideally any head injury which worries you, should be seen by a pediatrician- if not in an emergency, at least in the outpatient department.

The sign and symptoms of a bleed inside the skull are very subtle in a child and can be picked up only by a doctor who specialises in children.

Point to note here is that if the injury is due to abuse, the abuser who usually is the care-taker/parent might delay or avoid visiting a doctor in the fear of getting caught.

When to get a CT scan of head done

This decision is best left to the pediatrician who attends the child after the injury but for having some idea of how serious the fall is, you should get a CT scan done within 1 hour of the inury if you see the following symptoms in the child

1. drowsiness or unconciousness

2. any seiure like activity after the fall

3. episodes of vomiting

4. inury which causes depression over the skull

5. loss of memory after the fall

6. fall from height greater than 10 feet or 3 metres

7. leakage of clear fluid from the ear or nose, or darkening around the eyes

8. any child less than 1 year age

If you see any of the above symptoms in the child you probably need a CT scan of brain to look for internal injuries. You should rush to a pediatrician who will advice you whether to go for a scan immediately or after giving some initial treatment.

You should not give the child anything to eat or drink before getting him checked as the child needs to be empty stomach for CT scans.

Are X-rays and CT scans of neck also necessary?

Depends on the symptoms and examination findings by the pediatrician.

Again, the decision is best left to the treating pediatrician who may or may not go for a neck scan but for information purposes, children with the following symptoms usually require a neck scan:-

1. extremely drowsy

2. tingling sensations in arms or legs

3. multiple trauma at different sites apart from the head

4. fall directly on the head as in diving

5. decreased movement of the neck joint

What treatment is usually given for head injuries?

Treatment depends on the nature and amount of internal bleed in the brain.

It ranges from just obervation in a child ward for a day- to admission in a PICU with ventilation- to neurosurgeries where the skull is opened to drain the blood.

You should trust your doctor on the ongoing treatments but should also ask questions to keep yourself updated on the seriousness of injury, the risk to life and the treatment options available.

How to prevent head injuries in children.

Of course, we cannot prevent all such injuries because most of them are accidental, but we can take measures that can decrease the chances of fall or the chances of hurting the head even after a fall.

• use cots with railings on all 4 sides for newborns and children <1 year of age.

• allocating play area on the ground level and not on beds

• not leaving small children unsupervised

• use of helmets and seat-belts for older children while travelling

• use of protective gear like helmet and knee/elbow guards by the older child during cycling, skating, etc

Final words

Head injuries in most cases are not serious but the ones which do cause internal injuries can be fatal if not treated timely.

It is very difficult to interpret signs of serious injury in a child so in any confusion, you should always seek a pediatric opinion.

The first 24 hours are crucial because in many cases the symptoms may be delayed by 6-8 hours.

If the treatment begins early. the chances of recovery is good even in serious cases.

If you have any queries or confusion regarding head injuries in children, please feel free to comment below.

Regards,

Dr. Zeeshan

Click here to know more about me.