Head Injuries in Children: When to Worry

Head bumps are almost inevitable in childhood. Most are minor and heal on their own, but some can be serious. Knowing what to look for helps you respond appropriately—neither panicking over a minor bump nor missing signs of a serious injury.

Understanding Head Injuries AAP

Not all head injuries are the same:

Minor head injury:

• No loss of consciousness
• Brief crying followed by return to normal behavior
• Small bump or bruise
• No other symptoms

Concussion (mild traumatic brain injury):

• Temporary change in brain function
• May or may not involve loss of consciousness
• Symptoms can be subtle and delayed
• Full recovery expected with proper rest

Serious head injury:

• Skull fracture
• Bleeding inside the skull
• Brain contusion (bruising)
• Requires immediate medical attention

Important fact: The size of the external bump does NOT indicate the severity of injury. A large "goose egg" can be minor, while a serious internal injury may show little external sign.

Immediate Response to Head Injuries AAP

Right after the injury:

1. Stay calm—your child takes cues from you
2. Check for responsiveness—is your child alert and responding?
3. Control any bleeding—apply gentle pressure with clean cloth
4. Apply ice (wrapped in cloth) for 20 minutes to reduce swelling
5. Watch closely for the next 24-48 hours

Do NOT:

• Apply pressure to a deep wound or visible skull fracture
• Move child if you suspect neck injury
• Allow child to return to play or vigorous activity
• Give any medication without doctor guidance

When to Call 911 AAP

Seek emergency care immediately if your child:

• Lost consciousness for any length of time
• Is not breathing normally
• Won't wake up or is very difficult to wake
• Has a seizure
• Has clear or bloody fluid from nose or ears
• Has unequal pupils (one larger than the other)
• Is increasingly confused or disoriented
• Has significant bleeding that won't stop
• Shows weakness, numbness, or difficulty walking
• Has repeated vomiting (more than once)
• Shows worsening symptoms over time
• Has a visible skull fracture or depression

Also call 911 for:

• Falls from significant height (8+ feet, or any second-story fall)
• High-speed accidents (car crash, bike crash)
• Infant head injuries (under 12 months)

When to Call Your Pediatrician AAP

Contact your doctor if:

• Your child vomited once after the injury
• Your child has a persistent headache
• Your child seems unusually sleepy (beyond normal tiredness)
• Your child is irritable or acting differently
• The injury occurred in a child under 2
• You're unsure whether the injury is concerning
• Your child has any symptoms that worry you

Don't hesitate to call—pediatricians expect calls about head injuries and would rather hear from you than have you miss something.

Concussion Signs by Age CDC

Symptoms vary depending on your child's age:

Infants and toddlers (under 2 years):

• Won't stop crying or can't be consoled
• Won't nurse or eat
• Vomiting
• Loss of interest in toys or activities
• Changes in sleep patterns
• Loss of new skills (walking, talking)
• More fussy than usual
• Staring or dazed look

Children 2-5 years:

• Headache (may hold head or point to it)
• Nausea or vomiting
• Balance problems, clumsiness
• Sensitivity to light or noise
• Behavior changes
• Sleep changes
• Crying more than usual
• Loss of interest in favorite activities

School-age children:

• Headache
• Nausea or vomiting
• Balance problems
• Vision problems
• Sensitivity to light or noise
• Feeling foggy or groggy
• Concentration difficulties
• Memory problems
• Confusion
• Mood changes
• Sleep problems

The 24-48 Hour Watch Period AAP

After a head injury, monitor closely for at least 24-48 hours:

What to watch for:

• Changes in behavior, mood, or alertness
• Worsening headache
• Repeated vomiting
• Increasing confusion
• Difficulty waking from sleep
• Unsteady walking
• Slurred speech
• Seizures

Sleep monitoring:

• It's okay to let your child sleep—they don't need to be kept awake
• Do check on them every few hours
• It should be easy to wake them
• They should recognize you and be able to have a brief conversation

Activities to avoid during monitoring:

• Screen time (may worsen symptoms)
• Physical activity
• Activities requiring concentration

Concussion Recovery CDC

If a concussion is diagnosed:

Initial rest (first 24-48 hours):

• Rest is important but doesn't mean complete bed rest
• Light activities of daily living are okay
• Avoid screens, reading, and mentally demanding tasks
• Avoid physical activity

Gradual return to activity:

• Follow your doctor's guidance
• Each child recovers at their own pace
• Return to school before return to sports
• Any return of symptoms means scale back

Return to school:

• May need accommodations (reduced workload, breaks, quiet environment)
• Communicate with teachers
• Watch for return of symptoms with mental effort

Return to sports:

• Never same-day return after a concussion
• Follow a step-wise protocol supervised by healthcare provider
• Full clearance required before contact sports

Second Impact Syndrome CDC

Critical warning: If a child who has had a concussion returns to activity before fully healed and suffers another head injury, the consequences can be catastrophic.

Prevention:

• Never return to sports same day as head injury
• Complete full recovery before returning to contact activities
• Follow medical guidance on return-to-play
• When in doubt, sit out

Preventing Head Injuries Safe Kids

Helmets:

• Required for biking, skateboarding, scootering, skiing
• Ensure proper fit (level on head, snug but comfortable)
• Replace after any significant impact
• Replace every 5 years or per manufacturer guidelines

Car safety:

• Proper car seat use reduces head injury risk significantly
• Children in rear-facing seats have the best head protection

Home safety:

• Window guards and safety gates
• Anchor furniture to prevent tip-overs
• Soft corners on sharp furniture edges
• Non-slip mats in bathrooms

Sports:

• Proper technique training
• Appropriate protective equipment
• Following rules of the game

When It's "Just a Bump"

Most head injuries are minor. Signs that it's probably okay:

• Your child cried immediately after the injury
• Returned to normal behavior within 10-15 minutes
• No loss of consciousness
• No repeated vomiting
• No confusion or unusual behavior
• Bump or bruise but no other symptoms
• Eating, playing, and sleeping normally

Even with minor bumps:

• Monitor for 24-48 hours
• Trust your instincts—if something seems off, call your doctor
• Apply ice to reduce swelling

The Bottom Line

Most head bumps in children are minor and heal on their own with comfort and observation. However, any loss of consciousness, repeated vomiting, confusion, worsening symptoms, or concerning behavior warrants immediate medical attention. When in doubt, call your pediatrician—they'd rather hear from a concerned parent than have you miss something serious.

Clara is here to help you understand head injuries and answer your questions about when to seek care!