outer banks child

Head Trauma

Falling down and getting back up

by Dr. Christian Lige

Between falls, rough play and sports, children can receive plenty of blows to the head in their first 10 to 15 years. A parent’s job is to limit the major accidents through safety precautions and setting limits. Still, we all need to know how to respond when minor and major accidents happen.

When children fall and hit their heads, the severity of the injury normally depends on the mechanism of injury. In other words: how far was the fall and what did the head come into contact with? And we all know that falling onto concrete or hard wood is worse than hitting a soft rug — or that falling 6 feet is a lot farther than 3 feet.

With most falls or blows to the head, the child will end up with a big bump — or ‘goose egg’ — which can form very rapidly where the trauma occurred. This is normal. Apply ice and offer Motrin to relieve pain. The key problems to watch for following trauma are: persistent vomiting and erratic behavior.

With any head trauma an episode of vomiting can be expected, but if such episodes become frequent, immediately take the child to Emergency Room. An ER visit is also required when a child has 15-20 minute interludes of normal behavior followed by abnormal behavior. Parents can also shine a flashlight into their children’s eyes to make sure they are “reactive” (pupils should get smaller with light and larger when the light is withdrawn). If they do not react, or if the eye cannot be rotated through a full circle (360 degrees), then an ER visit is necessary.

Facial trauma normally consists of bruises, scrapes and cuts. Lacerations that need closing can benefit from either stitches or medical glue depending on the cut’s location. Most traumas inside the mouth, including tongue lacerations, will heal on their own without intervention. If a tooth becomes loose or cracked it is important to see a dentist within 24 hours; if a tooth does fall out, place it in milk or back in the socket where it came from and see your dentist right away.

With any trauma it is appropriate to use your doctor’s beeper/phone number and describe the scenario to help avoid unnecessary ER visits. However, the best step you can take is prevention. Set limits to avoid major falls and injuries. And, most importantly, make sure your child wears a helmet while riding bikes, skateboards, rip sticks and all those new toys with wheels — no matter their complaints or excuses. We parents must play an active role to engage our children and set proper examples to keep them safe.

Additional Information

Possible signs of a concussion

• “seeing stars” and feeling dazed, dizzy, or lightheaded
• memory loss
• nausea or vomiting
• headaches
• blurred vision and light sensitivity
• slurred or nonsensical speech
• difficulty concentrating or making decisions
• difficulty with coordination or balance
• feeling anxious or irritable for no apparent reason
• feeling overly tired

Possible signs of an internal injury

• unconsciousness
• abnormal breathing
• serious wound or fracture
• bleeding or clear fluid from the nose, ear, or mouth
• disturbance of speech or vision
• pupils of unequal size
• weakness or paralysis
• dizziness
• neck pain or stiffness
• seizure
• vomiting more than two to three times
• loss of bladder or bowel control

November 1, 2009