Head injuries in infants and toddlers are common and alarming events for parents, frequently occurring as children learn to crawl, walk, and explore. Young children are susceptible to falls because their heads are disproportionately large and heavy compared to the rest of their developing bodies. While a bump to the head can cause immediate panic, most falls result only in minor injuries. Understanding the specific signs helps parents determine when a simple “goose egg” requires home monitoring and when it signals a need for urgent care.
Initial Assessment of the Head Injury
The first step after an impact is to observe the circumstances of the fall and the child’s immediate reaction. A fall from a significant height, such as a changing table or a bed, carries a higher risk than a trip on a carpeted floor. The speed and mechanism of the injury are important factors in determining the potential severity.
Immediately check the baby’s behavior, noting if they cried right away. Crying immediately after a bump is a reassuring sign, indicating the child did not lose consciousness and their neurological function is intact. If the child remains silent, is slow to react, or has a delayed cry, a thorough medical evaluation is warranted.
Assess the impact site, paying attention to the location of the bump. The forehead is resilient and better able to absorb impact, while injuries to the side or back of the head are more concerning. A large, rapidly forming lump, often called a “goose egg,” is usually a sign of a superficial scalp injury because the area is highly vascular. Conversely, a noticeable dent or depressed area on the skull, or a bulging of the soft spot (fontanelle) when the baby is calm, should be evaluated immediately, as these may indicate a skull fracture or increased pressure.
Critical Signs That Require Immediate Medical Attention
Recognizing red flags that indicate a serious head injury necessitates immediate emergency care. Any period of unconsciousness, even if brief, is a reason to seek medical attention. Difficulty waking the baby or keeping them awake, often described as unusual lethargy or grogginess, is a severe warning sign.
Neurological symptoms demand urgent evaluation, including any instance of a seizure or uncontrolled, jerky movements. Seizures may present as twitching of the limbs or a persistent, unusual staring spell, which can signal irritation or injury to the brain. A severe change in the child’s level of awareness, such as confusion, extreme agitation, or the inability to recognize familiar parents, also requires prompt emergency intervention.
Vomiting is common after a mild head injury, but parents should seek medical care if the child vomits repeatedly (more than once or twice), particularly if the vomiting is projectile or occurs several hours after the injury. Other critical signs involve the eyes, specifically if the pupils are of unequal size or do not react normally to light. The presence of fluid draining from the ears or nose is a severe sign suggesting a fracture at the base of the skull. This discharge may appear clear, like water, or be mixed with blood. In infants, a high-pitched, persistent cry that cannot be soothed is also a concerning symptom that warrants immediate medical assessment.
Home Care and Monitoring for Delayed Symptoms
If the immediate assessment reveals only a minor injury and no critical red flags, the injury can likely be managed at home with close observation. Start by providing comfort and reassurance, then apply a cold compress to the site of the bump for short periods. An ice pack or bag of frozen vegetables wrapped in a thin towel can be used for up to 20 minutes at a time to reduce swelling and discomfort.
For pain management, acetaminophen may be given if the child is not vomiting. Parents should avoid administering aspirin or ibuprofen unless directed by a healthcare provider. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are sometimes discouraged immediately after a head injury due to a potential increase in bleeding risk. Do not use pain medication to mask symptoms that might indicate a more serious injury.
Symptoms of a concussion or internal issue can be delayed, so continuous monitoring is necessary for a minimum of 24 to 48 hours following the incident. During the first night, parents should check on the child every two to three hours to ensure they are easily rousable from sleep and return to a normal state of wakefulness. If the child is unusually difficult to wake, seek immediate medical evaluation.
Parents should watch for subtle changes in behavior that could indicate a delayed symptom, such as increasing irritability, poor coordination, or refusing to eat or nurse. While a mild headache or feeling slightly dazed is common, a persistent or worsening headache requires a call to the pediatrician.