Head Injury, Age 3 and Younger

Topic Overview

Almost all children will bump their heads, especially when they are babies or toddlers and are just learning to roll over, crawl, or walk. These accidents may upset you, but your anxiety is usually worse than the injury. Most head injuries in children are minor.

Head injury occurs more often in young children than adults. When compared with adults:

  • Young children cannot control the movement of their heads as well as adults.
    • Their heads are larger in relation to their bodies.
    • Their neck muscles are not as well developed.
  • Young children's legs are relatively shorter in proportion to the rest of their bodies. This makes a child's center of gravity closer to the head than an adult's center of gravity.
  • Young children are more likely to have an accident or fall as they learn new skills such as walking, running, and jumping.

Bumps, cuts, and scrapes on the head and face usually heal well and can be treated the same as injuries to other parts of the body. A superficial cut on the head often bleeds heavily because the face and scalp have many blood vessels close to the surface of the skin. This bleeding is alarming, but often the injury is not severe and the bleeding will stop with home treatment. See how to stop bleeding. When bleeding does not stop with home treatment, visit a doctor because a young child can lose a large amount of blood from a deep cut on the head.

The most common serious head injuries in young children are caused by falls and abuse (inflicted head injuries). Serious head injuries may involve injuries to the brain. The more force that is involved in a head injury, the more likely it is that a serious injury to the brain has occurred. If there has been a high-energy injury to the head, there is a greater likelihood that a serious injury has occurred. When a high-energy injury occurs, it is even more important to assess the child for signs of a serious head injury.

Shaken baby syndrome is thought to occur when a baby is violently shaken, thrown, or slammed, causing the baby's head to move forward and backward rapidly. This movement causes the brain to hit the sides of the skull forcefully, leading to bleeding in the eyes and injury and bleeding in the brain. Brain injury and bleeding can cause increased pressure in the brain. Increased pressure in the brain can lead to serious, permanent brain damage. Babies who have trouble breathing or who stop breathing during an episode of being shaken, thrown, or slammed may have more brain damage.

Following an injury, it can be difficult to tell the difference between a mild traumatic brain injury (concussion) and a more serious brain injury. Watch the child carefully for 24 hours after a head injury to see whether he or she develops any signs of a serious head injury.

When a head injury has occurred, look for injuries to other parts of the body. The alarm of seeing a head injury may cause you to overlook other injuries that need attention. Difficulty breathing, shock, spinal injuries, and severe bleeding are all life-threatening injuries that may occur along with a head injury and require immediate medical attention. Injuries to the spine, especially the neck, must be considered when a head injury has occurred.

Many head injuries can be prevented. Use car seats, seat belts, helmets, and make your home safe from falls to prevent an injury. Establish good safety habits early so your child will continue them when he or she is older.

Use the Check Your Symptoms section to decide if and when your child should see a doctor.

Check Your Symptoms

Home Treatment

Any child who has hit his or her head should be watched for several days after the injury. Home treatment can help relieve swelling and bruising of the skin or scalp and pain that occurs with a minor head injury.

  • If your child had an accident, try to remain calm and speak to your child in a calm, relaxed voice. This will help reduce your child's fear and allow you to assess the situation.
  • If your child has a cut that is bleeding, apply firm pressure directly over the cut with a clean cloth or bandage for 10 minutes. See how to stop bleeding. If the cut is deep and may have penetrated the skull, emergency treatment is needed.
  • Check for injuries to other parts of the body, especially if the child has fallen. The alarm from seeing a head injury may cause you to overlook other injuries that need attention.
  • Apply ice or cold packs to reduce the swelling. A "goose egg" lump may appear anyway, but ice will help ease the pain. Always keep a cloth between your child's skin and the ice pack. Do not apply ice for longer than 15 to 20 minutes at a time, and do not let your child fall asleep with the ice on his or her skin.

If your child is seen by a doctor

Be sure to follow the instructions given to you by your child's doctor. You may need to watch your child closely for the next 24 hours or longer. Here are some general instructions:

  • Check for the following signs of problems from a head injury every 2 hours for the next 24 hours. Call 911 or go to an emergency room immediately if you notice changes and cannot wake your child (unconsciousness). Seek medical care if your child has any symptoms of a serious head injury, such as:
    • A significant change in the child's level of consciousness
    • Confusion or not acting normal, such as extreme fussiness or crying that cannot be comforted
    • Abnormally deep sleep, difficulty waking up, or extreme sleepiness
    • Vomiting
    • Symptoms that affect one side of the body more than the other side, such as weakness or problems moving an arm or leg
    • Loss of vision in one or both eyes, changes in the size or shape of the pupils and the reaction to light or abnormal eye movements, such as jerking motions or the eyes not working together
    • Seizure
    • Fever
  • Continue to check on your child often during the night. If your child had a head injury right before going to bed or taking a nap and falls asleep soon afterward, check him or her for changes in color or breathing, or twitching arms or legs. You do not need to try to wake your child unless you notice changes.
  • Do not give any medicine, including nonprescription acetaminophen, such as Tylenol or Panadol, to a child you are watching for signs of a more serious head injury unless your doctor tells you to.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your child's symptoms if any of the following occur during home treatment:

  • Moderate bleeding has not stopped after 10 minutes of direct pressure.
  • Bruising or discoloring develops around the eyes, behind the ears, or on the scalp.
  • Moderate to severe swelling develops on the face or scalp.
  • Any of the following symptoms develop:
    • A significant change in the child's level of consciousness
    • Confusion or not acting normal, such as extreme fussiness or crying that cannot be comforted
    • Abnormally deep sleep, difficulty waking up, or extreme sleepiness
    • Vomiting
    • Symptoms that affect one side of the body more than the other side, such as weakness or problems moving an arm or leg
    • Loss of vision in one or both eyes, changes in the size or shape of the pupils and the reaction to light or abnormal eye movements, such as jerking motions or the eyes not working together
    • Seizure
    • Fever
  • Your child's symptoms become more severe or more frequent.

Prevention

Each new learning stage for your baby requires increased attention on your part to prevent an injury. It may surprise you how fast your baby can move from one stage to the next. Being aware of your baby's abilities and what skills he or she is likely to develop next will help you prevent injuries.

Always be gentle with your baby. It is important to protect your baby from a brain injury. Shaking or slapping a baby in anger can cause an injury to the brain. If a baby has been shaken or slapped, it is your responsibility to notify your doctor.

Be aware of your baby's risk of falling. Watch your baby carefully.

  • Never leave your baby alone in high places, such as on a tabletop, in a crib with the sides down, or even on a bed or sofa.
  • Do not leave your baby alone in any infant seat or "sitting" toy, such as a swing or jumper. Use all the safety straps provided.

Take steps to prevent falls:

  • Use stair gates to block stairways. Use gates at the top and bottom of the stairs, and use the gates properly.
  • Do not use baby walkers. Walkers have caused many injuries and are not safe even if the baby is watched closely.
  • Keep your baby away from elevated porches, decks, and landings.
  • Watch your toddler when he or she is outside. Uneven grass, sloping lawns, and hills may increase your toddler's risk of falling.
  • Make your home safe from falls by removing hazards that might cause a fall.

Practice good safety habits early so your child will continue them when he or she is older:

  • Place children in an approved child car seat when traveling in a motor vehicle. Follow the manufacturer's directions for installing and securing the seat.
  • Have your children wear helmets whenever necessary, such as when they are passengers on a bike or riding a tricycle on their own.
  • Set a good example by always using your seat belt when traveling in a motor vehicle. Wear a helmet and other protective clothing whenever you are biking, skateboarding, skiing, motorcycling, skating, kayaking, horseback riding, or rock climbing.
  • Do not keep guns in your home. If you must keep guns, lock them up and store them unloaded and uncocked. Lock bullets in a separate area.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your child's condition by being prepared to answer the following questions:

  • When and how did the injury occur?
  • How did your child act after the head injury?
  • Did your child cry immediately after the injury?
  • What are your child's main symptoms? How long has your child had symptoms?
  • Has your baby had a previous head injury? Does your child have any continuing problems because of the previous injury?
  • What object caused the injury? Was there or is there an object in a cut on the head?
  • Was this injury intentionally caused by another person?
  • What home treatment measures have you used to treat the head injury?
  • If a cut or scape occurred, is your child's tetanus immunization up-to-date?
  • Was the use of alcohol or drugs by a caregiver involved in your child's injury?
  • Does your child have any health risks?

Related Information

Credits

Author Jan Nissl, RN, BS
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Tracy Landauer
Primary Medical Reviewer Michael J. Sexton, MD - Pediatrics
Primary Medical Reviewer Steven L. Schneider, MD - Family Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Specialist Medical Reviewer Adam Husney, MD - Family Medicine
Last Updated July 9, 2008

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