He Fell Out Of Bed and Bumped His Head

This week’s guest columnist is Dr. Rachel Kumar, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Three year-olds sit on barstools.  Three year-olds get the wiggles.  And when you’re in the kitchen making dinner, she does both at the same time.  Then she drops out of sight and you hear a smack and a scream.  You abandon the spaghetti and rush around to find her flat on her back, shrieking at the top of her lungs.

All parents have had this nightmare.  Your child hits his head, screams bloody murder or acts odd in some other way, and you think “do I need to call 911?”  Parents often feel that an immediate assessment is a must.  However, most head injuries don’t require an Emergency Department visit.  Knowing the signs and symptoms of severe head injuries, versus those that can stay home, can save you lots of anxiety, and moolah, on medical bills.

You can simply ask yourself three main questions: What was the mechanism of injury, how was the child immediately after, and how is the child now?  The bad mechanisms- high speed car crashes, getting hit by baseball bats- they’re easy. Get seen!  Likewise, the toddler bonks his head on the coffee table, the car’s rear-ended in a parking lot- stay home!  It’s those in-between patients, like the toddler on the barstool or the baby rolling off the bed, that require some thought.

Here’s the mechanism rules, plain and simple.  If your kid is over two year’s old, it takes a fall from 5 feet or more to generate enough energy for bad head injuries.  Under two years-old: a 3 foot fall.  Use a measuring tape; sometimes we do, to show a parent what three feet looks like.  Is that how high your bed is, we ask?

High energy impacts, like thrown baseballs, swinging bats and golf clubs, also need checking.  Getting hit by a car, whether your kid’s walking or on a bike without a helmet, warrants an ER visit.  Getting hit by a thrown plastic toy- not so much.

Children jump from one couch to another- it’s what they do.  We all, you and me, did it as kids.  Who needs trampoline parks when we all have one at home, whether it’s couches or a room with two beds?  But then the inevitable- young Mary Lou Retton doesn’t stick the landing, stopping the fall with her scalp instead of her feet.

Let’s answer that second question from above: immediately after a head injury, how’s your kid acting?  There’s red flags at this stage that tell us a kid needs medical attention.  Of course, if the child is unconscious, he needs to be seen.  If the child isn’t knocked out, but is acting dazed and talking in a confused manner, that’s worrisome too.  This is the scenario with many football players- they aren’t knocked out, but are staggering around after the blow, can’t remember their plays or what just happened, or  even where they are.

For babies and toddlers, the immediate assessment is more vague.  Of course if after stopping crying, they go back to themselves, walking about and smiling and babbling, you can stay home.  But if they’re acting sleepy, seem more unsteady than usual, or are “just not acting right,” then you should call your doctor, or get seen.

The third question is: how is your child acting now, some time after the injury.  Of course if he goes back to playing and running,it’s cool.  But what if he goes to sleep?  Many kids tend to want to lie down and nap after a traumatic experience and some hard crying, but what’s the line between a normal nap and somnolence from head injury?  If it’s the child’s normal nap time, she takes her usual 30 minute nap and then wakes up, then cool.  But if after a half hour she’s harder-than-usual to wake up, it’s check time.

Other red flags are vomiting after a head injury, or severe headaches.  Children who are squinting and holding their heads hours after a head injury need to get seen.  What about lumps?  Many kids get them, just like characters on Bugs Bunny cartoons, rising from their scalps.  We only worry about lumps on kids under two years-old.  And even then, lumps on foreheads are okay.  Lumps on the sides or back of the head- come on in! 

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