Welcome to The Art of Patients, I’m Dr Golly and today we’re talking mild head injuries in children and teenagers – and when these can be safely managed at home.
Across Australia, every year, more than 15,000 children and young people – mostly boys – are admitted to hospital for a head injury from sport, accidents or falls. They’re really common, so it’s helpful to know whether a trip to your GP or Emergency Department is actually needed.
And before we go on, if the mechanism of head injury is traumatic, like being involved in a car accident or falling from a big height, then this needs urgent medical review. Furthermore, if you’re worried at any point – then you must go and have the injury checked. If you’re not sure whether or not you should worry – then this is for you… Let’s jump to the whiteboard and take a quick look at what happens when the head gets injured.
Despite three-quarters of the human brain being comprised of water, we have over 100 billion brain cells – or neurons – crammed inside, with information travelling down these neurons at speeds greater than 400km/h. This incredibly complex system of wiring is very precious, so to protect it from injury, the brain actually floats in a clear liquid – called cerebrospinal fluid, or CSF for short, which acts as a cushion when the head moves around.
Sometimes, a direct head impact can overwhelm this CSF cushion and cause a traumatic brain injury – which we classify as mild, moderate or severe. Today, we’re going to discuss mild head injuries, but if you’re in doubt – see a doctor.
If your child topples off a table, bumps the bath-edge or falls on the footy field, they’re most likely to have suffered just a mild head injury. This is where your child has not lost consciousness, is alert and interactive, may have vomited – but only once – and despite a small cut or bruise – is otherwise normal.
Most children with mild head injuries are ok to stay home and will make a full recovery. They don’t need to be rushed to the doctor and seldom require more than a little pain relief. Now they might be sleepier after the knock and there’s no need to keep them awake. But close supervision is the key.
You should check their condition every half to one hour, even if it’s the middle of the night – wake them and ask if they know where they are. If you have any difficulty waking your child following a head injury, if they continue to vomit, can’t get pain relief from regular paracetamol alone, display any abnormal behaviours or movements, have bleeding or discharge from the ear or nose or if you’re worried at any time, get them seen by a doctor immediately.
A common question we get from mums and dads out there – is about protective equipment.
Well, the most important protection is a simple mouth-guard. Helmets are absolutely necessary if your child enjoys skateboarding or riding a bike – where head trauma usually involves a hard surface. On the sporting field though, helmets may actually WORSEN the risk of concussion and – it’s not just because the player feels a sense of invincibility and might go in harder than normal, it’s because a helmet adds EXTRA weight to the head, potentially increasing the damage done if it snaps forward or backward suddenly.
So remember, a mild head injury is when your child never lost consciousness, is alert and interactive, vomited no more than once – and despite a small cut or bruise, is otherwise normal. These bumps can be managed at home with close, regular supervision, but if you notice any of the signs and symptoms we covered before – or if you’re worried at any point – then have them seen by your GP or Emergency Department.