Head Injury

Introduction Audio

Most head injuries are not serious and simply cause a bump or a bruise to the head or face.
If your child’s head is bleeding, apply pressure for 5-10 minutes. If it continues to bleed, they may need to have it glued (stitches are very rarely required). This can usually be done in a minor injuries unit, an urgent treatment centre or a walk in centre. Some GPs also assess and treat minor injuries.
A significant head injury can result in concussion. A child or young person does not have to have been unconscious, or “knocked out” for concussion to occur. Common symptoms of concussion include headache, fatigue, poor sleep and difficulty concentrating.

Please see Red-Amber-Green tables for advice on when and where to seek care for your child.

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When should you worry?

RED

Red Audio

If your child has had any of the following in the 48 hours following their head injury:

The head injury was high impact for example:
- A road traffic accident
- Fall from a height of more than 1 metre (more than the child’s own height, or more than 5 stairs)
A bruise, swelling or cut more than 5cm on the head
Vomits 3 times or more (at least 10 minutes between each vomit)
Behaves oddly, becomes confused or unaware of their surroundings
Loses consciousness, becomes drowsy or difficult to wake
Has a convulsion or fit (uncontrolled jerking, twitching movements)
Has difficulty speaking or understanding what you are saying
Has weakness in their arms and legs or starts losing their balance
Has new problems with their eyesight
Has clear fluid coming out of their nose or ears
Bruising around their eyes or behind their ears
Does not wake for feeds, is irritable or cries constantly and cannot be soothed
Has memory loss of events before or after the injury
Takes blood thinners or has a bleeding or clotting disorder

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or call 999 - dial 999.

AMBER

Amber Audio

If your child has had any of the following in the 48 hours following their head injury:

Has a headache that doesn’t go away or gets worse (despite painkillers such as paracetamol or ibuprofen)

You need to contact a doctor or nurse today.

Please contact your GP surgery or call NHS 111 - dial 111.

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.

AMBER

Green

Green Audio

If none of the above features are present

Is alert and interacts with you
Vomits, but only up to twice
Experiences mild headaches, struggles to concentrate, lacks appetite or has problems sleeping. If you are very concerned about these symptoms or they go on for more than 2 weeks, make an appointment to see your GP
Watch them closely for any change and look out for any red or amber symptoms
If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.

Self care

Continue providing your child’s care at home. If you are still concerned about your child, speak to your health visitor, local pharmacist or call NHS 111– dial 111.

Self care and Prevention

What should you do immediately?

In general, if your child cries immediately after a head injury and returns to their normal self in a short time, they can be managed at home.
Hold an ice pack (or a bag of frozen peas in a tea towel) to the area regularly for short periods to bring down any swelling.
You should observe them closely checking that they are responding normally to you.
You should:
- Make sure you or another adult stays with your child for at least the first 24 hours after a head injury
- You do not need to keep your child awake as it may make them irritable and bad tempered
- Allow your child to sleep as normal. We would encourage you to check on them a couple of times overnight to check:
  - Do they appear to be breathing normally?
  - Are they sleeping in a normal posture?
  - Do they make the expected response when you rouse them gently? (E.g. pulling up sheets, cuddling teddy-bear)
  - If you cannot satisfy yourself that your child is sleeping normally, then wake them fully to check.
  - Keep a regular sleep routine going to bed and waking at the same time each day

What should you do in the first few days?

For the first couple of days after a bump to the head it is normal for your child to:
- have a mild headache
- feel sick and not want to eat
- have difficulty concentrating
- feel more tired than usual
Encourage them to drink plenty of clear fluids and try a little food.
Allow them to play as normal but encourage quiet play and avoid strenuous activity until their symptoms have settled.
Avoid loud noise, TV and computer games.
Increase activity as symptoms improve at a manageable pace.
Give them Paracetamol and, or Ibuprofen if they are in pain.

Return to normal activities

Most children only need 24 to 48 hours of rest before they are able to return to light day to day activities.

They can return to school once they are symptom free but may need to start gradually with regular breaks.

Avoid rough play and contact sports for 3 weeks.

Concussion following a head injury

Symptoms of concussion include mild headache, feeling sick (without vomiting), dizziness, bad temper, problems concentrating, difficulty remembering things, tiredness, lack of appetite or problems sleeping. This can last for a few days, weeks or even months. Some symptoms resolve quickly whilst others may take a little longer.

Concussion can happen after a mild head injury, even if they haven’t been “knocked out”.

9 out of 10 children with concussion recover fully. Some can experience long term effects, especially if they return to sporting activities too quickly. It is really important that your child has a gradual return to normal activities.

It is best to avoid computer games, sporting activities and excessive exercise until all symptoms have improved.

If you are very concerned about these symptoms or they last longer than 2 months, you should seek medical advice from your doctor.

Here is a leaflet on returning to normal activities after concussion.

Return to sport

Repeated head injury during recovery from concussion can cause long term damage to a child’s brain.

Expect your child to stay off sport until at least 2 weeks after symptoms have fully resolved.

Speak to your child’s school and sports club about a gradual return to full activity.

Further information on return to sport:

Rugby

Football

How long will your child’s symptoms last?

Your child is likely to return to normal within a few hours of a minor head injury.

In the few days following a more significant head injury, your child may experience mild headaches, might be irritable, may struggle to concentrate, may lack appetite and may have problems sleeping. If these symptoms go on for more than 2 weeks, make an appointment to see your GP.

For more information

Visit The Children's Trust website. They are the UK's leading charity for children with brain injury. They deliver rehabilitation, education and community services through skilled teams who work with children and young people, and their families children’s brain injury trust links.