Bonk! Those Dreaded Head Hits

The hard knock life

Hearing that “thunk” or “bonk” is frightening for any parent. But almost all children at some point throughout their development will hit their head. 

It occurs most often early on, 9-15 months with pulling to stand and starting to take first steps. They may fall and hit their head on the floor, the carpet, the sidewalk. It also can occur later on in an injury with sports or in outdoor play.

As parents, we often worry: Did they harm more than the soft tissues of the head? What about a skull fracture or a brain injury? It all starts with an assessment.

Evaluate the injury

1. Assess to make sure your child is conscious. If the child passed out, they need to be medically evaluated.
2. Is there bleeding? If the edge of the skin has come apart, again have the child medically evaluated in the pediatrician’s office or ER. In most cases, head injuries are very minor. The head injury may swell, and the child may develop a "goose egg" or oval swelling on the forehead or scalp. 
3. Assess for bleeding inside the head. Only one or two percent of children who suffer a head injury will suffer a skull fracture. If the child has blurry vision, vomiting that won’t stop, trouble with balance or a headache that is not improved with Tylenol or ibuprofen, he or she should be medically evaluated.

What the doctor needs to know

If your child suffers a head injury, more than a minor injury, give your Methodist Physicians Clinic pediatrician a call. Make sure you have the following information:

• Time of injury
• How the head injury occurred
• Did your child lose consciousness or pass out?
• Did your child vomit?
• How is your child acting now?

If your child is alert and responds to you, the head injury is often considered minor. The child may cry for 10 minutes or more but should be able to be consoled. A cool compress may help with swelling. 

Keeping a watchful eye

If your child has had a minor head injury, your physician may recommend you monitor the child at home. Acetaminophen (Tylenol) may help with a headache. Rest will help as well. Your doctor may tell you to wake the child up several times overnight to make sure he or she is acting appropriately. 

Signs of worsening illness

If your child’s symptoms worsen, it’s time for a trip to the emergency room. What are those signs?

• Child will not stop vomiting 
• Child’s headache worsens
• Child will not stop crying
• Child appears confused
• Child has trouble walking, talking or getting around (different from behavior prior to head injury)
• Child begins to have abnormal movements or seizure activity
• Child becomes more drowsy or difficult to awaken
• Child has fluid or blood oozing from the nose or ears
• Child has blurry vision or ringing in the ears

Will my child get an x-ray?

There has been increasing concern in recent years about radiation risk to children. Before doing an x-ray, the doctor who evaluates your child will look at a number of different factors including: 

• Age of the child
• Loss of consciousness
• Not acting normally
• Severe headache
• Vomiting

These would all be factors that may indicate your child needs imaging. If none of these factors are present, the child may not need imaging. A head CT will look for skull fracture or brain bleed. 

With the head and the brain, it is best to ask questions and if you are concerned about your child, have him or her evaluated. 

Of course, if your child takes a nasty spill or you just need a little guidance after a big ol’ ‘bonk,’ feel free to consult with your Methodist Physicians Clinic provider.