From the Research
Return to the emergency department immediately if your child shows any of the following warning signs after a head injury: persistent or worsening headache, repeated vomiting, increasing confusion or unusual behavior, difficulty waking up or excessive sleepiness, seizures, weakness or numbness in any part of the body, problems with balance or coordination, slurred speech, or if one pupil becomes larger than the other. These warning signs could indicate a more serious injury requiring prompt medical attention, as suggested by the study on injury patterns after falling down stairs 1. Also, seek immediate care if your child develops clear fluid or blood draining from the ears or nose, or if symptoms worsen rather than gradually improve. While most children recover well from minor head injuries without needing imaging like CT scans, it is essential to monitor their condition closely, especially after a significant fall like 20 stairs, as the risk of traumatic brain injury increases with the height of the fall 1. In the meantime, you can give acetaminophen (Tylenol) for pain relief according to the age-appropriate dosing on the package, but avoid ibuprofen or aspirin as they may increase bleeding risk. For the first 24-48 hours, check on your child periodically, including once during the night, but complete awakening every hour is unnecessary and may hinder recovery through disrupted sleep. It is crucial to be aware of the potential long-term effects of traumatic brain injury, including behavioral and psychiatric symptoms, as highlighted in the study on behavioral and psychiatric symptoms in patients with severe traumatic brain injury 2. However, the most critical consideration is the immediate risk of severe injury, and the warning signs mentioned above should be prioritized when deciding whether to return to the emergency department. The study on head trauma from falling increases subsequent emergency department visits more than other fall-related injuries in older adults 3 also emphasizes the importance of close monitoring after a head injury. Overall, prioritizing the warning signs and seeking immediate medical attention if necessary is the best course of action to ensure the child's safety and well-being. Some key points to consider include:
- The height of the fall increases the risk of severe traumatic brain injury 1
- Warning signs such as persistent or worsening headache, repeated vomiting, and increasing confusion or unusual behavior require immediate medical attention
- Close monitoring of the child's condition is essential, especially in the first 24-48 hours after the injury
- Acetaminophen (Tylenol) can be used for pain relief, but ibuprofen or aspirin should be avoided due to the risk of bleeding 4.