What should I do if my baby has suffered a head injury?

Managing a Baby's Head Injury

If your baby has bumped their head, closely monitor them for concerning symptoms and seek immediate medical attention if they show any signs of serious injury such as vomiting, unusual drowsiness, or changes in behavior.

Initial Assessment at Home

When a baby bumps their head, it's important to assess the severity of the injury immediately:

Signs requiring immediate emergency care:

• Loss of consciousness (even briefly)
• Vomiting (more than once)
• Unusual drowsiness or difficulty waking
• Seizures
• Unequal pupil size
• Blood or clear fluid coming from ears or nose
• Significant swelling or depression of the skull
• Changes in behavior (excessive crying, irritability, or lethargy)
• Difficulty breathing
• Inability to move any body part

For minor head injuries:

• Apply a cold compress to the injured area for 20 minutes to reduce swelling
• Monitor your baby closely for the next 24-48 hours
• Wake your baby every 2-3 hours during sleep to check responsiveness

When to Seek Medical Care

The American College of Radiology guidelines indicate that children under 2 years of age are at higher risk for clinically important brain injuries even after minor head trauma 1. The PECARN (Pediatric Emergency Care Applied Research Network) criteria can help determine risk levels:

High-risk factors (require immediate medical attention):

• GCS score of 14 or other altered mental status
• Palpable skull fracture
• Signs of basilar skull fracture

Intermediate-risk factors (consider medical evaluation):

• Loss of consciousness > 5 seconds
• Severe mechanism of injury
• Not acting normally per parent
• Severe headache (in verbal children)
• Vomiting

Research shows that infants under 3 months with minor head trauma who don't meet PECARN low-risk criteria have a 4.2% risk of clinically important traumatic brain injury 2. Even those meeting low-risk criteria still have a small but present risk (0.2%) of significant injury.

Medical Evaluation

If medical care is sought, the evaluation may include:

1. Clinical assessment: Detailed neurological examination
2. Imaging:
   • CT scan is the first-line emergency imaging for suspected significant head injury 1
   • MRI may be used in non-emergency settings for further evaluation 1

The ACR guidelines state that "CT has the advantage of rapid acquisition and excellent sensitivity for acute intracranial hemorrhage and fractures" 1. However, imaging should not be performed routinely for all minor head injuries.

Special Considerations

Infant skull vulnerability

Infants' skulls are more susceptible to injury due to:

• Thinner skull bones
• Open fontanelles
• Larger head-to-body ratio
• Weaker neck muscles

However, research shows that infant skulls can withstand significant force before fracturing 3. When fractures do occur, the pattern can help distinguish between accidental and non-accidental trauma.

Child abuse concerns

If the mechanism of injury is unclear or inconsistent with the injury pattern, healthcare providers may consider the possibility of non-accidental trauma 1. Multiple fractures or unusual fracture patterns may raise suspicion for abuse.

Follow-up Care

After a head injury:

• Continue monitoring for 48-72 hours
• Follow any specific discharge instructions provided by healthcare providers
• Return to medical care if new or worsening symptoms develop

Prevention

To prevent future head injuries:

• Never leave babies unattended on elevated surfaces
• Use appropriate safety equipment (car seats, stair gates)
• Ensure home environment is safe for the baby's developmental stage
• Provide constant supervision during play

Remember that infant head injuries should be taken seriously, as the consequences of missed traumatic brain injury can be severe. When in doubt, it's always safer to seek medical evaluation.