Discharge Instructions for Parents of Pediatric Patients with Minor Head Injury and No Intracranial Hemorrhage
Parents of pediatric patients with minor head injury and no evidence of intracranial hemorrhage should be provided with comprehensive discharge instructions that include warning signs of serious injury, expected symptom course, activity management guidelines, and clear follow-up instructions. 1
Key Components of Discharge Instructions
Warning Signs Requiring Immediate Medical Attention
- Worsening headache
- Persistent or worsening dizziness
- Vomiting (especially if repeated)
- Confusion or altered mental status
- Difficulty walking or worsening balance
- New weakness or numbness
- Seizures
- Excessive drowsiness or difficulty waking
- Unequal pupil size
- Slurred speech
Expected Course of Symptoms and Recovery
- Explain that most children with minor head injuries recover completely within 1-3 months 1
- Common symptoms may include headache, dizziness, fatigue, and mild concentration difficulties
- Reassure parents that these symptoms typically improve gradually over days to weeks
Monitoring Instructions
- Observe child for first 24-48 hours after injury
- Regular checks during sleep may be warranted for the first night (without necessarily waking the child)
- Monitor for any new or worsening symptoms
Activity Management
- Recommend relative rest for the first 24-48 hours after injury 1
- Following these initial days, gradually resume normal activities that don't worsen symptoms 1
- Monitor symptom expression (number and severity) during activity resumption
- Avoid activities with high risk of another head injury until fully recovered
Return to School Guidelines
- Consider a gradual return to school with accommodations if needed
- Communicate with school about the injury and potential temporary needs
- Limit screen time and cognitive demands initially if they worsen symptoms
Return to Play/Recreation Instructions
- No return to contact sports or high-risk activities until completely symptom-free
- Follow a stepwise return to physical activity:
- Light aerobic exercise (walking, swimming)
- Sport-specific exercise without impact
- Non-contact training drills
- Full-contact practice after medical clearance
- Return to competition
Prevention of Further Injury
- Proper helmet use for activities like biking, skating, and sports
- Emphasize safety measures appropriate for the child's age and activities
- Avoid situations with risk of falls or collisions until fully recovered
Follow-Up Instructions
- Provide clear instructions on when to follow up with primary care provider
- Typically within 2-3 days for initial follow-up 2
- Consider referral to specialists if symptoms persist beyond 2-4 weeks
Special Considerations
Age-Specific Guidance
- For very young children who cannot clearly communicate symptoms, parents should watch for:
- Changes in eating or sleeping patterns
- Unusual irritability or crying
- Loss of interest in favorite toys or activities
- Balance problems or changes in walking
Documentation
- Provide written discharge instructions that cover all the above points
- Consider using standardized concussion information sheets
- Document that instructions were reviewed with and understood by parents
Medication Guidance
- Acetaminophen may be used for pain management
- Avoid NSAIDs initially (first 24 hours) due to theoretical bleeding risk
- Avoid sedating medications that might mask neurological changes
The CDC guidelines emphasize that standardized discharge instructions provide significant benefit for pediatric mild TBI outcomes 1. While the occurrence of delayed diagnosis of intracranial hemorrhage is rare in children with uncomplicated minor head injuries 3, proper education ensures parents can identify concerning symptoms promptly if they develop.
By providing clear, comprehensive discharge instructions, healthcare professionals can help ensure appropriate home monitoring and timely medical follow-up, which are essential for optimal recovery from pediatric minor head injuries.