When should I seek medical attention for a suspected concussion in a 2-year-old child?

When to Seek Medical Attention for Suspected Concussion in a 2-Year-Old

You should seek immediate medical evaluation for your 2-year-old if she has ANY of the following high-risk features after head trauma: altered mental status or Glasgow Coma Scale (GCS) less than 15, palpable skull fracture, nonfrontal scalp hematoma (bump on side or back of head), loss of consciousness greater than 5 seconds, severe mechanism of injury (such as motor vehicle collision or fall from significant height), or is not acting normally according to you as the parent. 1, 2, 3

Immediate Red Flags Requiring Emergency Evaluation

For children under 2 years of age, the following features indicate your child needs immediate medical assessment and possible CT imaging:

• Altered mental status or GCS score of 14 or less - This carries approximately 4.4% risk of clinically important brain injury 2, 3
• Palpable skull fracture - You can feel a depression or irregularity in the skull 1, 2, 3
• Nonfrontal scalp hematoma - A bump or swelling on the side or back of the head (not the forehead) 1, 2, 3
• Loss of consciousness greater than 5 seconds 1, 2, 3
• Severe mechanism of injury - Such as motor vehicle collision, fall from height greater than 3 feet, or being struck by a high-impact object 1, 2, 3
• Not acting normally per parent - You know your child best; if something seems "off" about their behavior, this is significant 1, 2, 3

Intermediate-Risk Features Requiring Medical Evaluation or Close Observation

These features carry approximately 0.9% risk of significant injury and warrant either medical evaluation or very careful home observation with ability to return immediately if symptoms worsen 2, 3:

• Loss of consciousness between 5 seconds and several minutes 2, 3
• Vomiting (especially if multiple episodes) 1
• Severe or worsening headache 1
• Child not acting normally but still alert 2, 3

When Your Child Can Be Safely Observed at Home

Your 2-year-old can be safely observed at home without immediate medical evaluation if she meets ALL of the following very low-risk criteria (risk of serious brain injury less than 0.02%) 1, 2, 3:

• GCS score of 15 (fully alert and responsive)
• Normal mental status
• No palpable skull fracture
• No nonfrontal scalp hematoma
• Loss of consciousness 5 seconds or less (or none at all)
• No severe mechanism of injury
• Acting normally per parent

This very low-risk classification has been validated in over 4,000 children under 2 years of age with 100% sensitivity and 100% negative predictive value 1, 2

Critical Warning Signs for Deterioration (Days 2-7)

Even if your child initially appears fine, 18% of patients who deteriorate after head injury do so between days 2-7 3. Seek immediate medical attention if any of these develop:

• Worsening headache that doesn't improve with acetaminophen 3
• Repeated vomiting 3
• Increasing confusion or disorientation 3
• Unusual drowsiness or difficulty waking 3
• Seizures 3
• Weakness or numbness 3
• Unequal pupil size 3
• Slurred speech 3
• Significant behavior changes 3

Important Considerations for Young Children

Age under 2 years is itself a risk factor for more serious injury 1, making careful evaluation particularly important in your daughter's age group. Young children may have more prolonged recovery and are more susceptible to catastrophic injury 4.

Common Pitfalls to Avoid:

• Don't assume a small bump on the forehead is harmless - Location matters; nonfrontal hematomas (side or back of head) are more concerning than frontal bumps 1, 2, 3
• Don't dismiss parental concern - "Not acting normally per parent" is a validated clinical criterion because parents know their child's baseline behavior best 1, 2, 3
• Don't wait to see if symptoms improve - If high-risk features are present, seek evaluation immediately rather than observing at home 1

Regarding CT Scans:

CT imaging should not be routinely obtained for all head injuries due to radiation exposure risks 1. However, CT remains the imaging modality of choice when clinically indicated because it rapidly identifies bleeding and fractures without requiring sedation 1, 2. The decision to obtain CT imaging should be based on validated clinical decision rules (PECARN criteria) that balance the small radiation risk against the need to identify serious brain injury 1, 2.