Baby Fall, Go Boom!

This week's guest columnist is Dr. Marc Fernandez, a Family Practice resident at the University Hospital and Clinics here in Lafayette. Bumps, scrapes, and bruises can be found on the scalp of any active child, some so much they look like a scuffed shoe.  Kids explore and lead with their big heads, so it comes with the territory. Usually it's easy to know when a scalp bump can be cured with a mommy's kiss.  These are the minor boo-boos from flying soccer balls or cups thrown by grumpy siblings. It's also not hard to know when a more traumatic blow requires an Emergency Room visit. It's an easy decision if your child gets knocked out cold by a baseball bat, or is in a high-impact traffic collision. These obvious ones you bring to the hospital. What about those in-between injuries:  the short falls on the head from a tree branch, the heavy tackles at football practice, the head-on sprints into an invisible glass door? Even if toddlers cry for a couple of minutes after a smack to the crown, or teens seem a little confused after a soccer ball to the head, they're usually soon skipping around like nothing happened. However, every parent has heard stories from someone they know, or about a celebrity, who seemed fine after a head injury, didn't go the hospital, and then didn't wake up the next morning.  These tales will make any parent rush the kid in with the teensiest knock on the noggin. Fortunately we now have scientifically valid criteria to evaluate those in-between cases, to decide who needs a brain scan and who doesn't: -Does your child complain of a really bad headache, or seem confused? -Was he knocked out? -Is she vomiting? -Did he fall from over 5 feet up, or have another high-impact injury to the head (like a thrown baseball)? These are the kids who need to get seen, but these criteria apply to kids 2 years-old and up.  What about the smaller fry? Babies and toddlers fall a lot.  Even before babies can sit up, they will roll.  Off the bed. They tumble out of car seats and strollers.  Then when they first start walking, toddlers look like high-wire artists, weaving about with their arms out for balance, everyone around wondering, will he fall, won't he?  Then the toddler learns to run, and is not deterred by walls or coffee tables. Like minor head injuries in older kids from above, it's usually easy to tell which baby or toddler is okay.  She bonks her head on the coffee table, cries for a minute, and then gets up and runs after the cat.  Baby flops out of the car seat that is on the floor, scrapes his forehead, then goes back to wiggling and cooing, and nurses fine. So when do we worry?  Our high-risk criteria for older kids we discussed above don't seem to apply to the littler ones.  How can you tell if baby has a bad headache, or is "confused?"  And many babies vomit daily, whether they hit their head or not.  For these reasons we have separate rules for head injuries involving kids under 2 years-old: -Does baby have a large bump anywhere on the scalp, except the forehead?  Forehead bumps are allowed, since that is where the skull is hardest, designed for the most common, front-end impacts. -Did the child lose consciousness for more than 5 seconds?  Many toddlers are temporarily dazed after smacking their heads, so we give them 5 seconds to recover their wits. -Is the child acting normally, or is he more sluggish or more fussy? -Did baby fall from more than 3 feet, or have a similarly traumatic blow? Note that vomiting is not on the list for babies and toddlers.  Some toddlers will vomit when they cry really hard, and many babies spit up randomly.  Vomiting doesn't correlate with bad head injuries in the littler ones- many toddlers who end up in Pediatric Intensive Care don't vomit, and many babies who are fine vomit all day anyway. So when baby falls and goes boom, you will initially freak out and want to rush to the doctor. Then take a breath, think about the above, and use your own noggin to decide!