"He Bumped His Head And Went To Bed..."

Today's guest columnist is Dr. Jesse Livingston, a family practice resident at the LSU-University Health Center here in Lafayette.   Kids fall and hit their heads a lot.  Though most children with head injuries are fine, some need evaluation in the Emergency Department.  The parent can have difficult decisions to make, while at the same time dealing with a crying baby: Is the brain okay?  Does my child need a CT scan?  Can he nap?  We have all heard the nursery rhyme about the old man who bumped his head, went to bed, and couldn't get up in the morning.  What about your two-year old, who despite every effort will "fall and go boom?" The decision is easy for the worst falls.  If a child loses consciousness, has a seizure, vomits repeatedly, has a severe headache, is lethargic or confused, then she needs to be seen.  The doctor can decide if tests are needed, or if observation is enough.  We need to consider the "mechanism of injury," meaning how it happened and what force was involved.  A child may seem fine after being struck in the head by a baseball, but such high-speed impacts need evaluation regardless of how well the kid is acting. Here are more criteria for needing to get seen now: car wrecks where the child is thrown from the car, another passenger in the car dies, or the car rolls over.  If he is hit by a car while walking, or while riding a bike without a helmet, that's concerning.  Kids under two years old need to be evaluated if they fall from over three feet; kids over two, falls higher than 5 feet.  If an infant or toddler under two gets a "goose egg" swelling anywhere but the forehead, that is worrisome. However, most kids who hit their heads are okay and can stay home.  Kids who fall from their own, standing height, are usually fine.  Kids who hit their heads but are not knocked out and go back to playing are okay too.  Toddlers who run into walls also don't generate enough force to hurt themselves badly. Several times per week in the Emergency Department, we see a baby who rolls off the bed or falls from the stroller.   Mom is understandably freaked out- "I just left the room for a second, she has never rolled over before!"  Most falls occur at home and are usually either from falling off beds or other furniture, tumbling down stairs, or from being dropped. Interventions used only weeks ago to keep baby safe are now obsolete due to the child's developing abilities.  Add to that the distractions of other children, pets, dinner on the stove, and the rest of the household confusion, and stuff will happen. Like we said above, after most falls the child doesn't need an Emergency Department visit.  If baby fell from a height less than three feet, then he is probably fine. Further, if he is acting normally, doesn't have any "goose egg" swelling on his head (except for the forehead- a goose egg there is okay), doesn't vomit, and is acting well, he is okay.  If you are unsure, call your doctor.  The doctor can help decide if baby can be observed at home or needs to come in. Many parents believe they must keep their child awake after a fall to prevent coma. However, this is an "old wive's tale."  Naps after a minor fall can be restorative and comforting.  If there is a question about how bad the injury was, we do like an observation period where the child is watched for warning signs (severe headache, vomiting, changes in behavior, confusion).  During normal waking hours this is easy. However, if it is nap or bed time baby can go to sleep, but you should wake him up hourly for a few hours.  If the child is alert after waking (as alert as a child who's just been awakened can be!), then okay.  If she seems overly groggy or lethargic, call your doctor or come in. Unlike the old man in the nursery rhyme, most kids who bump their heads and go to bed are perfectly fine- they are not old men!  Someone needs to write a new nursery rhyme for kids who bump their heads.