External - usually scalp injuries which are the more common type of injury in children
Internal - which may involve the skull, the blood vessels within the skull, or the brain
External (scalp) injury
There are many blood vessels on the scalp which means that even a minor injury can bleed profusely.
The swelling or bump which appears on the scalp after a blow to the head is caused by veins leaking fluid and blood into the skin on the scalp. This can take days or weeks to disappear.
What to do in the case of an external injury
- Call your doctor if the child has lost consciousness, even momentarily.
- If the child has not lost consciousness and is alert and behaving normally after the injury, apply an ice pack or cold pack to the area for 20 minutes. Wrap the pack in a cloth to prevent damage to the skin from extreme cold.
- Watch your child carefully for the next 24 hours. If he or she shows any signs of internal head injury (listed next), call your doctor immediately.
- If the incident occurs close to bedtime and the child falls asleep at his or her normal time, then check every two hours for disturbances in skin colour, breathing or twitching limbs:
- If colour and breathing are normal and all appears well, then let the child sleep.
- If colour and breathing are abnormal, or you do not feel comfortable that all is well (trust your instincts!) then wake the child up by sitting him up. The child should be irritated and attempt to go back to sleep. If he or she does not protest then try to rouse the child fully. If you cannot, call your doctor or an ambulance immediately.
The brain is usually cushioned from injury by the fluid which bathes it and the membranes which surround it. However, a severe blow to the head may knock the brain against the side of the skull or tear blood vessels, either above or below the membranes surrounding the brain.
Any internal brain injury such as a fractured skull, torn blood vessels or damage the brain itself can be serious and may be life-threatening.
What to do in the case of an internal injury
Call an ambulance if the child shows any of the following symptoms and signs:
- Abnormal breathing
- Obvious wound or fracture
- Bleeding from the nose, ear or mouth
- Disturbance of speech or vision
- Pupils of unequal size
- Weakness or paralysis
- Neck pain or stiffness
- Loss of bladder or bowel control
If the child is unconscious or drowsy or if there is any paralysis do not move him or her at all since there may be injury to the spine. Place your hands on either side of the head to immobilise the neck and leave him or her in the position in which you found the child.
If the child vomits, then try to roll him or her onto the side without moving the position of the head relative to the neck if you are worried about a spinal injury. Otherwise, simply roll the child onto its side to prevent him or her breathing in vomit.
If the child has a seizure, roll him or her onto the side, and make sure that the tongue has fallen forward in the mouth so keeping the airway clear.
If there is swelling to the head apply an ice pack.
Do not apply direct pressure to a wound if you think there is an underlying break in the skull (fracture).
Do not remove any object which is stuck in the wound.