What Should You Do When Your Baby Hits His Head?

Your little one is learning to walk! They’re taking steps, looking confident and happy. Then, bam, they’ve tumbled down and smacked their head with a clonk against your floor. Or they’re in a crib — a crib that they couldn’t climb out of yesterday — and out of nowhere you hear a loud thud, then a wail. When your baby hits their head, it’s a split second of terror followed by a lot of panic — from both of you, probably. What exactly are you supposed to do when your baby hits their head, and how do you know it’s not too serious?

Babies, because their heads are proportionally larger than their bodies and because they have weaker neck muscles, are much more prone to hitting their head when they fall than adults. Head injuries are often the scariest for parents — the head, after all, is where the brain is. There’s also been a growing awareness of the risks of concussions in children. And after any kind of fall, most babies cry like something truly horrible has happened. So how do you know when a baby’s head injury is something that needs medical attention, versus something that you can just keep an eye on at home?

What Kind Of Hit To Baby’s Head Should You Worry About?

It’s startling for parents when their toddler falls face-first, but forward-falls are often less serious. Dr. Sonal Patel, a primary care physician in Seattle, tells Romper that when babies fall when learning to crawl or walk, they “tend to hit the front of their head, which is the thickest part of their skull.” Those kinds of falls might result in a big goose egg on their forehead, but usually babies won’t need much more than an ice pack and some comfort to recover.

Doctors differentiate between falls that involve a “severe mechanism,” which can include a car accident, a fall from greater than 3 feet, or being struck by a vehicle without a helmet. Falls from the child’s height, Dr. Patel says, aren’t considered a severe mechanism. Nonetheless, when her now 3-year-old son was first mobile, she and her husband were “a little bit traumatized when he was learning to crawl and walk and was smacking his head against the floor.”

A 2009 study published in The Lancet breaks down the factors that are most important when determining the likelihood that a bonk to the head is a more serious injury. Researchers examined the medical records of thousands of children under age of 2 who presented with a head injury, and found five factors to be significant:

• location of the hematoma (the medical term for “goose egg”)
• whether the child has lost consciousness
• the mechanism of the injury
• the child’s behavior after the injury
• whether there was a skull fracture that a physician could feel

The study found that children who had a normal mental status exam, who didn’t have a severe mechanism of injury, who did not lose consciousness or who lost consciousness for less than 5 seconds, had a hematoma on the front of their head (or no hematoma), and who did not have a palpable skull fracture had a clinically-important traumatic brain injury 0% of the time. The study suggested that for children with those factors “CT can routinely be obviated” — in other words, if those factors are present, you and your doctor can be confident that there’s no serious issue, even without doing brain imaging.

How To Tell If Your Baby’s Head Injury Is Serious

Unsurprisingly, the factors outlined above also are useful for determining whether the head injury might be something more serious. One obvious sign is the mechanism of injury; Dr. Patel explains that serious mechanisms include falls from greater than 3 feet, a motor vehicle accident, or being struck by a large object. Parents should also be mindful of their child’s behavior. It’s common, she explains, for babies to cry hard and then sometimes need to rest or sleep because they’ve tired themselves out from crying. But if you’re noticing that your child is acting sluggish or not themselves after the initial crying period is over, that’s a good time to check with your pediatrician.

Another time to visit the pediatrician is if you notice swelling on the side of their head, or if that’s where they got injured. “If you’re noticing a hematoma towards the side of their head, those are thinner bones and can be an easy place to be fractured,” Dr. Patel explains. A pediatrician can often do an external exam to feel whether the skull plates are properly aligned.

Other signs to be aware of include vomiting and loss of consciousness. “Babies can’t tell you if you have a headache, and vomiting is a big deal. That’s one of the few signs you may get that something is really wrong. They don’t have to lose consciousness. An intracranial fracture, brain bleed, and brain swelling could all cause vomiting — if I was triaging a call where a young child was vomiting after a head injury, I would say go straight to the emergency room.” Researchers have found that “recurrent vomiting,” defined as more than four episodes of vomiting, is more likely to be a sign of a serious problem than an isolated incident.

The good thing for parents is that, the vast majority of the time, babies recover just fine from head injuries. The CDC publishes a guide for parents with some tips to help their child recover from an injury, and notes that even for children who have a concussion, most feel better within a few weeks. Usually, Dr. Patel says, when patients come to her office with a young child with a head injury “my role is to provide reassurance.”

Experts:

Dr. Sonal Patel, MD, https://www.pacificmedicalcenters.org/who-we-are/sonal-patel/

Studies referenced:

Araki, T., Yokota, H., & Morita, A. (2017). Pediatric Traumatic Brain Injury: Characteristic Features, Diagnosis, and Management. Neurologia medico-chirurgica, 57(2), 82–93. https://doi.org/10.2176/nmc.ra.2016-0191

Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, Nadel FM, Monroe D, Stanley RM, Borgialli DA, Badawy MK, Schunk JE, Quayle KS, Mahajan P, Lichenstein R, Lillis KA, Tunik MG, Jacobs ES, Callahan JM, Gorelick MH, Glass TF, Lee LK, Bachman MC, Cooper A, Powell EC, Gerardi MJ, Melville KA, Muizelaar JP, Wisner DH, Zuspan SJ, Dean JM, Wootton-Gorges SL; Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009 Oct 3;374(9696):1160-70. doi: 10.1016/S0140-6736(09)61558-0. Epub 2009 Sep 14.