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Facts and advice about head injuries and concussion. Written by pediatricians for parents. Children often fall and hit their head. Learn when it is dangerous and when to seek care. And is it dangerous when a baby hits the fontanelle or ‘soft spot’?
Fall from standing
When children learn to walk, they fall all the time. They often land on their head, because it’s so heavy. Generally when children fall from standing height, it is not ‘dangerous’ and doesn’t lead to a concussion.
Children may be in a lot of pain and have a bump and/or bruise if they fall onto a hard floor. But generally, it’s not more than that.
Fall from changing table
When a child falls from the changing table, the force of impact becomes greater. The risk of head injuries or concussion is not great, but may exist. It increases if the child has fallen against a really hard floor. Keep an eye out for signs and symptoms of concussion and seek help if necessary. For children under three months, who have fallen from the changing table – always seek the children’s emergency room.
A child who has fallen from standing or from the changing table, who is screaming and conscious, can be monitored at home for signs of concussion. You can use an ice pack (or preferably frozen peas) to reduce the pain and size of the bump.
You can give acetaminophen or ibuprofen for the pain. If the child has a single vomiting episode, then that’s OK. But if they have repeated vomiting or increasing headaches; becomes whiny or slow; you’ll need to seek medical care for assessment. It could be a concussion.
During the night, after a fall with blows to the head, you should set your alarm clock to watch the child every four hours. If the child looks like they’re sleeping as usual, you can fall asleep again. If the child appears to sleep deeper than usual, snores unusually more or lies in an unusual position, wake the child up to see if they react normally. If they don’t – seek medical care.
24 hours after the fall, you can forget about it and monitor the child as usual.
Fall from high altitude or at great speed
When a fall is more than two metres high (climbing trees, upstairs in stairs, etc.), there is a significantly greater risk of concussion, cerebral hemorrhage and head injuries. Seek medical care. If the child is passed out or has a sore neck or back, call an ambulance. If possible, do not move the child before the ambulance arrives. If there is a fracture in the neck or back, the child needs to be moved safely by the paramedics.
If the child has fallen at speed, for example from a swing or trampoline, there is also a risk of more serious head injuries. When cycling in particular, there is a risk of the child (as well as adults) being thrown forward at great speed with his head first, eg. when the bike stops suddenly. Wear a bicycle helmet!
Symptoms of concussion
Concussion occurs after a serious blow to the brain and causes symptoms such as headache, vomiting, fatigue and sometimes short-term loss of consciousness after the fall.
If the child has symptoms of concussion after a fall, seek medical care for assessment.
Symptoms of cerebral hemorrhage
The first symptoms of cerebral hemorrhage may be the same as a concussion – short-term loss of consciousness, headache, vomiting and fatigue. That’s why you should seek medical care. If the child loses consciousness for longer than 1-2 minutes, or becomes relaxed in any part of the body, or experiences cramps, you need to call an ambulance.
Babies’ skulls consists of several bone plates that have not grown together. At the top of the head there are two ‘holes’ between the plates called the front and rear fontanelle. The fontanelles harden and close over time. They tend to be completely closed at the age of 1-2 years.
Beneath the fontanelle is the meninges (tough membrane layer) and under that, the brain. You can feel how unprotected a small child is when you feel the fontanelle. But it can withstand more than you think. Children under three months of age who have fallen from changing tables or of similar height, should be assessed by pediatricians urgently. But for children larger than that, you can observe the child at home, even if they have an open fontanelle.
If the fontanelle curves sharply outwards, like a tense balloon, you should seek medical care urgently regardless of whether the child has hit their head or not. If the fontanelle varies a bit in how filled it is, and curves a little softly inwards or outwards, that’s normal. Please show the pediatric nurse if you are unsure.