Children fall on their heads. Frequently, in many cases. The toddler who tumbles off the sofa, the preschooler who runs headlong into a door frame, the baby who rolls off a changing mat: these are everyday events in families with young children, and the vast majority result in a bump, some crying, and nothing more.
The difficulty for parents is knowing which head injuries fall into the "wait and see" category and which need medical attention. The range is vast: from completely trivial to life-threatening, and they can sometimes look similar in the first minutes.
Healthbooq (healthbooq.com) covers first aid and safety in the early years, helping parents recognise when to manage at home and when to seek urgent help.
The Common Minor Head Injury
Most childhood head injuries are caused by a simple fall onto a hard surface, at a height appropriate to the child's age. A toddler falling from standing height falls less than a metre. A baby rolling off a low surface falls 60 to 90cm. These heights, while producing significant distress and usually a bump, are associated with very low rates of serious injury.
After a minor head impact, a child typically cries immediately (the immediate cry is actually a reassuring sign of consciousness and response), may develop a soft lump (goose egg) at the impact site, and settles within a few minutes. They return to normal behaviour quite quickly.
The goose egg is caused by blood pooling in the scalp tissue (subgaleal haematoma). It looks alarming but is harmless. It may increase in size over the first hour and then gradually resolves over days to weeks.
Warning Signs That Need Urgent Assessment
The following features warrant an immediate call to 999 or trip to A&E:
Loss of consciousness at any point after the injury, even briefly. Confusion, unusual drowsiness, or difficulty rousing the child. Any seizure (convulsion) following the head injury. Repeated vomiting, particularly three or more episodes. Weakness, numbness, or coordination problems appearing after the injury. Blood or clear fluid coming from the nose or ears. Visible deformity, depression, or wound to the skull. High-risk mechanism: fall from more than twice the child's standing height, road traffic collision, being struck by a high-speed object.
Age is a particular concern for infants. Under one year, the threshold for concern is lower, and any significant head impact in a baby under a year warrants assessment rather than home observation.
The NICE guideline on head injury (CG176) provides specific imaging criteria for children. A CT head scan is recommended if the child has any of: suspected non-accidental injury, loss of consciousness of more than 5 minutes, witnessed disorientation lasting more than 5 minutes, abnormal drowsiness, three or more discrete vomiting episodes, dangerous mechanism (fall from more than 3 metres, high-speed road traffic collision), or amnesia of more than 5 minutes.
Safe to Observe at Home
A child who had a minor head impact, cried immediately, settled back to normal behaviour within 30 minutes, has no concerning features from the list above, and is behaving normally can be observed at home.
The observation period for a mild head injury is typically 24 hours. During this time, the child can sleep normally: the myth that children must be kept awake after a head injury is exactly that. Sleep does not mask deterioration in a meaningful way, and a child who is hard to rouse from sleep is a concerning sign of deterioration regardless of whether you tried to keep them awake. Check the child during the night if you are concerned but do not prevent sleep.
Give paracetamol if the child is in pain from the impact. Avoid ibuprofen in the first hour or two of observation as it affects clotting.
Non-Accidental Injury
A small proportion of childhood head injuries are caused by non-accidental injury (NAI), and this is why the NICE guideline specifically identifies it as a criterion for imaging. Features that raise concern for NAI include injuries inconsistent with the developmental stage of the child (a two-month-old described as rolling off the sofa cannot actually roll), injuries inconsistent with the explanation given, multiple injuries at different stages of healing, and bruising patterns not consistent with the described mechanism.
Healthcare professionals are trained to consider and document concerns about NAI. The role of the parent in this context is simply to provide an accurate account of what happened.
Concussion
Concussion (mild traumatic brain injury) in children presents as a brief period of confusion, feeling dazed, not quite right, or having a headache after the injury, with no imaging abnormality. Recovery is expected but takes variable time. Children who play contact sports and sustain a suspected concussion should follow the child-specific return to sport protocol (UK consensus guidelines recommend a minimum of 14 days for children, longer than the adult protocol).
During recovery, cognitive rest (reduced screen time, reduced academic load, reduced noise exposure) helps. A child who returns to intensive activity before symptoms have cleared often takes longer to recover.
Key Takeaways
Head injuries in young children are extremely common and the vast majority are minor, self-limiting, and require only observation at home. The features that indicate a need for urgent medical assessment include loss of consciousness, prolonged vomiting, abnormal behaviour or confusion, seizure after the injury, very young age (under one year), high-risk mechanism (fall from height, road traffic collision), and visible skull depression or deformity. NICE guidance (CG176) provides specific criteria for imaging and hospital admission.
