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Head injuries fall into two categories:
  1. external injuries, usually involving the scalp
  2. internal head injuries, which may involve the skull, the blood vessels within the skull, or the brain
Fortunately, most childhood fallsor blows to the head cause injury to the scalp only. While these can be scary-looking, they usually aren't dangerous. An internal head injury could be more serious because it may cause bleeding or bruising of the brain.

External (Scalp) Injuries

The scalp is rich with blood vessels, so even a minor cut there can bleed a lot. Sometimes the scalp’s veins leak fluid or blood into (and under) the scalp. This appears as a "goose egg" or swelling on the head. It may take days or even a week to disappear.
What to look for and what to do:
  • Call the doctor if your child is an infant; has lost consciousness, even briefly; or if a child of any age has any of these symptoms:
    • won't stop crying
    • complains of head and neck pain (younger or nonverbal children may be more fussy)
    • vomits several times
    • won't awaken easily
    • becomes hard to console
    • isn't walking or talking normally
  • If your child is not an infant, has not lost consciousness, and is alert and behaving normally after the fall or blow:
    • Apply an ice pack or instant cold pack to the injured area for 20 minutes every 3 to 4 hours. If you use ice, always wrap it in a washcloth or sock; ice applied directly to bare skin can injure it.
    • Watch your child carefully for the next 24 hours. If you notice any of the signs of internal injury, call your doctor right away.
    • If the incident happens close to bedtime or naptime and your child falls asleep soon afterward, check in a few times while he or she sleeps.
  • If color and breathing are normal, and you don't sense a problem, let your child sleep (unless the doctor has advised otherwise). There's no need to keep a child awake after a head injury.
  • Trust your instincts. If you aren't comfortable with your child's appearance, partly awaken your child by sitting him or her up. Your child should fuss a bit and attempt to resettle. If he or she still seems very drowsy, try to awaken your child fully. If your child can't be awakened or shows any signs of internal injury, call the doctor or 911 for an ambulance.
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