Head Injury
Most head injuries are not serious and simply cause a bump or a bruise to the head or face.
If your child’s head is bleeding, apply pressure for 5-10 minutes. If it continues to bleed, they may need to have it glued (stitches are very rarely required).
This can usually be done in a minor injuries unit, an urgent treatment centre or a walk in centre. Some GPs also assess and treat minor injuries
A significant head injury can result in concussion. A child or young person does not have to have been unconscious, or “knocked out” for concussion to occur.
Common symptoms of concussion include headache, fatigue, poor sleep and difficulty concentrating.
When should you worry?
If your child has had any of the following in the 48 hours following their head injury:
● The head injury was high impact for example:
○ A road traffic accident
○ Fall from a height of more than 1 metre (more than the child’s ownhe height, or more than 5 stairs)
● A bruise, swelling or cut more than 5cm on the head
● Vomits 3 times or more (at least 10 minutes between each vomit)
● Behaves oddly, becomes confused or unaware of their surroundings
● Loses consciousness, becomes drowsy or difficult to wake
● Has a convulsion or fit (uncontrolled jerking, twitching movements)
● Has difficulty speaking or understanding what you are saying
● Has weakness in their arms and legs or starts losing their balance
● Has new problems with their eyesight
● Has clear fluid coming out of their nose or ears
● Bruising around their eyes or behind their ears
● Does not wake for feeds, is irritable or cries constantly and cannot be soothed
● Has memory loss of events before or after the injury
● Takes blood thinners or has a bleeding or clotting disorder
You need urgent help.
Go to the nearest Hospital Emergency (A&E) Department or phone 999
If your child has had any of the following in the 48 hours following their head injury:
- Has a headache that doesn’t go away or gets worse (despite painkillers such as paracetamol or ibuprofen)
You need to contact a doctor or nurse today.
Please ring your GP surgery or call NHS 111 Wales- dial 111
If symptoms persist and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.
If your child:
- Is alert and interacts with you
● Vomits, but only up to twice
● Experiences mild headaches, struggles to concentrate, lacks appetite or has problems sleeping. - If you are very concerned about these symptoms or they
go on for more than 2 weeks, make an appointment to see your GP - Watch them closely for any change and look out for any red or amber symptoms
- Additional advice is also available for families for help cope with crying in otherwise well babies
- If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.
Self care
Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111
What should you do immediately?
● In general, if your child cries immediately after a head injury and returns to
their normal self in a short time, they can be managed at home.
● Hold an ice pack (or a bag of frozen peas in a tea towel) to the area regularly
for short periods to bring down any swelling
● You should observe them closely checking that they are responding normally
to you.
● You should:
○ Make sure you or another adult stays with your child for at least the first
24 hours after a head injury
○ You do not need to keep your child awake as it may make them
irritable and bad tempered
○ Allow your child to sleep as normal.
We would encourage you to check on them a couple of times overnight to check:
■ Do they appear to be breathing normally?
■ Are they sleeping in a normal posture?
■ Do they make the expected response when you rouse them
gently? (E.g. pulling up sheets, cuddling teddy-bear)
■ If you cannot satisfy yourself that your child is sleeping normally,
then wake them fully to check.
■ Keep a regular sleep routine going to bed and waking at the
same time each day
How long will your child’s symptoms last?
What should you do in the first few days?
● For the first couple of days after a bump to the head it is normal for your child
to:
○ have a mild headache
○ feel sick and not want to eat
○ have difficulty concentrating
○ feel more tired than usual
● Encourage them to drink plenty of clear fluids and try a little food
● Allow them to play as normal but encourage quiet play and avoid strenuous
activity until their symptoms have settled
● Avoid loud noise, TV and computer games
● Increase activity as symptoms improve at a manageable pace
● Give them Paracetamol and, or Ibuprofen if they are in pain
Return to normal activities
Most children only need 24 to 48 hours of rest before they are able to return to light
day to day activities
They can return to school once they are symptom free but may need to start
gradually with regular breaks
Avoid rough play and contact sports for 3 weeks
Concussion following a head injury
Symptoms of concussion include mild headache, feeling sick (without vomiting),
dizziness, bad temper, problems concentrating, difficulty remembering things,
tiredness, lack of appetite or problems sleeping. This can last for a few days, weeks
or even months. Some symptoms resolve quickly whilst others may take a little
longer.
Concussion can happen after a mild head injury, even if they haven’t been “knocked
out”.
9 out of 10 children with concussion recover fully. Some can experience long term
effects, especially if they return to sporting activities too quickly. It is really important
that your child has a gradual return to normal activities.
It is best to avoid computer games, sporting activities and excessive exercise until all
symptoms have improved.
If you are very concerned about these symptoms or they last longer than 2 months,
you should seek medical advice from your doctor.
Here is a leaflet on returning to normal activities after concussion.
Return to sport
Repeated head injury during recovery from concussion can cause long term damage
to a child’s brain.
Expect your child to stay off sport until at least 2 weeks after symptoms have fully
resolved.
Speak to your child’s school and sports club about a gradual return to full activity.
Further information on return to sport:
How long will your child’s symptoms last?
Your child is likely to return to normal within a few hours of a minor head injury
In the few days following a more significant head injury, your child may experience
mild headaches, might be irritable, may struggle to concentrate, may lack appetite
and may have problems sleeping. If these symptoms go on for more than 2 weeks,
make an appointment to see your GP
For more information
Visit The Children's Trust website. They are the UK's leading charity for children with
brain injury. They deliver rehabilitation, education and community services through
skilled teams who work with children and young people, and their families children’s
Where should you seek help?
If your child is under a year of age, begins vomiting, has a headache that is getting worse, is behaving oddly or has fallen from a height taller than they are, they will need to be seen urgently by a medical practitioner. Call your GP surgery or ring NHS 111 Wales.
If your child has any of the above features, they need urgent help. Call 999 or go your nearest A&E department
For wear and tear, minor trips and everything in between.
Self-care
You can treat your child's very minor illnesses and injuries at home.
Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.
Sound advice
Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.
For information on common childhood illnesses go to What is wrong with my child?
Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.
Sound advice
- Visit a pharmacy if your child is ill, but does not need to see a GP.
- Remember that if your child's condition gets worse, you should seek further medical advice immediately.
- Help your child to understand - watch this video with them about going to the pharmacy.
For information on common childhood illnesses go to What is wrong with my child?
Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Wales Programme. They work with you through your pregnancy up until your child is ready to start school.
Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.
Contact them by phoning your Health Visitor Team or local Children’s Centre.
Sound advice
Health visitors also provide advice, support and guidance in caring for your child, including:
- Breastfeeding, weaning and healthy eating
- Exercise, hygiene and safety
- Your child’s growth and development
- Emotional health and wellbeing, including postnatal depression
- Safety in the home
- Stopping smoking
- Contraception and sexual health
- Sleep and behaviour management (including temper tantrums!)
- Toilet training
- Minor illnesses
For more information watch the video: What does a health visitor do?
School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and/or emotional health needs.
Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.
There is also a specialist nurse who works with families who choose to educate their children at home.
Sound Advice
Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.
They all have a role in preventing disease and promoting health and wellbeing, by:-
- encouraging healthier lifestyles
- offering immunisations
- giving information, advice and support to children, young people and their families
- supporting children with complex health needs
Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.
If you’re not sure which NHS service you need, call 111. An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.
Sound advice
Use NHS 111 Wales if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services.
For information on common childhood illnesses go to What is wrong with my child?
A&E departments provide vital care for life-threatening emergencies, such as loss of consciousness, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.
Sound advice
