Head injuries are frequent as toddlers explore their environment. While a loud cry and a temporary “goose egg” are common, most head bumps are minor and require only comfort and observation at home. However, the potential for a serious underlying injury makes knowing the appropriate response necessary. This guide helps distinguish between a simple bump and a medical emergency.
Immediate Red Flags: When to Seek Emergency Care Now
Certain symptoms signal a high probability of a severe traumatic brain injury or skull fracture, requiring immediate emergency medical attention. Any momentary loss of consciousness at the time of injury, even if the child quickly recovers, warrants an emergency room visit. Seizures or convulsions, manifesting as uncontrolled twitching or full-body shaking, are signs of a serious neurological event.
Persistent or forceful vomiting is a major concern, especially if it occurs more than one or two times after the trauma, as repeated vomiting can indicate rising pressure within the skull. Look for clear or bloody fluid draining from the nose or ears, which may be cerebrospinal fluid suggesting a fracture in the base of the skull. A toddler who is extremely lethargic, difficult to wake up, or cannot be roused from sleep requires immediate emergency transport.
Physical signs of severe injury include bruising around the eyes (“raccoon eyes”) or bruising behind the ears (Battle’s sign). These patterns are associated with a skull fracture and require immediate medical evaluation. Seek emergency care if one pupil appears significantly larger than the other, or if the child develops slurred speech or a sudden inability to walk or balance. For very young toddlers, a bulging soft spot (fontanelle) present when they are calm and upright is a sign of increased intracranial pressure.
Monitoring After a Head Bump: Recognizing Delayed Symptoms
Most head injuries require careful observation over the following 24 to 48 hours, as some symptoms can develop hours later. Even if a toddler sustained a mild bump, cried immediately, and quickly returned to normal behavior, close monitoring at home is necessary. A persistent headache that steadily worsens over time or is not relieved by acetaminophen is a concerning sign.
Changes in mood or personality are important to note, such as unusual irritability, extreme fussiness, or inconsolable crying. Indicators of a delayed reaction include mild confusion, a “foggy” appearance, or difficulty following directions. Pay attention to gait and coordination; new clumsiness, stumbling, or difficulty maintaining balance when walking warrants a call to the pediatrician.
Minor changes in sleep patterns may occur, such as sleeping much more or less than usual, or difficulty being roused from a nap. While one instance of vomiting may be due to stress, two or more episodes should prompt a medical consultation. If delayed symptoms are mild and non-worsening, contact your pediatrician; if they become severe or worsen rapidly, go to the emergency room.
What to Expect at the Emergency Room
Upon arrival at the emergency department, the first step is triage, where nurses assess the toddler’s vital signs and neurological status. They use specialized scales, like the pediatric Glasgow Coma Scale, to gauge responsiveness and mental clarity. A medical provider then conducts a thorough physical and neurological exam, checking reflexes, pupil reaction, and looking for signs of injury to the head and neck.
You will be asked for a detailed history of the event, including the mechanism of injury, the height of the fall, the surface they landed on, and the time the injury occurred. This information helps the medical team assess the force of the impact and the risk of severe injury. For children with mild symptoms, diagnostic imaging like a CT scan is not routinely performed due to radiation risk.
Many facilities follow clinical decision rules that prioritize a period of observation, often for four to six hours, to see if symptoms improve or worsen. A CT scan is reserved for cases with concerning signs, such as skull fracture, persistent altered mental status, or a severe mechanism of injury. If the assessment is reassuring, the child is discharged with written instructions for continued home monitoring, emphasizing when to return for reassessment.