Head Injury, Age 3 and Younger

British Columbia Specific Information

Knowing the signs and symptoms of a serious head injury will help you get the right care. Speak with a health care provider about the injury as soon as possible. If you think a head injury might be serious, call 9-1-1 or visit an emergency department right away. For non-emergency information or advice, call 8-1-1 to speak with a registered nurse any time of the day, every day of the year.

If your child’s health care provider finds no signs of a serious head injury, you may be advised to monitor your child in the hours, days and weeks following the injury. Only when your child’s health care provider advises you that it is safe for your child to go home in your care, follow the advice on caring for your child at home:

BC Children’s Hospital – Head Injury Advice for Parents and Caregivers

For more information about head injury, including concussion recognition, diagnosis, treatment and management, see:

Topic Overview

Head injury

Almost all children will bump their heads, especially when they are babies or toddlers and are just learning to roll over, crawl, or walk. These accidents may upset you, but your anxiety is usually worse than the injury. Most head injuries in children are minor.

Head injury occurs more often in young children than adults. When compared with adults:

Young children can't control the movement of their heads as well as adults.
- Their heads are larger in relation to their bodies.
- Their neck muscles are not as well developed.
Young children's legs are somewhat shorter in proportion to the rest of their bodies. This makes a child's centre of gravity closer to the head than an adult's centre of gravity.
Young children are more likely to have an injury or fall as they learn new skills such as walking, running, and jumping.

Bumps, cuts, and scrapes on the head and face usually heal well and can be treated the same as injuries to other parts of the body. A superficial cut on the head often bleeds heavily because the face and scalp have many blood vessels close to the surface of the skin. This bleeding is alarming, but often the injury is not severe and you can stop the bleeding with home treatment. When bleeding does not stop with home treatment, visit a doctor because a young child can lose a large amount of blood from a deep cut on the head.

The most common serious head injuries in young children are caused by falls and abuse (inflicted head injuries), such as shaken baby syndrome. Serious head injuries may involve injuries to the brain. The more force that is involved in a head injury, the more likely it is that a serious injury to the brain has occurred. If there has been a high-energy injury to the head, there is a greater likelihood that a serious injury has occurred. When a high-energy injury occurs, it is even more important to assess the child for signs of a serious head injury.

Following an injury, it can be hard to tell the difference between a mild traumatic brain injury (concussion) and a more serious brain injury. Watch the child carefully for 24 hours after a head injury to see whether he or she develops any signs of a serious head injury.

When a head injury has occurred, look for injuries to other parts of the body. The alarm of seeing a head injury may cause you to overlook other injuries that need attention. Trouble breathing, shock, spinal injuries, and severe bleeding are all life-threatening injuries that may occur along with a head injury and require immediate medical attention. Injuries to the spine, especially the neck, must be considered when a head injury has occurred. Be sure to check for other injuries to the face, mouth, or teeth whenever there is a head injury.

Many head injuries can be prevented. Use car seats, seat belts, helmets, and make your home safe from falls to prevent an injury. Establish good safety habits early so your child will continue them when he or she is older.

Check your child's symptoms to decide if and when your child should see a doctor.

Check Your Symptoms

Has your child had a head injury?

Yes

Head injury

How old are you?

Less than 4 years

4 years or older

Are you male or female?

Male

Female

The medical assessment of symptoms is based on the body parts you have.

If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.

Is the wound bleeding?

If you think the wound may need stitches, it's best to get them within 8 hours of the injury.

Yes

Bleeding wound

Would you describe the bleeding as severe, moderate, or mild?

Severe

Severe bleeding

Moderate

Moderate bleeding

Mild

Mild bleeding

Does your child have symptoms of shock?

Yes

Signs of shock

Do you think there could be a spinal cord injury?

Yes

Possible spinal cord injury

Are there any signs that the head injury is serious?

These could appear at the time of the injury or later.

Yes

Symptoms of serious head injury

Did a seizure occur after the head injury?

Yes

Seizure after head injury

Did the seizure occur within the past 2 days (48 hours)?

Yes

Seizure occurred within past 2 days

Is there a wound that goes through the skull, such as a knife or gunshot wound?

Yes

Penetrating wound

Are there any symptoms of a skull fracture?

Yes

Symptoms of skull fracture

Is there swelling anywhere on the head?

Swelling in certain areas of the head can be a sign of a skull fracture.

Yes

Swelling on head

Is the only swelling a bump or "goose egg" on the forehead?

Swelling in any other area of the head, such as the temple area or the side or back of the head, could be more serious.

Yes

Only swelling is bump or goose egg on forehead

Did your child pass out (lose consciousness) after the injury?

Yes

Lost consciousness after injury

When did your child pass out?

Within the past 24 hours

Loss of consciousness within past 24 hours

More than 24 hours (1 full day) after the injury

Loss of consciousness more than 24 hours ago

Was there a lot of force involved in the head injury?

Some examples are a fall onto the head from a height taller than the child, or a very hard blow to the head, such as in a car crash or a forceful sports injury.

Yes

A lot of force involved in head injury

When did the head injury occur?

Less than 24 hours ago

Injury occurred less than 24 hours ago

From 1 full day (24 hours) to 1 week ago

Injury occurred from 1 day to 1 week ago

More than 1 week ago

Injury occurred more than 1 week ago

Has your child vomited more than once since the injury?

Yes

Vomited more than once after injury

Do you think that the head injury may have been caused by abuse?

A head injury caused by abuse is serious at any age, but this is especially true for babies.

Yes

Injury may have been caused by abuse

Are there any other symptoms that may be related to the head injury?

Some symptoms may appear days or even more than a week after a head injury.

Yes

Other symptoms after head injury

Are the symptoms:

Getting worse?

Symptoms are getting worse

Staying about the same (not better or worse)?

Symptoms are unchanged

Getting better?

Symptoms are improving

Has your child had symptoms for more than 2 weeks after the injury?

Yes

Symptoms for more than 2 weeks after injury

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

Your age. Babies and older adults tend to get sicker quicker.
Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products can cause symptoms or make them worse.
Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

Try home treatment to relieve the symptoms.
Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

HomeTreatment

RelatedInformation

With severe bleeding, any of these may be true:

Blood is pumping from the wound.
The bleeding does not stop or slow down with pressure.
Blood is quickly soaking through bandage after bandage.

With moderate bleeding, any of these may be true:

The bleeding slows or stops with pressure but starts again if you remove the pressure.
The blood may soak through a few bandages, but it is not fast or out of control.

With mild bleeding, any of these may be true:

The bleeding stops on its own or with pressure.
The bleeding stops or slows to an ooze or trickle after 15 minutes of pressure. It may ooze or trickle for up to 45 minutes.

Other symptoms related to a head injury that may appear later include:

Repeated episodes of feeling dizzy or light-headed.
Changes in mood or personality. For a baby or toddler, you may notice this as the child being a lot fussier than normal.
Changes in the ability to concentrate and listen.
Ringing in the ears.

Symptoms of a spinal cord injury in a child may include:

Severe neck or back pain.
Being unable to move part of the body.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Babies and young children often have several symptoms of shock. These include:

Passing out (losing consciousness).
Being very sleepy or hard to wake up.
Not responding when being touched or talked to.
Breathing much faster than usual.
Acting confused. The child may not know where he or she is.

Symptoms of a skull fracture may include:

Clear or bloody fluid draining from the ears or nose.
Bruising under the eyes or behind the ears.
Drooping of the face.
A dent anywhere on the head.

Symptoms of a serious head injury may include:

Passing out.
Becoming more and more drowsy, or hard to wake up.
Cannot stop crying.
A difference in the size of the pupils of the eyes.
Worsening headache.
Repeated vomiting.
Seizures.
Confusion.

Babies' heads are easily damaged, and their neck muscles are not strong enough to control the movement of the head. Shaking or throwing a baby can cause the head to jerk back and forth. This can make the skull hit the brain with force, causing brain damage, serious vision problems, or even death.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care in the next hour.
You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care today.
If it is evening, watch the symptoms and seek care in the morning.
If the symptoms get worse, seek care sooner.

HomeTreatment

RelatedInformation

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Put direct, steady pressure on the wound until help arrives. Keep the area raised if you can.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Do not move the person unless there is an immediate threat to the person's life, such as a fire. If you have to move the person, keep the head and neck supported and in a straight line at all times. If the person may have a spinal injury from diving into the water and is still in the water, float the person face up in the water.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

Make an appointment to see your doctor in the next 1 to 2 weeks.
If appropriate, try home treatment while you are waiting for the appointment.
If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

HomeTreatment

RelatedInformation

Head Injury, Age 4 and Older

Home Treatment

First aid for a head injury

Parents should watch their child for any problems after the injury. Home treatment can help relieve swelling and bruising of the skin or scalp and pain that occurs with a minor head injury.

If your child had an injury, try to remain calm and speak to your child in a calm, relaxed voice. This will help reduce your child's fear and allow you to assess the situation.
To stop any bleeding, apply firm pressure directly over the cut with a clean cloth or bandage for 15 minutes. If the cut is deep and may have penetrated the skull, emergency treatment is needed.
Check for injuries to other parts of the body, especially if the child has fallen. The alarm from seeing a head injury may cause you to overlook other injuries that need attention.
Apply ice or cold packs to reduce the swelling if your child will let you hold a cold pack on the injury. A "goose egg" lump may appear anyway, but ice will help ease the pain. Always keep a cloth between your child's skin and the ice pack. Do not apply ice for longer than 15 to 20 minutes at a time, and do not let your child fall asleep with the ice on his or her skin.

If your child is seen by a doctor

Be sure to follow the instructions given to you by your child's doctor. He or she will tell you what problems to look for and how closely to watch your child for the next 24 hours or longer.

Do not give any medicine, including non-prescription acetaminophen, such as Tylenol, to a child you are watching for signs of a more serious head injury unless your health care provider tells you to.

Symptoms to watch for during home treatment

Call your child's doctor if any of the following occur during home treatment:

New headache develops or headache becomes worse.
New nausea or vomiting develops or nausea or vomiting becomes worse.
Crying does not stop.
Drowsiness gets worse, or it is hard to wake up your child.
Weakness develops in any part of the body.
Confusion or not acting normally develops.
Bleeding or swelling increases.
Symptoms become more severe or more frequent.

Prevention

Prevent head injuries

Each new learning stage for your baby requires increased attention on your part to prevent an injury. It may surprise you how fast your baby can move from one stage to the next. Being aware of your baby's abilities and what skills he or she is likely to develop next will help you prevent injuries.

Always be gentle with your baby. Be sure to protect your baby from a brain injury. Shaking or slapping a baby in anger can cause an injury to the brain. If a baby has been shaken or slapped, it is your responsibility to notify your doctor.

Be aware of your baby's risk of falling. Watch your baby carefully.

Never leave your baby alone in high places, such as on a tabletop, in a crib with the sides down, or even on a bed or sofa.
Do not leave your baby alone in any infant seat or "sitting" toy, such as a swing or jumper. Use all the safety straps provided.

Take steps to prevent falls:

Use stair gates to block stairways. Use gates at the top and bottom of the stairs, and use the gates properly.
Baby walkers should not be used. They are not safe. Canada has banned baby walkers because many babies have been seriously injured while using them. It is illegal to manufacture, sell, advertise, or import new or used baby walkers. A stationary activity centre, with adult supervision, is a better choice.
Keep your baby away from elevated porches, decks, and landings.
Watch your toddler when he or she is outside. Uneven grass, sloping lawns, and hills may increase your toddler's risk of falling.
Make your home safe from falls by removing hazards that might cause a fall.

Practice good safety habits early so your child will continue them when he or she is older:

Place children in an approved child car seat when travelling in a motor vehicle. Follow the manufacturer's directions for installing and securing the seat.
Have your children wear helmets whenever necessary, such as when they are passengers on a bike or riding a tricycle on their own.
Set a good example by always using your seat belt when travelling in a motor vehicle. Wear a helmet and other protective clothing whenever you are biking, skateboarding, skiing, motorcycling, skating, kayaking, horseback riding, or rock climbing.

For more information on health and safety for children, see the topic Health and Safety, Age Birth to 2 Years or Health and Safety, Ages 2 to 5 Years.

Preparing For Your Appointment

Questions to prepare for your appointment

You can help your doctor diagnose and treat your child's condition by being prepared to answer the following questions:

When and how did the injury occur?
How did your child act after the head injury?
Did your child cry immediately after the injury?
What are your child's main symptoms? How long has your child had symptoms?
Has your baby had a previous head injury? Does your child have any continuing problems because of the previous injury?
What object caused the injury? Was there or is there an object in a cut on the head?
Was this injury intentionally caused by another person?
What home treatment measures have you used to treat the head injury?
If a cut or scape occurred, is your child's tetanus immunization up-to-date?
Was the use of alcohol or drugs by a caregiver involved in your child's injury?
Does your child have any health risks?