Child's Head Injury: Symptoms and When to Seek Help

Bleeding from the back of the head after hitting a stone step?

Hello, doctor~~~ My child, who is over 6 years old, fell backward while sitting on the stone steps in Miaoli on October 21 and hit the back of his head, causing bleeding.
We performed emergency first aid and called an ambulance to take him to the hospital.
The hospital examination indicated no major issues, and a CT scan showed no internal bleeding.
After applying some topical medication, we returned to Taoyuan.
Until October 22, my child mentioned feeling a bit nauseous at school but did not vomit.
However, on October 23, the teacher called to inform us that he vomited a significant amount at school.
We quickly took him to the hospital for evaluation, where the doctors found no abnormalities, but his appetite has decreased.
The teacher also noted that he is not as enthusiastic and energetic as before and is particularly clingy.
Doctor, is this normal??? Should we be concerned about his poor appetite and consider a follow-up appointment (and if so, which department should we see)?

Xiao Ya, 30~39 year old female. Ask Date: 2019/10/24

Dr. Zhang Junwei reply Neurosurgery

The sequelae of head trauma include headaches and dizziness.
Children may exhibit decreased energy levels.
It is important to closely monitor the child's level of consciousness; if they are lethargic and cannot be awakened, seek medical attention immediately.

Reply Date: 2019/10/24

More Info

When a child experiences a head injury, it is crucial for parents to understand the symptoms and know when to seek medical help. In your case, your 6-year-old child suffered a head injury after falling and hitting the back of their head, which resulted in bleeding. Fortunately, the initial evaluation at the hospital indicated no significant issues, and a CT scan showed no internal bleeding. However, the subsequent symptoms of nausea and vomiting, along with changes in behavior and appetite, warrant careful consideration.

Symptoms to Monitor After a Head Injury
1. Nausea and Vomiting: While mild nausea can occur after a head injury, persistent vomiting, especially if it is forceful or projectile, can be a sign of increased intracranial pressure or other complications. In your case, the fact that your child vomited at school is concerning and should be monitored closely.

2. Behavioral Changes: A noticeable decrease in energy, enthusiasm, or an increase in clinginess can indicate that your child is not feeling well. These changes can be a response to the trauma or may suggest a more serious underlying issue.

3. Appetite Changes: A decrease in appetite can be common after a head injury, especially if the child is feeling nauseous or unwell. However, if this persists, it is essential to consult a healthcare provider.

4. Headache: While headaches can be a common symptom after a head injury, they should not be severe or persistent. If your child complains of a worsening headache, it is essential to seek medical attention.

5. Drowsiness or Confusion: If your child is harder to wake, seems unusually confused, or is not responding normally, these are red flags that require immediate medical evaluation.

When to Seek Help
Given your child's symptoms of vomiting and behavioral changes, it is advisable to follow up with a healthcare provider. While the initial assessment did not reveal any serious issues, the emergence of new symptoms can indicate that further evaluation is necessary. Here are some steps to consider:
- Return to the Emergency Room: If your child continues to vomit, shows signs of confusion, or exhibits any other concerning symptoms, it is crucial to return to the emergency room for further evaluation.

- Follow-Up Appointment: If your child’s symptoms are mild but persistent (e.g., decreased appetite, mild nausea), consider scheduling a follow-up appointment with a pediatrician. They can assess your child's overall health and determine if any additional tests or referrals are needed.

- Neurology Consultation: If there are ongoing concerns about your child's neurological status, a referral to a pediatric neurologist may be appropriate. They can conduct a more thorough evaluation and determine if any further imaging or testing is necessary.

Conclusion
In summary, while your child's initial evaluation was reassuring, the development of new symptoms such as vomiting and behavioral changes should not be ignored. It is essential to monitor your child's condition closely and seek medical advice as needed. Early intervention can help prevent potential complications and ensure your child's well-being. Always trust your instincts as a parent; if something feels off, it is better to err on the side of caution and consult a healthcare professional.

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