Is My Child's Forehead Injury Serious? When to Seek Medical Attention

Hit the forehead from a fall?

An eight-year-old child at home fell and hit their forehead.
On the first day, there was swelling only on the right side of the forehead, and ice was applied.
Now, four days later, there is swelling and bruising at the bridge of the nose and under the eyes.
Dr.
Chen, is this situation serious? Should I take them to the hospital? Should I see a surgeon? Thank you.

Mr. Li, 40~49 year old female. Ask Date: 2023/02/10

Dr. Chen Jiaming reply Surgery

A forehead hematoma, over the course of several days, will begin to spread and disperse subcutaneously as the internal bruising resolves, which is a normal occurrence.
The larger the hematoma, the further it can spread, potentially reaching the chin.
Most of the time, it will be absorbed within two weeks to a month.
When children bump their heads, their brain tissue is more voluminous, making them less prone to bleeding; instead, it is common for brain tissue swelling to cause increased intracranial pressure.
Common symptoms include vomiting, and if such symptoms occur, it is advisable to seek further evaluation at a hospital.
Other aspects can generally be reassured.

Reply Date: 2023/02/10

More Info

When it comes to head injuries in children, especially those involving the forehead, it is crucial to monitor the situation closely. In your case, your child fell and initially showed swelling on the right side of the forehead, which is common after such an incident. However, the subsequent development of swelling and bruising around the nose and under the eyes four days later raises some concerns that warrant further evaluation.

Understanding Head Injuries in Children
1. Initial Assessment: After a head injury, it is essential to observe for immediate symptoms such as loss of consciousness, severe headache, vomiting, confusion, or unusual behavior. If any of these symptoms occur, it is critical to seek medical attention immediately.

2. Delayed Symptoms: The appearance of new symptoms, such as swelling and bruising days after the injury, can indicate a few possibilities. It could be a result of the body's inflammatory response to the injury, but it could also suggest complications such as a hematoma (a localized collection of blood outside of blood vessels) or even a fracture that may not have been evident initially.

3. Signs of Serious Injury: While many head injuries in children are mild and resolve without intervention, certain signs should prompt immediate medical evaluation:
- Persistent or worsening headache
- Drowsiness or difficulty waking the child
- Confusion or disorientation
- Seizures
- Clear fluid or blood leaking from the nose or ears
- Swelling that continues to worsen or does not improve

When to Seek Medical Attention
Given the timeline of your child's injury and the new symptoms, it is advisable to seek medical attention. Here are some steps you can take:
- Visit a Healthcare Provider: Since there is swelling and bruising that has developed after the initial injury, it would be prudent to take your child to a healthcare provider. You can consider visiting a pediatrician or an urgent care facility that specializes in children's health.

- Specialist Referral: If the pediatrician finds it necessary, they may refer you to a pediatric neurologist or a pediatric surgeon for further evaluation, especially if there are concerns about a possible fracture or intracranial injury.

- Imaging Studies: Depending on the examination, the doctor may recommend imaging studies such as an X-ray or a CT scan to rule out any serious injuries, especially if there are signs of a fracture or if the swelling continues to increase.

Monitoring and Care at Home
While waiting for the appointment or if you decide to monitor at home, keep an eye on your child for any changes in behavior or new symptoms. Ensure they rest and avoid any activities that could lead to another injury. Ice packs can help reduce swelling, but be sure to apply them in intervals to avoid skin damage.

Conclusion
In summary, while many forehead injuries in children are not serious, the development of new symptoms after a few days necessitates a medical evaluation. It is always better to err on the side of caution when it comes to head injuries in children. Seek medical attention to ensure your child's safety and well-being.

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