Head Injury in Toddlers: When to Seek Medical Attention After a Fall

Q: Head Injury in Toddlers: When to Seek Medical Attention After a Fall

Hello： The first 72 hours after a head injury are the most critical; as time passes, the risk decreases. <br>If a child is alert, has normal vision, is active, and can eat and play without any specific complaints, they can be monitored further. <br>However, if there is confusion,

Follow-up after a 3-year-old child falls and hits their head?

A 3-year-old child (100 cm) fell and hit their head yesterday morning at 9 AM.
There were no external injuries or swelling.
The child cried for over an hour while clinging to their mother, but then returned to normal play.
The only unusual behavior was during nap time when the child complained of a headache upon lying down and getting up, but everything else seemed normal.
This morning, upon waking, the child asked their mother, "What happened to my eye?" When asked, the child did not respond.
A test of finger counting was normal.
Five minutes later, when leaving the room, the child mentioned they could not see out of their right eye.
An immediate test showed that vision was intact (the child correctly identified numbers when one eye was covered and also accurately described the color of a passerby’s clothing when asked).
The child stated they felt better when held by their mother.
When asked again about their eye upon waking, the child said they could not see out of one eye but could see out of the other.
Observations during playtime indicated everything was normal with no abnormalities, and when asked about their eyes, the child said there was no issue.
(The child's expressive language skills are adequate, and they have not previously expressed similar concerns.)
Should the current situation warrant immediate medical attention, or can it be monitored further? Additionally, is it normal for a child to experience temporary vision issues the day after a head injury? Thank you.

chia, 30~39 year old female. Ask Date: 2023/03/28

Dr. Lai Zhaokang reply Neurosurgery

Hello: The first 72 hours after a head injury are the most critical; as time passes, the risk decreases.
If a child is alert, has normal vision, is active, and can eat and play without any specific complaints, they can be monitored further.
However, if there is confusion, unsteady gait, seizures, nausea, vomiting, or severe headache, and the mother feels something is wrong, it is advisable to consult a neurosurgeon and seek emergency care.
Sudden blurred vision is abnormal, but if, according to your description, the condition has improved, it is acceptable to continue monitoring for three more days.
If there are any unusual symptoms, please seek medical attention.
Best wishes from Dr.
Lai Chao-Kang, Department of Neurosurgery, Changhua Hospital.

Reply Date: 2023/03/28

More Info

When it comes to head injuries in toddlers, especially after a fall, it is crucial to monitor the child closely for any signs of complications. In your case, the child experienced a fall but did not show any immediate signs of external injury, which is a positive indicator. However, the subsequent complaints about head pain and the unusual statements regarding vision are concerning and warrant careful consideration.

Firstly, it is important to understand that head injuries can sometimes lead to delayed symptoms, including intracranial bleeding or concussion. In toddlers, the brain is still developing, and they may not always be able to articulate their feelings or symptoms clearly. This makes it essential for caregivers to be vigilant. The fact that your child initially cried and then returned to normal play is a good sign, but the later complaints about head pain and the peculiar comments about vision should not be overlooked.

In general, the following symptoms after a head injury in a toddler should prompt immediate medical attention:
1. Persistent or worsening headache: If the child continues to complain of head pain, especially if it intensifies, this could indicate a more serious issue.

2. Changes in consciousness: If the child becomes unusually lethargic, difficult to wake, or shows signs of confusion, this is a red flag.

3. Vision changes: The child’s comments about not being able to see out of one eye, even if they later seem to see normally, should be taken seriously. Vision changes can indicate pressure on the brain or other complications.

4. Vomiting: Repeated vomiting after a head injury can be a sign of increased intracranial pressure.

5. Seizures: Any seizure activity following a head injury requires immediate medical evaluation.

6. Behavioral changes: If the child becomes irritable, excessively sleepy, or exhibits unusual behavior, this could indicate a problem.

Given the situation you described, where the child mentioned head pain and made comments about vision that seemed inconsistent, it is advisable to err on the side of caution. While it is possible that these symptoms could be transient and not serious, they could also indicate an underlying issue that needs to be addressed.
In terms of observation, it is generally recommended to keep a close watch on the child for at least 24 to 48 hours following a head injury. During this time, monitor for any of the aforementioned symptoms. If any concerning signs develop, or if you feel uneasy about the child’s condition, it is best to seek medical attention promptly.
In conclusion, while the child may appear to be fine at times, the combination of head pain and the unusual comments about vision suggests that a medical evaluation is warranted. It is always better to be safe and have a healthcare professional assess the situation, especially in young children who may not fully understand or communicate their symptoms effectively.

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