Head Injuries in Children: When to Seek Further Medical Attention

Head injury

My 5-year-old child accidentally fell down the stairs and hit their forehead.
We applied ice and cleaned the area to reduce swelling.
My child has been able to move around and eat normally, and has been attending kindergarten as usual.
A week later, I noticed that the forehead had swollen and felt soft, as if there was fluid inside.
We took them to see a surgeon, who informed us that the swollen area would resolve on its own and advised us to monitor it.
However, four days later, I noticed that the swelling had increased, almost the entire forehead was swollen and felt soft.
I would like to ask if we should go back to the hospital for further examination? Should the fluid be drained?

york, 40~49 year old female. Ask Date: 2006/02/24

Dr. Huang Junxiong reply Surgery

Most hematomas in the facial area or scalp are self-limiting and typically resolve within two to four weeks.
In the initial one to two weeks, aspiration is usually not necessary.
However, if the hematoma is large and the resolution is slow, it is recommended to have a follow-up with a physician within one to two weeks post-injury to determine if aspiration or surgical removal of the clot is needed.
Generally, physical therapy is advised: apply ice for the first two to three days, followed by alternating heat (approximately 40°C) and cold (approximately 10°C) treatments, which can enhance recovery of the hematoma and the injured area.
Wishing you good health!

Reply Date: 2006/02/24

More Info

When it comes to head injuries in children, especially in young ones like your 5-year-old, it is crucial to monitor their condition closely and understand when to seek further medical attention. Based on your description, your child fell down the stairs and hit their forehead, which is a common scenario that can lead to various types of injuries, including contusions, hematomas, or even more severe intracranial injuries.

Initially, it is good that you applied ice and cleaned the area to reduce swelling. However, the development of a soft, swollen area on the forehead a week after the injury raises some concerns. This could indicate a few possibilities, such as a hematoma (a localized collection of blood outside of blood vessels) or a seroma (a collection of fluid that can develop after trauma).
Here are some key points to consider regarding your child's condition:
1. Observation of Symptoms: After a head injury, it is essential to watch for symptoms such as persistent vomiting, severe headache, confusion, unusual drowsiness, or any changes in behavior. If your child exhibits any of these symptoms, it is crucial to seek immediate medical attention.

2. Soft Swelling: The soft swelling you described could be a hematoma or seroma. While some of these can resolve on their own, if the swelling increases or does not improve over time, further evaluation is warranted. The fact that the swelling has increased significantly over four days suggests that it may not be resolving as expected.

3. Medical Evaluation: Given that the swelling has worsened, it would be prudent to return to a healthcare provider for a re-evaluation. They may recommend imaging studies, such as an ultrasound or CT scan, to assess the underlying structures and determine if there is any significant bleeding or other complications.

4. Aspiration of Fluid: The decision to aspirate (draw out) the fluid from the swelling should be made by a medical professional. Aspiration can relieve pressure and discomfort, but it also carries risks, such as infection or further injury. Therefore, it should only be done if deemed necessary by a physician.

5. Follow-Up Care: If the physician determines that the swelling is benign and will resolve on its own, they may recommend follow-up visits to monitor the situation. It is essential to keep an eye on the swelling and any new symptoms that may arise.

In conclusion, while some swelling after a head injury can be normal, the increase in size and the soft texture of the swelling in your child's case warrants further medical evaluation. It is always better to err on the side of caution when it comes to head injuries in children. If you have any doubts or concerns, do not hesitate to seek medical advice. Your child's health and safety are the top priority, and timely intervention can prevent potential complications.

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