Children hit their heads often, and a hard fall or collision can be frightening to watch. Most head injuries in children are minor and don't cause any lasting harm. The real question for a parent is usually which injury can be watched at home and which one needs to be seen right away. This guide walks through that decision in the order you'll actually face it: what to do first, when it's an emergency, when to call us, and how a concussion heals.
What should I do right after my child hits their head?
Start with the basics. Most of the time, this is all that's needed.
- Comfort your child. Crying for a few minutes after a fall is normal and expected.
- Check them over. Look for a deep cut, a soft or dented spot on the skull, or trouble moving an arm or leg.
- Use ice for swelling. A cold compress for about 20 minutes helps a bump or goose egg.
- Then watch how they look and act over the next few hours. That tells you more than the size of the bump does.
When is a head injury an emergency?
Go to the emergency room or call 911 if your child:
- Loses consciousness, even briefly
- Won't wake up or is very hard to wake
- Has a seizure
- Vomits repeatedly
- Has slurred speech, confusion, or doesn't recognize you
- Has one pupil larger than the other, or sudden vision changes
- Has weakness, numbness, or trouble walking
- Has clear or bloody fluid draining from the nose or ears
- Has severe or worsening neck pain
- Has a headache that keeps getting worse
- Is a baby who won't stop crying, or won't nurse or feed
These signs can point to bleeding or swelling inside the skull, or to a neck injury. That's rare, but it needs to be seen right away. Many things help a doctor judge how serious a head injury is. Loss of consciousness, repeated vomiting, a worsening level of alertness, and signs of a skull fracture are among the findings that call for prompt evaluation. When in doubt after a head injury, it's reasonable to have your child checked.
When should I call my pediatrician?
Between a clear emergency and an ordinary bump, there's a wide middle ground, and that's exactly when a phone call helps. Call us the same day if your child:
- Has a headache that's getting worse but isn't severe
- Vomited once or twice
- Has any possible concussion symptoms
- Has symptoms lasting longer than you'd expect
- Needs guidance on returning to school or sports
- Simply doesn't seem like themselves
A short phone call is often all it takes to sort out whether your child needs to be seen. You don't have to make that call on your own.
One important exception. Infants and toddlers deserve extra attention after a head injury. Because young children can't describe symptoms and are harder to examine, we have a lower threshold for talking these injuries through with families. If your child is under 2, give us a call so we can help decide whether they should be seen.
When can I watch my child at home?
Many children with a minor head injury can recover safely at home. If your child is alert, recognizes you, settled within a few minutes, has no emergency signs, and is acting like themselves, watching at home is usually the right call. A bump or goose egg that looks dramatic is usually just bruising under the skin and says little about the brain.
What you're watching for over the next day or two is a concussion, which can appear right away or take a day or two to show up. Signs include:
- Headache or pressure in the head
- Nausea or vomiting
- Dizziness, balance problems, or blurry or double vision
- Sensitivity to light or noise
- Seeming foggy, slow to answer, or hard to focus
- Sleeping more or less than usual
- Mood or personality changes, or just seeming "off"
Babies and young children can't tell you how they feel, so you watch their behavior instead. In a little one, a concussion may look like extra fussiness, more crying, clinginess, poor feeding, or a change in sleep. You know what's normal for your child. If something just doesn't seem right, give us a call.
What if my child takes a blood thinner or has a bleeding disorder?
The watch-at-home guidance above assumes an otherwise healthy child. A child who has a bleeding disorder, such as hemophilia, or who takes a blood-thinning medication should be evaluated promptly after a significant head injury, even if they seem fine at first. The same goes for a child with a shunt or a known problem with the blood vessels in the brain. If this is your child, call us right away rather than waiting to watch.
What is a concussion, and how is it different from a bump?
A head injury is any bump, blow, or jolt to the head. A concussion is one specific kind, where the force makes the brain move inside the skull and briefly changes how it works. Most head injuries are not concussions.
A concussion is a mild traumatic brain injury. In almost all cases there's no bleeding and no structural damage. The brain looks normal but isn't functioning normally yet. That's why a concussion is diagnosed from symptoms and a careful exam, not from a picture of the brain. A scan can be completely normal and the concussion still real. A concussion can also come from a hit to the body, not only a direct blow to the head, if the force is enough to jolt the head.
Does my child need a CT scan?
Most children don't. A CT scan looks for bleeding or a skull fracture, not a concussion, so it can't diagnose the thing parents are most often worried about. CT scans also use radiation, which matters more in a child than in an adult. Even in the emergency department, many children are safely watched for several hours instead of having an immediate scan.
For these reasons, pediatricians and emergency doctors don't scan every head injury. They use validated checklists, like one called PECARN, that weigh a child's age, how the injury happened, and their symptoms to decide who actually benefits from a scan and who is safer with careful observation. For a child who is alert and acting normally, watching closely is often the better and safer choice than imaging. A scan that isn't needed carries cost and radiation without changing what you'd do.
Do I need to wake my child up overnight?
No. This is one of the most common questions parents ask, and the old advice to wake a child every hour has changed.
If your child has been evaluated or is otherwise low risk and resting comfortably, let them sleep. Sleep helps the brain heal. You can look in on them to see that they're breathing normally and resting peacefully. What matters is whether they wake normally if you do need to rouse them. If you ever can't wake your child, or their symptoms are clearly worsening, treat that as an emergency.
How does a concussion heal, and how do I help?
Most concussions get better with time and a sensible return to normal activity. The approach has shifted in recent years, and a lot of advice online is out of date.
For the first 24 to 48 hours, ease back. Keep things quiet and low-key, but don't put your child in a dark room and don't keep them on the couch all day. Limit screens for the first day or two, then add them back gradually.
After that, get moving again, gently. Light activity like short walks is good for recovery, even with some mild symptoms. Mild symptoms during recovery are common and don't mean something is wrong. If an activity clearly makes symptoms worse, scale back and try again the next day. The goal is steady progress, not zero activity.
Return to school usually happens within a day or two for most children, often with temporary supports like rest breaks, a lighter workload, or extra time on tests, and holding off on big exams while symptoms are present. Keeping a child home too long can actually lengthen recovery.
Return to sports comes after school, not before, and only after a doctor has cleared your child. It follows a step-by-step progression and never happens on the same day as the injury. A child should be back to normal school and daily life before finishing the return-to-sports steps. A second concussion before the brain has fully healed can lead to a longer recovery and, in rare cases, serious complications. That's the reason for the wait.
For pain, acetaminophen is usually the first choice. Whether and when ibuprofen is appropriate depends on the injury, so check with us before using it. Never give aspirin to a child after a head injury.
Most children feel better within a few weeks, often within 2 to 4. Younger children can take a little longer, since their brains are still developing. If symptoms last beyond that or get worse, let us know, since some children benefit from seeing a specialist.
How can I prevent head injuries?
Not every head injury can be prevented, but you can lower the odds and the force.
- Use a well-fitted helmet for bikes, scooters, skateboards, skiing, and contact sports.
- Buckle your child correctly in a car seat or booster every time.
- Don't leave a baby alone on a bed, couch, or changing table, even one you think can't roll yet. First rolls happen without warning, and falls from these are one of the most common head injuries we see in babies.
- For little ones, use stair gates and window guards, and secure heavy furniture to the wall.
- Choose age-appropriate playground equipment and keep an eye on play.
Common myths about head injuries and concussions
You have to lose consciousness to have a concussion. Most concussions happen with no loss of consciousness at all.
My child cried right away, so it can't be a concussion. Crying immediately after a fall is normal and doesn't rule out a concussion.
A bigger bump means a more serious injury. The size of a goose egg tells you very little about what's happening inside the skull.
Rest in a dark room until every symptom is gone. Current guidance is the opposite. A quiet day or two, then a gradual return to light activity and routine, recovers most children faster than isolation.
A helmet means my child can't get a concussion. Helmets lower the force of a hit and help prevent severe brain injuries and skull fractures, but they can't fully prevent a concussion.
They have to be completely symptom-free before going back to school. Most children go back within a day or two with some supports, and returning sooner often helps recovery rather than hurting it.
The bottom line
Most head injuries are minor, and most concussions get better with time and a sensible return to routine. In the first hours, the job is simple. Comfort your child, watch how they look and act, and learn the handful of signs that mean go in now. After that, keep them comfortable, let them sleep, and ease them back toward normal rather than shutting them in a dark room.
One of the advantages of having a pediatrician who knows your child is having someone who can help you decide whether a fall can be watched at home or needs to be seen. That's part of why we cap each physician's panel at about 300 children rather than the usual 1,500 to 2,000. When you call after a fall, you reach a doctor who knows your child and has time to help you decide what to do. Call us, or let us know, and we'll help you sort out what's needed.
Frequently asked questions
Can my child sleep after hitting their head? Yes. Sleep helps the brain heal. The old advice to keep a child awake or wake them repeatedly has changed.
Do I need to wake my child up overnight? No, not routinely. Let them sleep and look in on them. If you ever can't wake your child normally, treat that as an emergency.
Can my child watch TV or use a phone after a concussion? Limit screens for the first day or two, especially if they make symptoms worse. As symptoms improve, screens can be added back gradually rather than avoided completely.
Can my child go to school the next day? Often yes, sometimes with temporary supports like rest breaks or a lighter workload. Returning within a day or two tends to help recovery rather than slow it.
Does vomiting always mean a concussion? No. One episode of vomiting after a head injury is common and not necessarily serious. Repeated vomiting is different and is a reason to be seen right away.
Does every concussion involve loss of consciousness? No. Most concussions happen without any loss of consciousness. A child can have a concussion and never have passed out.
Can a CT scan diagnose a concussion? No. A CT looks for bleeding or a fracture. A concussion is about how the brain is working, so the scan is usually normal even when a concussion is present.
How long should symptoms last? Most children feel better within 2 to 4 weeks. Younger children can take a little longer. If symptoms persist or worsen, let us know.
