Did your child hit their head during play yesterday, felt fine all day but in the middle of the night vomited?
Are you still wondering if an ER visit is necessary?
“With a head injury, the thing that pediatricians worry about the most is bleeding in or around the brain,” says Dr. Tiff Jumaily, MD, a board certified pediatrician with Integrative Pediatrics and Medicine.
“Bleeding in the brain is an emergency that needs urgent medical attention.
“However, it is rare. So, we try not to send every bump on the head to the ER.
“If there were bleeding in the brain, it could cause increased pressure in the head — which might manifest as an extremely painful headache, vomiting (especially when lying down) or seizures.”
I was inspired to write this post after reading about a woman whose young son bonked his head at the playground. He got right back up and felt fine all day (seemingly, anyways).
He seemed fine in the evening too, but then awakened in the middle of the night and vomited.
His parents decided to wait till “morning” to take him to the emergency room. Needless to say, a scan revealed bleeding in his brain. He fully recovered. He was lucky.
But this lucky story doesn’t mean you can wait till “morning” if your child upchucks in the middle of the night — even if they felt or seemed fine all throughout the preceding day and evening.
If a bang to the head (hit by a hard ball; hits head on a hard object on the way down from a fall; or slams head to hard ground during sport or play) occurred in the day prior to overnight, and then there’s vomiting for no apparent reason late into the night …
Get to the ER Now
Do not “wait till morning,” even though in the case I read about, there was a happy ending.
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“If a child hits their head and then vomits within the next 12 hours, I would recommend the child is examined in the emergency department right away,” says Dr. Jumaily.
“The dangers of a bleed in the head are too great to risk ignoring.”
Vomiting as a result from head trauma can be delayed while blood and fluid slowly and stealthily build up in the brain.
But once an overt symptom occurs, the deterioration can be rapid – and deadly.
The presence or absence of a visible injury is NO indicator of seriousness or prognosis.
Well of course, if there’s a gaping deep gash that reveals brain matter and bone fragments, common sense says this is immediately life threatening.
But a “little bump” does not mean there can’t be a serious head injury.
And NO bump, bruise, cut or redness certainly cannot be taken to mean “it’s nothing.”
Symptoms are a tell-all sign that something sinister can be brewing unseen under the skull: bleeding in the brain.
Don’t wait till morning to take your child to the ER if there’s upchucking or even just a little spitting up. The sunrise will not wait for you.
If the next 12 hours coincides with when the child will be asleep – even if that means overnight – you should periodically check on him to make sure that there’s been no vomiting.
As a matter of fact, it’d be a smart move to have the child sleep in your room so that if she vomits, there’ll be a greater chance of you immediately awakening to it rather than sleeping through it.
Though vomiting can indicate bleeding in the brain, this isn’t always the case. But are you going to leave this to chance?
Your child just vomited. He or she got hit in the head hours earlier.
There is no way that you, sitting there at home, can see into their brain. But a CT scan can.
Now you may be concerned over a CT scan’s radiation.
However, an ER doctor will weigh the risk benefit ratio of ordering a CT scan for your child’s head.
Progressive bleeding in the brain causes progressive neurological symptoms that an ER doctor will be looking for.
UpToDate.com says about 10 percent of kids vomit at least once after a head injury, and that “Children who vomit after a head injury do not necessarily have a serious brain injury.”
Vomiting warrants a trip to the ER to rule out a brain hemorrhage.
Which action is more regrettable for the rest of your life:
• Took my child to the ER right after they vomited but the CT scan was clean and he was sent home soon after.
• Delayed taking my child to the ER because I wanted to wait till morning, but by then he couldn’t be wakened. I rushed him to the ER but by then he’d stopped breathing.
They got him resuscitated but then said he was brain dead. A brain scan showed an acute subdural hematoma.
Fear of CT Scan Radiation
UpToDate.com points out that “In studies, some children with vomiting, headache, or a brief loss of consciousness (without other symptoms) have a traumatic brain injury while others do not.”
The emergency room physician may simply place your child under observation rather than rushing to order a CT scan.
UpToDate points out that in these situations, one reasonable approach is to observe the child closely for four to six hours following the injury. This usually takes place in an ER setting.
If there are no further symptoms, the young patient will not usually need a CT scan.
Kids who are doing well more than 12 hours after a bang to the head have a very low risk of a brain injury that would require surgical intervention — although there always is a very small chance.
It’s all about being safe rather than sorry. If your child vomits overnight, following getting hit in the head the previous day, don’t panic, but do take him or her to the emergency room and let the physician make a determination.
Dr. Jumaily
