Here are guidelines on when to take your baby or toddler to the emergency room if they hit their head from a fall or from running into something.
The presence or absence of screaming is not predictive of serious head injury.
Even though they aren’t far from the floor, a fall to the floor can result in a significant impact to the head.
Under Age Two
“Any child under the age of two years old should go to the emergency room if they struck their head, and their parents or guardian feel that they are acting differently, or if there’s a mark on their head,” says Irene Tien, MD, a board-certified emergency medicine and pediatric emergency medicine physician in MA.
So let’s say that your toddler is trotting down your driveway and suddenly slips, falling backwards and hitting their head on the asphalt.
Of course, he’s going to let out a very loud cry, which you might think is a good sign, as it indicates full consciousness.
But the loudness of bawling is not predictive of whether or not there will be serious harm to the brain.
“Infants under three months of age are at especially high risk for serious intracranial injury, otherwise known as some sort of bleeding in or around the brain, even after what seems like an extremely minor fall, like falling out of bouncy chair,” says Dr. Tien.
The baby or two year old may seem quite perky, crying her head off from the shock of the incident, having immediately stood back up from falling on her head – yet, hours later, begins becoming increasingly drowsy and then unarousable.
In the emergency room, a brain bleed known as an acute subdural hematoma is diagnosed. “This is life-threatening, especially if identification is delayed,” says Dr. Tien.
There is no way to tell, simply by how a baby or toddler responds after falling on their head, whether or not the injury has caused, or will soon cause, brain injury.
Never take a “he seems fine” observation to mean that you don’t have to take your baby to the ER — or even to a pediatric office visit — after they hit their head.
“If the child seems okay and does not appear sick, there is time to call your pediatrician,” says Dr. Tien.
If your child seemed fine right from the get-go, you should at least make an appointment with the pediatrician instead of waiting several days.
There could still be an early brain bleed going on at the get-go that has the potential to cause brain tissue death in the ensuing days.
A pediatrician will know what to look for that might indicate this latent development.
The parent, who believes she “knows” her child, will not know all the signs to look for unless she is trained in medicine.
Of course, some neurological symptoms are obvious such as difficulty arousing the baby, as well as the following:
• Difficulty walking
• Difficulty talking
• Cognitive deterioration
• Vomiting, especially in a projectile
• Seizure
• Self-report (if toddler is articulate enough) of a headache, especially if it’s worsening
Just play it safe and take the baby or toddler to the emergency room if there are any symptoms or changes in cognition or awareness.
At a minimum, let your child’s doctor know what happened. This reminds me of a toddler whose fall to a cement driveway across the street was witnessed by me.
Suddenly, BOOM! He fell backwards and I actually heard the smacking sound of the back of his head striking the pavement.
Amazingly he got up quickly and let out some fierce crying, and his mother ran out to comfort him. I told her he should go to the ER.
She said she’d keep a careful eye on him. I never knew what happened after that.
At a minimum, she should have reported the incident to the toddler’s pediatrician.
And maybe she did, maybe she didn’t, and maybe nothing ever came of the accident.
But we can’t depend on crossed fingers and luck when a toddler and especially infant gets hit in the head.
In practice for 20+ years, Dr. Tien is a leading medical voice on social media, providing the public with accurate information to empower them to live their healthiest life.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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