An injury caused by any blow to the head. A concussion is defined as a head injury which is followed immediately with a period of loss of consciousness (the child is not arousable).

• Toddlers who are learning to walk take many falls along the way. It is unusual for a child falling from their own height to have any serious head injury.
• If a child cries immediately after an injury to the head and has no loss of consciousness, this is most likely to be a minor head injury. A child may have nausea, vomiting, headache or dizziness in the first 24 to 48 hours after minor head injury. This is not cause for alarm, unless the symptoms appear to worsen over time and especially if associated with progressive lethargy. By lethargy, we mean the child may appear disoriented, or very sleepy when it is not bedtime, or be hard to awaken if it is their normal sleep time.
• With any head injury where the child does not cry immediately and appears to "pass out" for seconds or minutes after the event, the doctor should be contacted immediately.
• Often, a large bump or "goose egg" develops on the head after a head injury. The size of the bump or how quickly it appears does not tell us the seriousness of the injury. What is more important is if there was any loss of consciousness and how the child is acting.

• Any loss of consciousness where the child appears to "pass out" and is unarousable after the injury
• Vomiting 2 or 3 times after the injury, especially if the child is not acting normally
• Disoriented, confused behavior
• Pupils of the eyes appear unequal (this is usually a late sign for serious head injury)
• Extremely sleepy behavior during usual awake time
• Very difficult to awaken if during usual sleep time
• Mechanism of the head injury seems severe (for example, falling down several stairs onto tile or falling from a large height)
• There appears to be a slight depression of the skull bone at the point of injury

• Headache, nausea or dizziness are not going away after 48 to 72 hours of the injury

Observation at home. Most children with minor head injuries can be observed at home. During daytime hours, observe their behavior and also watch for vomiting. If a child normally naps, try to keep the child up for a short period, so that you may observe their behavior and then allow them to sleep. Awaken them when they have napped their usual amount of time. If it is bedtime, try to observe for a short period and then allow them to sleep. The child should be awakened every 3 to 6 hours, depending on how significant an injury occurred and how the child is acting before bedtime. The more concerned we are, the more often we will awaken the child.

Treatment of bumps and headaches. Headaches can be managed with appropriate doses of acetaminophen or ibuprofen (see chart under fever). Place ice on bumps on the skull that swell up after the injury.

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