Head Injuries: Emergency or not?

Head injuries in children are extremely common but knowing what is normal versus what requires emergency care can feel overwhelming in the moment. Below is a clear, parent-friendly guide that walks through the most important red flags, what to expect in the ER, how age and mechanism of injury matter, concussion symptoms and recovery, natural support for minor bumps, and when to return for further evaluation.

This post is a collab with Ashley Gondek (@vitalityash on Instagram). We both are ER nurses with a passion for holistic health and low-tox living. We hope that this guide is helpful in navigating how to care for your little ones and confidently assess their head injuries.

As always, this is for educational purposes only and is not medical advice.

How to Immediately Assess Your Child at Home After a Head Injury

Before deciding whether to treat at home, call your pediatrician, go to urgent care, or head straight to the ER, parents can do a quick but thorough assessment at home. This is often the very first step in understanding the severity of the injury. Think of this as a calm, systematic “once-over” to help you catch important details early.

1. Check for Loss of Consciousness

   1. Ask yourself: Did they lose consciousness at any point? Even a brief loss of consciousness is considered a major red flag. If they passed out, even for a second, they need to be evaluated in the ER.

   2. If the child is old enough, ask: “What is the last thing you remember?” Confusion about the event or memory loss on either side of the injury can also be concerning.

2. Observe Their Crying Response (Especially in Babies + Toddlers)

   1. In young children, an important sign is whether they cried immediately. A normal cry right after the injury shows their brain responded appropriately.

   2. Concerning signs include:

      1. No cry at all after a significant injury

      2. A delayed cry

      3. A cry that suddenly stops and is followed by lethargy

3. Evaluate Their Alertness and Behavior: Compare your child to their normal baseline.

   1. Ask yourself:

      1. Are they unusually sleepy at a time they would not normally nap?

      2. Are they hard to wake up?

      3. Are they acting confused or disoriented?

      4. Do they recognize you and respond normally?

      5. Are they speaking normally for their age?

      6. Are they moving around normally?

      7. Are they acting “off,” not themselves, or not interested in usual activities?

   2. For infants and toddlers, because they can’t explain how they feel, look for:

      1. Excessive crying or irritability

      2. Trouble being consoled

      3. Not wanting to feed

      4. Too quiet or unusually calm

      5. Loss of balance or unusual clumsiness

      6. Bulging fontanels

4. Check for Vomiting

   1. Vomiting can be normal with stress or crying. But the pattern matters.

   2. Ask: Did they vomit once or are they vomiting multiple times or vomiting later, after seeming okay at first?

   3. Repeated vomiting (more than once, spaced apart) is a red flag and should be evaluated in the ER.

5. Do a Quick Neurological Check

   1. These are simple, at-home neuro checks parents can do:

      1. Eye contact: Are they making normal, appropriate eye contact?

      2. Pupils: Are their pupils equal in size? Unequal pupils = ER immediately.

      3. Balance: Can they walk normally (if age-appropriate)?

      4. Speech: Are they slurring words or mumbling unusually?

      5. Weakness: Can they move arms and legs normally?

      6. Coordination: Are they reaching for objects normally or seem shaky/off-balance?

   2. Any abnormality in these areas requires medical evaluation.

6. Examine the Head and Scalp

   1. This is where you check for goose eggs, cuts, scrapes, bruising, and swelling. Take your time. Head injuries can bleed a lot, and swelling can look dramatic.

   2. How to Evaluate a Goose Egg or Swelling

      1. A “goose egg” is usually a firm bump caused by swelling over the skull. This is generally a normal response to trauma.

      2. Safe for home care if:

         1. The swelling is firm

         2. The child is otherwise acting normal

         3. There is no soft dent or squishiness

         4. The swelling is on the forehead (less concerning than sides/back)

      3. More concerning if:

         1. The swelling feels soft, squishy, or boggy → could mean bleeding deeper than the skin

         2. Swelling is rapidly growing in size

         3. The bump is on the side or back of the head (higher-risk locations)

   3. How to Evaluate Bruises

      1. Bruises on the forehead or near the hairline are usually normal.

      2. Concerning bruises: go to the ER

         1. Behind the ear (Battle’s sign) → can indicate a skull fracture

         2. Around the eyes (raccoon eyes) without a direct facial hit

         3. A bruise that appears hours later and is accompanied by lethargy, vomiting, or confusion

   4. How to Evaluate Cuts or Scrapes

      1. Head cuts bleed a lot, so first clean the area with a saline solution or clean water while applying gentle pressure.

      2. You likely can manage at home if:

         1. The cut is very small (less than ½ inch)

         2. It stops bleeding with 5–10 minutes of gentle pressure

         3. The edges of the cut come together easily

         4. There is no exposed skull or deep tissue

         5. Your child is acting normal otherwise

      3. You should go to the ER or urgent care if:

         1. The wound is gaping open

         2. You can see the white of the skull or fatty tissue

         3. Bleeding won’t stop after 10–15 minutes of pressure

         4. There is debris stuck inside the wound

         5. The child was hit with a heavy object

         6. The wound is in a place that will likely require sutures (eyebrow, forehead, scalp that won’t stop bleeding)

   5. Checking for Tender Spots or Skull Irregularities

      1. Gently run your hand over the entire scalp.

      2. Concerning findings include:

         1. A soft spot that bulges (in infants)

         2. A depressed or “dented” area of the skull

         3. Extreme tenderness in one localized spot

         4. A crackling sensation under the skin (air trapped, rare but concerning)

7. Monitor How Symptoms Change Over the First Hour

   1. The first hour after injury tells you a lot.

   2. Signs that things are improving:

      1. They stop crying

      2. They begin playing normally

      3. Their alertness returns to baseline

      4. No new symptoms appear

      5. The bump stops growing

   3. Worsening symptoms in the first hour is more concerning and should prompt medical evaluation.

      
      

How to Decide Home Care vs. Urgent Care vs. ER

1. Home Care is Reasonable If:

   1. No loss of consciousness

   2. Normal crying response

   3. Child is alert and acting normally

   4. One episode of vomiting only

   5. Pupils equal

   6. Normal movement

   7. Goose egg is firm

   8. Minor bruise or small scrape

   9. Cut is small, shallow, and bleeding stopped

2. Urgent Care is Reasonable If:

   1. Cut likely needs glue or steri-strips

   2. You want exam/rule-out but child is overall stable

   3. Mild behavior changes but improving

   4. Uncertain mechanism (e.g., fell off couch and you didn’t see it)

   5. Note: many urgent cares can suture, but you may want to call ahead to conform before you waste a trip

3. ER is Necessary If:

   1. Loss of consciousness

   2. Fall from a height more than twice their height

   3. More than one vomiting episode

   4. Unequal pupils

   5. Confusion, disorientation, not making sense

   6. Hard to wake up

   7. Lethargy outside normal nap times

   8. Seizure

   9. Fluid or blood leaking from nose/ears

   10. Inconsolable crying

   11. Soft, squishy swelling

   12. Bruise behind the ear

   13. Worsening symptoms of any kind

Emergent Head Injuries: Go to the ER!

Let's talk a little more about emergent symptoms and emergency care. Certain symptoms after a head injury indicate an urgent need for medical evaluation.

1. Loss of consciousness: even if brief

2. Unable to move their limbs. Spinal cord injuries can accompany significant head trauma. If a child is unable to move their limbs, do not pick them up and keep them as still as possible while calling 911.

3. Severe posterior neck pain: This can indicate a fracture of the cervical spine. Lay the child down and keep the neck still while you call 911.

4. Not crying right away: if infants or small children do not cry after a severe head injury, it could indicate a temporary loss of consciousness or a disruption in normal brain function, both of which are red flags for more serious trauma.

5. Change in mental status: being unusually sleepy during a time they would not normally nap, being difficult to wake up, acting confused, or speaking abnormally for their age.

6. Vomiting more than once: especially if the vomiting starts hours after the head injury.

7. Unequal pupils: the pupils (middle black circle of the eye) is different sizes or different shapes on each eye.

8. Large open wound, or any wound that bleeds heavily also warrant a prompt ER visit. Head wounds bleed a lot, and children may need the area cleaned thoroughly, assessed, and possibly closed with staples or sutures.

Let's talk about the difference between a normal “goose egg” and signs of deeper injury. A goose egg is typically a firm bump caused by swelling outside the skull. While this is painful for a child and scary to see, it is not an emergency.

But, if the bump on the head is soft or squishy, or there is bruising located behind the ear (Battle’s sign) it may indicate a more serious problem and requires immediate medical evaluation. Oftentimes, the Battle's sign will be accompanied by bruising around the eyes (black eyes)

Goose Egg: if firm, is often not an emergency

If symptoms are mild, parents have the option of visiting urgent care or calling the pediatrician for a same-day assessment. However, pediatricians frequently err on the side of caution and may recommend going directly to the ER.

What to Expect in the ER

When you arrive at the ER, the first step is registration, followed by an evaluation from the triage nurse. As they ask what brought you in, they will begin collecting vital signs, including height, weight, temperature, heart rate, blood pressure, oxygen saturation, and respiratory rate. Throughout the interaction, the nurse will be assessing your child’s level of consciousness and asking age-appropriate questions to evaluate mental status.

Once vitals and mental status are assessed, the triage nurse assigns an acuity level, which determines how quickly your child needs to be seen. Children with altered consciousness are considered higher acuity and seen sooner, while a child acting normally after a head injury may safely wait for the physician.

Providers are cautious about imaging in children. CT scans involve radiation, so unless absolutely necessary, most ER physicians, NPs, and PAs rely on evidence-based decision tools, such as the PECARN Pediatric Head Injury Rule, to determine whether imaging is appropriate. These tools help balance safety with the risks of radiation exposure.

If no immediate red flags are present, children are often observed in the ER for 4-8 hours to ensure symptoms do not progress. You will remain with your child the entire time. Depending on severity, they may be placed on continuous vital sign monitoring, or staff may check vitals periodically. Nurses will perform ongoing neuro checks and report any changes to the provider.

If concerning symptoms develop during observation, additional testing (like imaging or labs) may be ordered, and the care plan will be updated accordingly.

As ER nurses, we often see Urgent Care centers sending children to the ER “to rule out a concussion.” In reality, there is nothing the ER can do for diagnosing a concussion that Urgent Care cannot. A concussion cannot be seen on a CT scan, so the diagnosis is entirely based on symptoms and clinical assessment. We will discuss concussion care later in this guide.

After discharge, it’s normal for a child to be more tired, emotional, or irritable for 24–48 hours, and mild headaches are common. Light activity is fine once symptoms are improving, but rough play should be avoided for several days.

How Age and Injury Mechanism Affect Evaluation

Head injuries are evaluated differently depending on the child’s age and the mechanism of injury. One of the biggest factors is the height from which the child fell. A fall from a height greater than the child’s own height, or greater than twice their height, is more concerning.

For example, a baby falling off a changing table (2–3 times their height) is far more likely to sustain a skull fracture or internal injury, whereas a 10-year-old falling from that same height would likely be uninjured because it is below their full height.

Another key consideration is the amount of force involved. A fall where a child bumps into a piece of furniture is usually a lower-energy impact. In contrast, an object thrown at the child, especially something heavy or traveling at high speed, delivers concentrated force to a small area of the skull. These higher-energy impacts are more likely to cause deeper injuries such as concussions, fractures, or internal bleeding.

Age also plays a role in communication. Babies and young toddlers cannot describe symptoms, which often leads physicians to be more cautious and more willing to obtain imaging if the mechanism of injury is significant. Toddlers are particularly prone to head injuries because their heads are proportionally larger than their bodies (similar to a “bobble head”) and this increases their fall risk.

Concussions: Definition, Symptoms, & Management

A concussion is a type of mild traumatic brain injury that happens when a sudden impact or force causes the brain to move rapidly inside the skull. This movement can stretch or temporarily disturb brain cells, leading to physical, cognitive, emotional, and sleep-related symptoms. You can think of it as a "bruise on the brain". Concussions do not show up on CT scans or X-rays; they are diagnosed entirely based on symptoms and behavior.

Concussions can affect multiple areas: physical, cognitive, emotional/behavioral, and sleep. Parents should watch for changes compared to a child’s usual baseline.

Physical symptoms may include:

• Headache or pressure

• Nausea or early vomiting

• Dizziness or balance problems

• Sensitivity to light or noise

• Fatigue or low energy

• Blurred or double vision

Cognitive symptoms include:

• Trouble concentrating

• Feeling foggy or slowed down

• Memory problems

• Decline in school performance or difficulty with thinking tasks

Emotional or behavioral changes include:

• Irritability or increased emotional sensitivity

• Anxiety or sadness

• Changes in play behavior in younger children

Sleep-related symptoms include:

• Sleeping more or less than usual

• Difficulty falling asleep

• Changes in sleep patterns

In very young children, look for:

• Excessive crying or irritability

• Feeding changes or refusal

• Altered sleep patterns

• Unsteady walking

• Vomiting without other explanation

Monitoring at Home After a Concussion

• Parents should assume a concussion is possible after any significant head impact.

• During the first 24–48 hours, limit physical exertion and reduce cognitive load: meaning less screen time, homework, and intense play. Offer plenty of rest, healthy food, hydration, and maintain a consistent sleep schedule.

• Keeping a symptom log can help track what improves or worsens symptoms. Avoid situations where re-injury could occur, including sports or rough play, until your child is cleared. Communication with the child’s school can help with temporary academic adjustments.

Concussion Recovery Timeline

• Most children begin to recover within 2–4 weeks, with many improving sooner. About 15-30% may have lingering symptoms lasting beyond one month which will need follow-up with a provider.

• The recommended approach is:

  • Immediate removal from play/physical activity after an injury

  • 24–48 hours of relative rest (not strict bed rest)

  • Gradual reintroduction of light activity

  • Limit screen time

  • Return to school within 1-2 days with accommodations as needed

  • Return to sports only once the child is symptom-free and cleared by a provider

Prolonged symptoms are more common in children who had loss of consciousness, initial dizziness, early vomiting, older age, prior concussions, or learning/behavioral disorders.

Natural Support for Minor Head Bumps and Bruises

For everyday bumps without concerning symptoms, parents can safely use several natural approaches.

Arnica montana, is one of the most popular remedies. It is used in traditional and homeopathic medicine, may help reduce swelling, bruising, inflammation, and soreness.

• It can be given as homeopathic pellets or applied as a cream, gel, or salve (should never be applied to broken skin)

• For my own children, I typically give 2–3 pellets of arnica 30C, repeating every 15 minutes for two to three doses. If there is a goose egg without broken skin, I follow with an arnica salve.

• Links:

  • Pellets

  • Gel

  • Cream

  • Salve: Natalie10off for 10% off

Red light therapy is another gentle, supportive tool. Red and near-infrared wavelengths can help reduce inflammation and support tissue repair. Keep treatments short and avoid shining the light into the eyes.

LumeBox link: this link gives you 40-50% off!

Tea Bag Compresses: green, black, and chamomile tea bags contain natural compounds (tannins & antioxidants) that help:

• constrict blood vessels to reduce swelling

• pull fluid out of tissues to help with puffiness

• calm irritation & redness

• provide gentle cooling when used cold

• Black tea (most effective)

  • highest tannin content

  • best for swelling and bruises

  • use if you want fast results

• Green tea

  • anti-inflammatory

  • gentle

  • great for sensitive skin or young children

• Chamomile tea

  • soothing and calming

  • nice option for younger kids

  • ideal if they're worked up or crying

How to use a tea bag compress:

1. Steep tea bag briefly in warm water

2. Let it cool or refrigerate until cold

3. Apply to bump for 10-25 mins

4. Repeat 1-3 times the first day as needed.

Kids usually tolerate this better than ice because it's softer and less of a cold-shock.

Additional supportive measures may include:

• Ice to the area: this can be controversial topic in recent years. Icing an injury helps diminish inflammation to the area by restricting blood flow. The problem is, the blood itself offers healing properties so by restricting its flow, you may be prolonging the injury duration. My rule of thumb is, we use ice for rapidly swelling injuries that result in a lot of pain. If the swelling is gradual, we do not use ice.

• Magnesium flakes bath: soothes inflammation and supports healing

• Light lymphatic drainage: light strokes away from the bump to encourage fluid drainage.

• Elevate the heads: helps with drainage

• Hydration, minerals, and balanced nutrition (no sugar and no artificial dyes): supports the body after crying or stress. The brain heals best when the body is supported

• Chamomile tea: calms irritability and promotes relaxation

• Chamomilia homeopathy: can help with pain relief, irritability, and restlessness (is not just for teething pains!)

• Lavender diffusion: helps settle the nervous system after the fall. (some people love essential oils, some hate them – use what works for you and your family) 

• Comfort + observation: stay close, keep things calm, and monitor behavior.

• Anti-inflammatory foods: berries, leafy greens, quality protein, omega-3s.

• NO SCREENS

We hope that this guide helps you navigate caring for your little one at home and empowers you in medical decision making! Knowledge is power!