There is a specific sound that every parent dreads. It isnāt the sound of crying or screaming; it is that distinct, hollow thud of a head hitting the floor. In my years of practice here in Beverly Hills, I have seen countless panicked parents rush through my doors or call my after-hours line, breathless and terrified, because their little one took a tumble.
I am here to tell you that you can take a deep breath. While head injuries should always be taken seriously, the human skullāeven a tiny oneāis incredibly resilient. As a pediatrician, my goal is to empower you with the knowledge to distinguish between a terrifying-looking “goose egg” and a situation that requires emergency intervention. Letās walk through the anatomy of a bump, the signs of a concussion, and exactly when you need to grab the car keys.
The Anatomy of a “Goose Egg”
One of the first things parents notice after a fall is the immediate swelling. It can be shocking how quickly a large lump appears on a child’s forehead. However, big bumps aren’t always bad news. The scalp is one of the most vascular parts of the human body, meaning it is packed with tiny blood vessels.
When your child hits their head, these vessels break and bleed effectively under the skin. Because the skull is hard bone, that blood has nowhere to go but outward. This results in a hematoma, or what we affectionately call a “goose egg.”
From a medical perspective, I actually prefer seeing a bump grow outward. It usually means the blood is pooling outside the skull rather than pressing inward on the brain. While a large, purple lump looks scary, it is often just a superficial injury that will heal with ice and time.
Immediate Assessment: The First 10 Minutes
Before you start Googling “baby hit head when to worry,” take a moment to observe your child immediately after the incident. The reaction in the first few minutes tells me a lot about the severity of the injury.
If your child cries immediately, that is actually a positive sign. Crying requires high-level brain function; it means they are conscious, feeling sensation, and reacting to it. The scary scenario is when a child falls and is silent or goes limp.
The Console Factor
In my office, I look for “consolability.” After 10 to 15 minutes of cuddling, calm words, and maybe an ice pack, does your child settle down? Do they return to playing, reach for a toy, or ask for a snack? If your child is back to their normal self within 20 minutes, the likelihood of a severe brain injury is significantly lower.
Signs of Concussion vs. Normal Bumps
A concussion is a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head. It changes how the brain normally works. The tricky part for parents is that you cannot “see” a concussion like you can a cut or a bruise. You have to observe behavior.
To make this easier to visualize, I have put together a chart comparing normal reactions to a head bump versus signs that indicate a potential concussion or more serious injury.
| Symptom Category | Normal / Mild Injury | Red Flag (Seek Help) |
|---|---|---|
| Consciousness | Alert, crying immediately, easily woken up. | Loss of consciousness (even for a second), confusion, or won’t wake up. |
| Vomiting | Maybe spits up once due to crying/gagging. | Repeated forceful vomiting (more than 2 times). |
| Balance & Movement | Walking normally (for their age) after calming down. | Stumbling, dizziness, loss of balance, or weakness in one arm/leg. |
| Eyes | Pupils are equal size and react to light. | One pupil is larger than the other; eyes darting abnormally. |
| Mood | Cries but is consolable; returns to play. | Extreme irritability, inconsolable crying for hours, or totally lethargic. |
The “Baby Hit Head When to Worry” Checklist
When dealing with infants (under 1 year old), the stakes feel higher because they cannot tell you their head hurts or that their vision is blurry. If you are typing “baby hit head when to worry” into your search bar, here are the specific criteria I use to determine if a baby needs a CT scan or ER visit, largely based on the PECARN (Pediatric Emergency Care Applied Research Network) rules.
Go to the Emergency Room if your infant:
- Fell from a height greater than 3 feet (like a changing table or counter).
- Lost consciousness (passed out).
- Is vomiting repeatedly.
- Has a soft spot (fontanelle) that is bulging significantly when they are upright and not crying.
- Has bruising around the eyes (raccoon eyes) or behind the ears (Battleās sign).
- Is not acting like themselves (excessively sleepy, refusing to nurse/eat).
The Sleep Myth: To Wake or Not to Wake?
This is perhaps the most common question I get: “Doctor, can I let them go to sleep?”
Decades ago, medical advice was to keep a child awake after a head injury to ensure they didn’t slip into a coma. We have since updated our thinking. If your child has bumped their head, cried, calmed down, and is acting normal, but it is their nap time or bedtime, let them sleep.
Sleep is actually vital for the brain to heal. Keeping an exhausted, injured child awake can make them cranky and irritable, which mimics the signs of a concussion and makes it harder for you to assess them. However, I do recommend a modified observation schedule for the first night.
Observation Timeline Chart
Here is a guide on how to monitor your child whilst they sleep following a significant bump.
| Time Since Injury | Action to Take |
|---|---|
| 0 – 4 Hours | Keep a close watch. Do not give pain medication (Tylenol/Advil) yet, as it can mask worsening symptoms. If they sleep, check them every hour. |
| Sleep Checks | You don’t need to fully wake them. Gently nudge them or shine a light. If they shift, moan, or fuss, they are okay. You just want to ensure they are rousable. |
| 4 – 24 Hours | If they are acting normal, you can give acetaminophen for soreness. Monitor for delayed vomiting or changes in balance. |
| 24+ Hours | Most danger has passed. If headache persists or worsens, call the office. |
Prevention and Baby-Proofing
While we can’t prevent every stumble, we can minimize the dangerous ones. The most concerning head injuries usually come from heights or momentum (like running full speed into a wall). In my practice, I always emphasize that supervision is the best safety net, but environmental changes help too.
Anchoring furniture is non-negotiable. Using gates at the top and bottom of stairs is essential. And for those slippery sock moments, rug grippers are a lifesaver. If you are looking for a more comprehensive guide on setting up a safe zone for your toddler, I suggest you read my previous guide on toddler home safety essentials, where I break down room-by-room hazards.
Trust Your Gut
We rely heavily on data and checklists in medicine, but there is one diagnostic tool I never underestimate: Parental Intuition.
You know your child better than anyone. You know their specific cry, their energy levels, and the sparkle in their eyes. If a checklist tells you they are “fine,” but something deep in your gut feels wrongāperhaps they are just too quiet, or their color looks offābring them in. I would always rather check a healthy child and send you home with peace of mind than miss a subtle sign of injury.
Head injuries are frightening, but they are also a rite of passage for growing children. Most of the time, a hug and an ice pack are the only prescriptions needed.
Frequently Asked Questions (FAQ)
1. My child has a dent in their head after a fall, should I worry?
If you feel a depression or a “dent” in the skull rather than a bump, this is a reason to seek immediate medical attention. While it could be a quirk of swelling, we need to rule out a depressed skull fracture. Head to the ER if the skull feels indented.
2. How long should I wait to give Tylenol after a head injury?
I generally recommend waiting at least 2 to 4 hours after the injury before giving pain medication. If the child has a worsening headache that requires medication, I want to know about it, as a worsening headache is a sign of increasing pressure. Also, avoid Ibuprofen (Advil/Motrin) immediately after a fall, as it can theoretically increase bleeding risk if there is an internal injury.
3. Can a baby get a concussion from falling off the bed?
Yes, it is possible. Beds are typically about 2 feet high. While falls from this height usually result in minor bumps, if the baby lands on a hardwood floor at an awkward angle, a concussion or fracture can occur. Always use the observation checklist above for bed falls.
4. What if my child vomits once after hitting their head?
One episode of vomiting can be a reaction to the pain, the crying, or the shock of the event (vagale response). It is not automatically a sign of severe brain injury. However, if they vomit a second or third time, or if the vomiting happens hours later, that is a red flag requiring a doctor’s visit.
5. When can my child return to sports?
If your child has been diagnosed with a concussion, they must follow a strict “Return to Play” protocol. This usually involves complete rest until symptoms vanish, followed by a gradual increase in physical activity. Never send a child back to sports the same day as a head injury.
