A Bump on the Head of my Toddler

my 3yo son and the bump on his forehead

It was the usual morning, my 3yo son in front of the telly watching Nick channel in the 1st floor bedroom, me checking my Facebook and Email and my 2yo daughter playing her toys in the 2nd floor. I heard a loud bang then the cries of my son, saying he fell off the bed. I rush towards him and held him in my arms. I saw the big bump on his forehead and I was shaking as I tried to comfort him. Sure, he had accidents before, bumping on to almost anything as clumsy as he is, he even fell off the stairs. But this time, I was terrified, his bump was so big, it's like an egg or o giant egg for that matter protruding on his left forehead. I was praying as I tried to calm him down. I ran to the fridge and got a cold frozen Tocino and put it on the bump. I asked him heaps of questions him if his dizzy, hurting,  his name, his age, what happen to him etc etc. He was able to speak, answering my questions while crying. I sent text messages to people who could advise me on what proper action should I do next. I am already preparing to leave for the hospital, I was really scared, but was able to calm down when i got messages that I shouldn't worry too much. My son's bump has decrease in size, thanks to the frozen tocino and ice, he already stop crying and begging me not to go to the hospital. But as moms, we tend to over react sometime, I was persistent to go the hospital. We got on the car, me, my son and daughter and my adult niece, with the hospital on my mind. But since my son was so persistent that he doesn't want to go to the hospital, we ended up going to the mall instead. He asked for a toy, which a guilty mom could afford. We had lunch and bought some stuffs and went home. The bump was still visible but have decrease in size considerably. by the time we get home. He was back to his normal playfulness but i haven't got my nerves off. I still worry a lot although I have medical background, I still have to be sure. And sites on the internet and words from trusted friend and family help ease my worries. I hope the following will help you in case you get in to the same situation.

WHAT TO DO WHEN YOUR CHILD BUMPS HIS HEAD:

1. Don't panic. Stay calm. If your child sees you remain relaxed, he is more likely to calm down.
2. Cold Compress. Ice,ice,ice. If your child will let you, gently hold an ice pack (a "boo-boo bunny") to the bump (bag of frozen vegetables works great!). This will decrease the eventual size of the bump. Apply the ice for 20 minutes and then take a 5-minute break, then 20 minutes again. Offer your child a treat to eat during the icing to console him.
3. Many children will kick and scream if you try to apply ice. You can decide if it is worth it. The main benefit from ice is cosmetic appearance. Rarely, a large bump will leave a tiny pea-sized residual hard calcium deposit felt under the skin. Applying ice may help prevent this.
4. Stop the bleeding. The skin on the face and scalp is extremely rich in blood vessels. Cuts on the face and scalp will bleed much more than other areas of the body. Simply apply gentle pressure to the cut using a cloth (may have ice inside it). The bleeding will stop with time. Children virtually never lose too much blood from a cut or bump, even though it may seem like a lot.
5. If there is a cut over the bump, wait for the bleeding to stop, then examine in closely if it needs stitches.
6. Acetaminophen. When your child has calmed down, you may want to give a dose to relieve the headache that might start. 
7. You need to observe your child's mental status as explained below. Try to keep him awake for at least an hour. After that, you can allow him to take short naps, but no more than 20 minutes without observing him.
8. Observe your child. If your child is alert and conscious, walking, talking, playing, and acting like she was before the fall, administer a dose of parental sympathy, apply an ice pack to the cut or bump for twenty minutes, and begin a period of observation before calling your doctor. The reason for the period of observation is because doctors often rely more on how the child behaves after the injury than what happened at the time of the injury. If the brain has been injured, signs may show immediately, or they may appear slowly during the next twenty-four hours. After the period of observation, depending on your baby's condition, you may or may not wish to call the doctor. Besides any when-to-call-the-doctor list there is an overriding inner voice. Trust this monitoring system as much as the most sophisticated electronics. If it tells you something's not quite right, call your doctor to report baby's condition, seek advice, and above all tell the doctor why you are concerned. 

WHEN TO WORRY:

Bumps on the head, even large ones, don't always warrant a trip to the ER or even a call to your doctor. However a hard hit may shake up the brain – called a concussion, also blood can slowly leak out from a damaged blood vessel beneath the skull, called a hematoma that push into the brain tissue. A small hematoma is not dangerous, but larger ones can push into the brain tissue. This can either happen very quickly within an hour, or it can take two or three days. This is an emergency and requires a CAT scan of the head to diagnose. Remember, considering the many times children hit their head, injury to the brain is unusual. Most bumps on the head, even large ones, are not serious. Here are some signs to watch for that warrant a call to the doctor or the ER immediately:

1. Loss of consciousness. If your child blacks out, even for a few seconds, this can mean that the force of the bump was strong enough to cause a hematoma. A reassuring sign is that you either hear or see your child start to cry immediately after the bump. This means he did not lose consciousness. If your child is unconscious, but breathing and pink (no blue lips), lay her on a flat surface and call emergency medical services. If you have cause to suspect a neck injury, don't move the child but let the trained experts in neck injuries transport her. If she is not breathing, apply CPR, or if she's having a convulsion, keep her airway clear. Sometimes, if baby is sensitive and prone to temper tantrums, she may be pushed into a breath-holding spell, which could be mistaken for a convulsion. This scene naturally pushes panic buttons and gets baby rushed to the hospital. Even if this turns out to be unnecessary, it is better to be safe. When in doubt, take baby and sit in the waiting room of the local hospital emergency room.
2. Vomiting. Many children will vomit once or twice after a big bump on the head, either from crying, coughing and gagging, or just from the shock to the skull. This is expected. However, if your child vomits three or more times, he should be looked at in the ER. As a precaution feed the recovering faller clear liquids for a few hours. Breastfeeding is therapeutic.
3. Altered mental status. This means that your child won't focus on you, look you in the eyes, or respond to questions or commands. Fighting you when you try to apply ice are actually goods signs that he is okay.
4. Loss of balance while walking. Many children may complain of dizziness. This is expected. But if your child actually loses is balance and repeatedly falls over while walking, he needs to see a doctor. Watch your child's normal play. Is he doing everything the same after the fall: sitting straight, walking well, moving arms and legs normally? Or is he off balance, wobbly, dragging a leg, or becoming increasingly disoriented? In the pre- walker, do you notice any change in sitting or crawling skills or in manipulative hand skills
5. Prolonged crying. If an infant continues to cry inconsolably for more than an hour after a good dose of acetaminophen, he should probably see a doctor.
6. Severe headache. If a child continues to complain of a very severe headache you should consult a doctor immediately.
7. Eye signs. The eyes mirror what's going on inside the body, especially inside the brain. In fact, the back of the eye is so intimately connected with the brain that your doctor looks at the backs of the eyes for evidence of brain swelling while examining a child following a head injury. A child's signs are more difficult to assess, but here are the call-doctor cues:
   • Crossed eyes or rolling eyes
   • One pupil larger than the other
   • Behavior such as tripping or running into things that indicates baby's vision is diminished
   • In the older child, add complaints of seeing double and blurred vision to the worry list
8. When in doubt always seek medical attention.

WHAT TO LOOK FOR OVER THE NEXT 12-24 HOURS:

 

Check your child frequently for any of the above signs. Also check for:

Changes in baby's sleep behavior. Babies normally retreat into sleep after trauma, which makes the usual admonition to "watch for a change in consciousness" an anxiety-producing instruction for the parent. If a head injury occurs near night or nap time in an already tired child, you may be confused about whether the drowsiness is due to the injury or whether it's just time for sleep to naturally overtake the child. And it may be impossible to follow the advice "Don't let baby go to sleep." Let baby fall asleep, but awaken yourself every two hours and do a baby check. This is what to look for:

1. Change in color. From pink to pale or, even more alarming, blue.
2. Change in breathing. Periods of very shallow breathing, ten-to twenty-second periods of stop-breathing episodes followed by irregular breathing, or gasping episodes (remember that newborns normally have irregular breathing).
3. Twitches. On one side of the body involving a whole limb.

If baby's color and breathing patterns are normal (no change from usual) and your parental instincts sense nothing's wrong, there's no need to awaken baby unless advised to do so by you doctor. The deep sleep from a head injury is nearly always associated with shallow, irregular breathing patterns that you are unlikely to have seen before.

If, however, you are uncertain or child's appearance sets off a "not normal" alarm, do a partial arousal. Sit or stand your child up and then put her back down. Normally, a child will fuss a bit and thrash around in the bed to resettle. If your child does not act like this, try to fully arouse her by sitting or standing her up, opening her eyes, and calling her name. If she awakens, looks at you, fusses or smiles, and struggles to be left undisturbed, you can go back to sleep without worrying. If, on the other hand, she does not protest, can't be awakened enough to begin fussing, is pale, shows irregular breathing, and is drooling profusely, or shows any of the signs of brain injury listed above, seek medical attention immediately.