Kids Health Info

Head injury - general advice

  • It is common for children to bang or bump their head and it can sometimes be difficult to tell whether an injury is serious or not. Many head injuries are not serious and simply result in a bump or bruise. Occasionally, head injuries can result in damage to the brain. Any knock to the head that causes lumps, bruises, cuts or more severe injuries is classified as a head injury. If your child has received an injury to the head, they should see a doctor.

    Seek medical help immediately by calling an ambulance on 000 if:

    • your child has had a hard bang to the head, such as falling off something high, or from a car accident
    • your child loses consciousness (passes out)
    • your child seems unwell and vomits several times after hitting their head.

    Glossary of Terms

    Concussion – traumatic brain injury that alters the way the brain functions. Effects of concussion are usually temporary but can include altered levels of consciousness, headaches, confusion, dizziness, memory loss of events surrounding the injury, and visual disturbance.
    Acquired Brain Injury (ABI) – an injury to the brain that has occurred at any time after birth. Causes of ABI can include infection, stroke or injury.
    Traumatic head injury – an injury caused by an impact to the head.  
    Loss of consciousness – time when a person is unable to open their eyes, speak or follow commands. They have no awareness of stimulation from outside their body. 
    Convulsion, seizure or fit – this can occur when there is a momentary imbalance within the electrical and chemical circuits in the brain. The imbalance may create a temporary disturbance in the way the brain controls awareness and responsiveness, and may cause unusual sensations and/or abnormal movements and postures. 

    Signs and symptoms

    The symptoms experienced after a head injury are used to determine how serious the injury is. Head injuries can be classified as mild, moderate or severe. The information below is a guideline. If you see any of these symptoms in your child following an injury to the head, please seek medical assistance. 

    A severe head injury is when your child:

    • has lost consciousness for a prolonged period, or has an ongoing decreased conscious state
    • experiences visual disturbance
    • is drowsy and does not respond to your voice
    • has other significant head injury signs, such as unequally sized pupils or arm and leg weakness
    • has something stuck in their head
    • has a second seizure, convulsion or fit, other than a single brief one when the injury happened
    • has confusion or loss of orientation to time, person or place, or memory loss.

    You should call 000 for an ambulance immediately if your child has a severe head injury.

    A moderate head injury is when your child:

    • has lost consciousness for a brief period of time
    • is alert and responds to your voice
    • has vomited two or more times
    • has a persistent or recurring headache
    • experiences visual disturbance
    • may have had one brief seizure, convulsion or fit straight after the head injury
    • may have a large bruise, lump or cut on their head 
    • has confusion, loss of orientation to person, place or time, or memory loss.

    You should call 000 for an ambulance immediately if your child has a moderate head injury.

    A mild head injury/concussion is when your child:

    • may display altered level of consciousness
    • is alert or interacts with you
    • may have vomited
    • may have bruising or cuts on their head
    • is otherwise normal.

    You should seek medical advice if any of the above symptoms are concerning you, otherwise continue to observe your child for any of the signs and symptoms listed below.

    Parents should watch for the following symptoms in the coming weeks in children who have experienced a head injury:

    NB: Children often become fatigues (i.e. get tired) quickly after a head injury, and this can exaggerate any of these following symptoms.


    Physical symptoms:

    • Headache. Your child may have a headache. Give paracetamol every six hours if needed to relieve pain. If pain is not relieved by paracetamol, please seek medical advice. 
    • Vomiting. Your child may have vomited once, but if vomiting continues go back to your doctor or to your nearest hospital emergency department.
    • Drowsiness or fatigue. On discharge we would encourage your child to get lots of rest and sleep. If your child's energy levels are not improving go back to your doctor.  If your child is difficult to wake, take them to your nearest hospital emergency department urgently, or call an ambulance on 000. 
    • Bleeding or discharge from the ear or nose. If your child has clear fluid or blood coming from their ears or nose, go back to your doctor or to your nearest hospital emergency department immediately. 
    • Fits/seizures/twitching/convulsions. If your child experiences any of these go back to your doctor or to your nearest hospital emergency department immediately.
    • Blurred or double vision. If your child experiences any blurred or double vision go back to your doctor or to your nearest hospital emergency department immediately.
    • Poor coordination or clumsiness. If you notice that your child is less physically coordinated or more clumsy than usual, go back to your doctor or to your nearest hospital emergency department immediately.
    • Arm or leg weakness. If any new weakness develops or any existing weakness gets worse and does not improve, go back to your doctor or to your nearest hospital emergency department immediately. 
    • Difficulties swallowing, or coughing when eating or drinking. If these symptoms are happening to your child, go back to your doctor or to your nearest hospital emergency department immediately. 
    • Sensitivity to noise.  Go back to your doctor or to your nearest hospital emergency department.
    • Unusual or confused behaviour.   To assess your child, ask some age-appropriate questions such as:
      Where are you? 
      What is your name? 
      What day is it? 
      Is it day time or night time?
      How old are you?
      Do they know familiar people’s names?
      If the answers are out of the ordinary and your child appears more confused or is more forgetful than usual, go back to your doctor or nearest hospital emergency department straight away.

    Remember, if you have any difficulty in waking your child, take them to the nearest emergency department or call an ambulance on 000


    Behavioural and emotional symptoms:

    Your child may:

    • be more demanding than usual, and become  easily frustrated
    • be more fearful and anxious
    • have changed sleep patterns
    • be irritable
    • experience mood swings


    Cognitive, thinking and communication symptoms:

    • Your child may experience some or all of the following:
    • Slowness with thinking, understanding and responding to questions or commands.
    • Problems concentrating.
    • Difficulties with memory.
    • Slurred speech. If your child develops slurred speech, or speech that is unclear, go back to your doctor or nearest hospital emergency department immediately.
    • Difficulty thinking of the right words to say.

    Cognitive fatigue 

    This is a special kind of fatigue or tiredness and is a common problem that can happen after a head injury. When a child has cognitive fatigue, it means their brain has to work harder to concentrate on tasks it used to be able to do easily, for example watching TV, playing computer games, or having a long conversation. Cognitive fatigue is not related to a child’s intellectual capacity or physical energy levels, and can lead to behavioural problems, mood swings and educational difficulties.

    If your child experiences cognitive fatigue they may need extra rest periods and a gradual return to activities such as school that require periods of greater concentration or thinking. 

    Returning to school

    Please also refer to the Kids Health Info factsheet: Head Injury - return to sport.

    A minimum of one week away from school is recommended for children who have sustained a head injury that requires medical attention. It is important to let the school know about your child’s head injury. If your child is tired, allow them to return to school and other activities gradually. An individual plan will be recommended for your child as every head injury is different. Discuss the details with your child's treating team. 


    We recommend your child be off school for   __________  weeks. 
    Your child may return to school for half days on this date  __________________________________________________

    Returning to sport

    Your child should avoid sports and activities that involve height and speed, and any other activities where they are at risk of another head injury.  

    Your child may be able to participate in sports listed below after six weeks, however, this will be determined by the treating medical team when your child attends a clinic for a follow up appointment.  

    Following a head injury your child’s reaction times and thinking may be slower, and this can put them at risk of further injury.

    At risk sports and activities include:

    • tackle football
    • soccer and hockey
    • basketball and netball
    • horse riding
    • riding motorbikes or BMX bikes
    • skiing, snowboarding and surfing
    • riding a bike, scooter, skateboard or skates
    • playing on a trampoline
    • climbing trees or other high structures.

    Make sure your child always wears a helmet when bike riding or skateboarding.

    It is important to encourage gradual return to physical activity. Encourage your child’s participation in gentle physical activities such as the following:

    • swimming
    • walking
    • using an exercise bike
    • practicing ball skills (with a soft ball)
    • tennis
    • dancing.

    If your child’s behaviour is very different to their normal behaviour, or the pain does not go away, go back to the doctor or to your nearest hospital emergency department.


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Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.