Children often bump or bang their heads, and it can be difficult to tell whether an injury is serious or not. Any knock to the head is considered a head injury.

Head injuries are classified as mild, moderate or severe. Many head injuries are mild, and simply result in a small lump or bruise. Mild head injuries can be managed at home, but if your child has concussion symptoms, they should see a doctor.

You should call an ambulance immediately if your child:

• has had a head injury involving high speed or height greater than a metre, for example, a car crash, a high-speed skateboard accident or falling from playground equipment.
• loses consciousness (passes out).
• has a seizure, convulsion or fit.
• is increasingly confused, has memory loss or is less responsive or drowsy.
• has loss of vision or double vision.
• has weakness or numbness/tingling in more than one arm or leg.
• has neck pain or tenderness.
• seems unwell and vomits more than once.
• has a severe or increasing headache.
• is increasingly restless, agitated, or combative.

Glossary of head injury terms

Concussion – a mild traumatic brain injury that alters the way the brain functions. Concussion symptoms are usually temporary, but can include a range of physical symptoms (headaches, nausea, dizziness, fatigue, visual problems, poor balance, sensitivity to noise), changes in emotion (anxiety, irritability, sadness), changes in thinking (fogginess, confusion, difficulty remembering, slower thinking), and sleep disturbances. 

Loss of consciousness – when a person is unable to open their eyes, speak or follow commands. They have no awareness of stimulation from outside their body and may not remember the immediate periods before and after the injury.

Signs and symptoms of head injury

The symptoms experienced straight after a head injury are used to determine how serious the injury is. The information below is a guideline. 

Moderate to severe head injury

If your child has a moderate or severe head injury, they may exhibit ‘red flag’ symptoms such as those listed above.

Mild head injury (no concussion)

A mild head injury is when your child:

• has had a bump to the head.
• is now alert and interacts with you.
• has not vomited.
• may have bruises or cuts on their head.
• is otherwise normal.

You should seek medical advice if your child develops new symptoms of head injury or you are worried about them. Otherwise, continue to observe your child for any of the signs and symptoms listed under care at home.

Mild head injury (possible concussion)

A concussion is when your child:

• may have displayed altered level of consciousness (e.g. passed out, confused or forgetful) at the time of the injury.
• may experience a range of physical symptoms (headaches, nausea, dizziness, fatigue, visual problems, poor balance, sensitivity to noise).
• may experience changes in emotion (anxiety, irritability, sadness).
• may have changes in thinking (fogginess, confusion, difficulty remembering, slower thinking) and sleep disturbances.
• these symptoms are usually temporary.
  

You should seek medical advice if your child has any of the above symptoms of concussion.

Care at home

Children and adolescents with concussion can take up to four weeks to recover, but most concussions will get better on their own over several days. Following a mild head injury, your child should have a period of relative (not strict) rest for the first 24 to 48 hours. They should return to activities of daily living and light physical activity (e.g. walking) but should minimise intense exercise, contact sports and screen time such as television, computers and smartphones during this time.

The HeadCheck app can help manage concussion recovery at home and is freely available on the App store and Google store. HeadCheck is an interactive tool; the main benefit is allowing families to monitor children’s symptoms on a daily basis, and then providing examples of appropriate activities based on symptoms and age.

Your child may have a headache after a head injury. Give them paracetamol, not ibuprofen or aspirin) every six hours if needed to relieve pain.

There is no need to wake your child during the night unless you have been advised to do so by a doctor. Call an ambulance immediately if you have any difficulty waking your child.

Children who have had a head injury may develop symptoms at various times. Some of the symptoms may not be evident immediately after the initial injury, but may show up over a few days (e.g. fatigue, sleep problems, changes in mood).

If your child experiences any of the following 'red flag' symptoms, take them to the doctor or nearest hospital emergency department immediately:

• worsening symptoms of headache (severe, persistent, not relieved by paracetamol), confusion (unusual or confused behaviour), irritability or vomiting.
• excessive sleepiness or difficulty waking.
• bleeding or any discharge from the ear or nose.
• fits/seizures/twitching/convulsions.
• blurred or double vision.
• poor coordination or clumsiness.
• any new arm or leg weakness, or any existing weakness that gets worse or does not improve.
• difficulty swallowing or coughing when eating or drinking.
• sensitivity to noise.
• slurred or unclear speech.

If your child has had a head injury, they should return to school and sport gradually. For moderate to severe head injuries, your doctor will advise you. For advice on returning your child to their usual activities if they have had a mild head injury, see our fact sheet Head injury – return to school and sport.

Excessive fatigue 

Fatigue is a common problem that can happen after a head injury. When a child has ‘excessive’ fatigue, it means their brain has to work harder on tasks that were usually easily done, for example doing school work, physical routines, watching TV, playing computer games, or having a long conversation.

Your child may experience some or all of the following symptoms after a concussion, and usually these will gradually decrease and resolve by four weeks post-injury:

• headaches.
• blurred vision.
• dizziness, poor balance, sensitivity to noise and light.
• slowness when thinking, understanding and responding to questions or commands.
• problems concentrating.
• difficulties with memory.
• difficulty thinking of the right words to say.
• being more demanding than usual, and become easily frustrated.
• being more fearful and anxious.
• changed sleep patterns.
• mood swings and irritability.

If your child’s physical or cognitive performance or behaviour is very different to normal, or it is getting worse, take them back to the doctor or your nearest hospital emergency department.

While symptoms persist, children should have a period of relative (not strict) rest but should continue with activities of daily living and return to light physical activity e.g. walking. Children should have sufficient sleep, a healthy diet and limit watching of TV or playing on mobile electronic devices. Allow your child to gradually return to reading and other activities that require periods of greater concentration or thinking.

Key points to remember

• Head injuries can be mild, moderate or severe.
• Call an ambulance if your child has had a head injury involving high speeds or height, or if after a knock to the head they lose consciousness or vomit more than once.
• Your child may develop a number of different symptoms in the weeks after a head injury. If your child develops any of the red flag symptoms described above, you should seek immediate medical attention.
• Children with concussion should have a period of relative (not strict) rest for the first 24-48 hours. Your child should have sufficient sleep, limit screen time but continue with daily activities e.g. reading, walking and gradually increase these activities as long as it only results in brief (less than one hour), mild worsening of symptoms.
• Most children recover well after a mild head injury. If your child is still requiring support to return to everyday activities after two weeks following a mild head injury, they should be reviewed by their GP for a medical assessment. Children with symptoms lasting more than four weeks can be referred to the RCH Victorian Paediatric Rehabilitation Service (VPRS). GPs can make referrals to your local outpatient VPRS services via its website.
• If you have any questions regarding accessing outpatient VPRS, you can contact the RCH VPRS outpatient coordinator by calling 03 9345 9300 or emailing rehab.services@rch.org.au.

For more information

• Kids Health Info fact sheet: Head injury – return to school and sport
• Kids Health Info fact sheet: Preventing falls
• Kids Health Info fact sheet: Pain relief for children
• The RCH National Child Health Poll: Summer safety
  
• The Murdoch Children’s Research Institute’s HeadCheck app is a checklist to help parents and sports coaches recognise the symptoms of concussion. It is available from the App Store or Google Play.

Developed by The Royal Children's Hospital Emergency, Neurosurgery and Neuropsychology departments. We acknowledge the input of RCH consumers and carers.

Reviewed October 2023

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit  www.rchfoundation.org.au.