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Head injury: When to call the doctor

The morning I read of actress Natasha Richardson’s death from a seemingly innocuous fall, my 21-month-old daughter, Orli, toppled off the bed.

Too far away to catch her yet close enough to see it happen in excruciatingly slow-motion, I watched as she scooted too close to the edge of the mattress, lost her balance, then struck her head on the burnished hardwoods.

I gasped. She wailed. And my thoughts immediately started churning, punctuated by visions of the unfortunate actress.

Richardson had apparently turned down medical assistance after her recent fall on a Canadian ski slope. She soldiered on, unaware of the blood pooling between her brain and her skull.

I tried to stay calm while I decided what to do. Should I call the doctor? Speed Orli to the emergency room?

I decided to concentrate first on soothing her, then putting her to bed. It was time for her afternoon nap anyway.

After tucking her in, I went straight to my computer. I had a date with Dr. Google.

What I learned was both reassuring and terrifying. Head injuries are extremely common, especially in small children. Most of the time, everything ends up being fine. But sometimes, it’s hard to tell.

Don’t let your baby fall asleep, cautioned several Web sites.

Oops.

The reason for keeping her awake, I learned, is to monitor her behavior. Is she pursuing her usual toddler activities (clomping around in her sister’s boots, pretend-nursing her baby doll) or is she lethargic or crying inconsolably?

The advice made sense, but it wasn’t an option. Naptime’s naptime: When the baby’s tired, the baby sleeps. That’s all there is to it.

Instead, I opted to take a different piece of advice and check on her periodically. Each time I tiptoed into her room, she woke up. And she was mad. I took anger as a good sign.

The afternoon wore on and Orli seemed just fine. Two weeks later, the tumble is just a bad memory.

But curious to know if I’d handled the situation correctly or I’d just been lucky, I called Carolina Kids Pediatrics, which cares for all my children.

Leanna Willey, one of the pediatricians, said kids’ heads get bumped and bruised all the time.

“Should we be CTing all those kids’ heads?” she said. “That’s the hard part.”

Doctors consider several factors when deciding whether to order a head CT scan to rule out internal bleeding.

If a child has fallen from his own height, it’s usually not a problem. Even a low bed or couch generally doesn’t trigger warning bells.

What’s more worrisome is an injury that results from some kind of impact or momentum – a car accident, for example. A skiing accident, for another.

When children cry right away, it’s a good sign. If they’re confused or don’t recall what happened, it’s cause for concern.

At least one child’s life has been saved due to Richardson’s death calling attention to head injuries. Morgan McCracken, a 7-year-old girl from Ohio, was hit in the head by a baseball the day before Richardson died. When Morgan began complaining of a headache, her parents – who’d been following Richardson’s case -- rushed her to the hospital. Morgan was operated on to relieve an epidural hematoma, which is what killed Richardson.

The increased awareness is happening here, too. Another doctor at Carolina Kids said ever since Richardson’s death, the practice has been fielding more calls about head injuries.

“It takes the temperature of our worry level,” Willey said. “We worry about things we’ve heard about recently.”

Most of the time, as with Orli, the worries are mercifully unfounded.

Once in a while, as with Morgan, they’re justified, and parental zealousness can save a child’s life.

Bonnie appears Saturdays on TriangleMom2Mom.

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bonnierochman's picture

Bonnie Rochman

Bonnie is a TriangleMom2Mom featured blogger, appearing every Monday.

She lives in Raleigh and has written for The News & Observer since 1998. She has covered political unrest in the Middle East and chronicled the experiences of entrepreneurs in Vietnam, but that was long before her new bosses -- there are three of them, one more demanding than the next -- presenting her with her most challenging assignment to date: juggling the needs and perceived wants of boy/girl preschoolers and their baby sister.

Bonnie also writes kids music reviews for TriangleMom2Mom. 

Posted on April 4, 2009 by bonnierochman.

Comments

nataliegott's picture
by nataliegott 11 mon. ago.

I love Dr. Google! And, I have been known to wake my kids after a tumble, just to see how angry they are at me. It's a good barometer.

lilybug's picture
by lilybug 11 mon. ago.

I'm the opposite of a nervous mother in most regards, but head injuries have always made me VERY nervous.

dineer526's picture
by dineer526 11 mon. ago.

Head falls or not, my kids are always angry with me...so I guess they are safe!

CalvinM's picture
by CalvinM 5 mon. ago.

Thanks for the great and useful information. I don't think that we have to go to the hospital right away after the baby falls down. The best advice was written in this article: Just observe her/his behavior and everything will be clear for you. It hard to answer should you go to the hospital or not, because every situation is unique. I think you just have to decide by yourself, and this decision must be based on child's behavior. But really thanks for the great article, I have found a lot of useful information in your website.
Sincerely,
Calvin Mattson

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