so how worried should I be? (baby hit his head)

[ktgrok]

So yesterday my 6 month old fell off the changing table. He threw his teether off and I leaned down to get it and took my hand off of him for a fraction of a second. He's the one that NEVER tries to squirm off, and I got complacent. I didn't quite manage to catch him...I kind of broke his fall by bobbling him. He didn't land head first, it was butt/side first, but his head hit the side of the wood toddler bed frame and then the floor. He cried, I almost puked I was so upset, but he stopped crying in a minute, and was back to his normal self. Even giggling and such. I put one of those cold pack/boo boo things on it right away, and it was a bit red but didn't bleed/bruise/swell at all. Later he took a nap, and was totally normal all day, so after googling head injuries I didn't worry. He seemed (and still seems) totally normal. It isn't even sore to the touch as far as I can tell. But this evening I noticed that now there is some soft swelling on that side of his head, a bit lower than where he hit...like the bruising/fluid/swelling drained to that area. (I know in my background in vet medicine that often happens). I'd say it's a seroma/hematoma as a best guess. Like I said, he seems perfectly fine otherwise. But..I googled again after finding the soft swelling and it says that can indicate a fractured skull! Now I'm trying not to panic, and going to call the pediatrician to get him in there in the morning. I'm HOPING they will check him and say no worries. But I am reading that they may need to do skull xrays and even a CAT scan, and am freaking out a bit. He'd need to be still for a CAT scan...that would be sedation I imagine, and an IV, and maybe contrast dye, and given that my mom and I have a shellfish allergy the dye scares me, the sedation idea scares me, and to be fully honest the bills scare me. We have a 3,000 dollar deductible per person, so yeah...that is SO not in the budget after my other son's recent spinal fracture.

 

Anyone have any idea how worried I should actually be? From what I understand even if it is a skull fracture they don't really do anything? Unless it needs surgery...ugh.

 

this sucks! The mama guilt is KILLING me, and I just want my kids to stop BREAKING themselves!

[Starr]

First of all :grouphug: :grouphug: :grouphug: . Most often if a person acts completely *normal for them* all is well. If you notice anything unusual, pupils don't match, confusion, harder to wake than normal...take him right in. Praying all is well.

[Mandylubug]

awe, I think every mama has a scare like that. My first one was when my oldest was napping on our bed and I stepped into our bathroom to get ready, he rolled right on off the bed and screamed for what seemed like forever! It is SO scary!

 

Baby sounds fine to me. I would speak to a nurse and go from there!

[Reflections]

Oh uck... I remember when my ds8 fell off the bed backwards when he was 6 months old because I was playing peekaboo with him with the laundry I was folding. I almost threw up. I took him to the after hours ped clinic and they checked him over and sent us home.

 

I agreee with Starr...usually when all seems well they think that all is well.

 

:grouphug: :grouphug: :grouphug:

[GSOchristie]

When an ironing board fell on P's head when she was 4 weeks old, we took her to the ER. They observed her for 6 hours and we found out that one of her pupils is normally bigger than the other :/. Other than this anamoly, she had no symptoms of a brain injury so no CT scan was offered. They told us to watch her closely for the next 48 hours and sent us home.

[magnificent_baby]

:grouphug:

 

I would not be too concerned since he is acting normal, but based on what you read, can you call the on call doc just in case?

 

As far as CT, it is highly unlikely he would get contrast if looking for a fracture or a bleed. It's possible they may try it without sedation, CT's are very quick.

[Mergath]

Sounds like he's fine. I had almost the exact same thing happen when dd was a baby, and she was fine, too. Scared the living he** out of me, and I rushed her to the ER like it was the end of the world. They checked her pupils, felt her head, and told me she was fine. ;) I'm guessing it'll go about the same for you when you bring in your baby, so try not to worry. *hugs*

[LMV]

Some (hopefully helpful) information:

-CT Scan bone windows (and even the potential for 3-D reconstruction) are at a point where there really isn't a role for skull films any more. When I'm working up pediatric head trauma I just order a Head CT without contrast.

-Contrast in a Head CT is most helpful if you are looking for enhancing lesions (i.e. toxoplasmosis, late stroke, MS, some CNS malignancies etc). In your child's case they are looking for fractures, cerebral contusions, and cerebral bleeds mostly and these should be apparent on a non-contrasted study.

-Most of the Head CTs we order for trauma even in infants we manage to get without using sedation. There is some motion artifact but usually the technical quality is good enough to be diagnostic.

-Skull fractures in infants have a much higher risk of brain pathology than in adults so we do usually admit these children at least overnight (which usually allows for a repeat CT in the morning). There is also more of a role for surgical intervention in the younger age groups. Linear non depressed fractures can often be observed but most depressed fractures do require elevation for proper healing (although this is an area that is under study now and I think we may be approaching a time where we start observing some of the simple depressed fractures).

 

Of course none of this is a substitute for a physician who can actually see your child. You should definitely follow up with your pediatrician in the morning and if there is any further deterioration you should go to your nearest emergency department. Best wishes to you and your child!

[ktgrok]

Some (hopefully helpful) information:

-CT Scan bone windows (and even the potential for 3-D reconstruction) are at a point where there really isn't a role for skull films any more. When I'm working up pediatric head trauma I just order a Head CT without contrast.

-Contrast in a Head CT is most helpful if you are looking for enhancing lesions (i.e. toxoplasmosis, late stroke, MS, some CNS malignancies etc). In your child's case they are looking for fractures, cerebral contusions, and cerebral bleeds mostly and these should be apparent on a non-contrasted study.

-Most of the Head CTs we order for trauma even in infants we manage to get without using sedation. There is some motion artifact but usually the technical quality is good enough to be diagnostic.

-Skull fractures in infants have a much higher risk of brain pathology than in adults so we do usually admit these children at least overnight (which usually allows for a repeat CT in the morning). There is also more of a role for surgical intervention in the younger age groups. Linear non depressed fractures can often be observed but most depressed fractures do require elevation for proper healing (although this is an area that is under study now and I think we may be approaching a time where we start observing some of the simple depressed fractures).

 

Of course none of this is a substitute for a physician who can actually see your child. You should definitely follow up with your pediatrician in the morning and if there is any further deterioration you should go to your nearest emergency department. Best wishes to you and your child!

 

Thank you for the information! At this point, it happened over 24 hours ago, it will be more like 48 by the time he is seen tomorrow..would you still admit overnight at that point? If there had been swelling like this at the time it happened or he had seemed to be in pain/disoriented/irritable,sleepier than normal/etc I would have taken him right away, of course. But he seemed fine. Still does..just has a squishy area on the side of his head that is freaking me the hell out.

[LMV]

 

Thank you for the information! At this point, it happened over 24 hours ago, it will be more like 48 by the time he is seen tomorrow..would you still admit overnight at that point? If there had been swelling like this at the time it happened or he had seemed to be in pain/disoriented/irritable,sleepier than normal/etc I would have taken him right away, of course. But he seemed fine. Still does..just has a squishy area on the side of his head that is freaking me the hell out.

 

 

Clinical judgment is based on an attempt to put together the big picture from all pieces. I can't really commit one way or the other without seeing the child and having all of the information to put together. I guess I can perhaps see a few situations where if there was good follow up and the CT of the brain was completely normal and the skull fracture was linear and not depressed that I might be comfortable with that. I can also envision some scenarios where I probably wouldn't be. It really depends and there are probably some nuances that can't be conveyed well through online environments. Good Luck!

[Catwoman]

 

Thank you for the information! At this point, it happened over 24 hours ago, it will be more like 48 by the time he is seen tomorrow..would you still admit overnight at that point? If there had been swelling like this at the time it happened or he had seemed to be in pain/disoriented/irritable,sleepier than normal/etc I would have taken him right away, of course. But he seemed fine. Still does..just has a squishy area on the side of his head that is freaking me the hell out.

 

 

I am the first person to panic over a head injury, but I truly think your baby is OK, and I doubt the doctor is going to go hog-wild with tests as long as the baby is behaving normally and isn't exhibiting any scary symptoms. Honestly, the soft bump on his head sounds perfectly normal for the type of injury -- I would bet the bump is where his head hit the side of the wooden toddler bed. If you'd whacked yourself on a wooden bed, you'd probably have a bump, too -- even if you hadn't hit it that hard.

 

I know you're really scared and nervous, and I would be too, because I am a paranoid lunatic about medical stuff, but I'm about 99.9% sure the doctor is going to tell you that everything is fine, and just to watch him for a few days to make sure he keeps acting normally.

 

That said, I would still keep a close eye on him overnight, just to be extra-safe, but I'm sure you'll do that anyway!

 

Let us know how it goes at the doctor!

[Catwoman]

Some (hopefully helpful) information:

-CT Scan bone windows (and even the potential for 3-D reconstruction) are at a point where there really isn't a role for skull films any more. When I'm working up pediatric head trauma I just order a Head CT without contrast.

-Contrast in a Head CT is most helpful if you are looking for enhancing lesions (i.e. toxoplasmosis, late stroke, MS, some CNS malignancies etc). In your child's case they are looking for fractures, cerebral contusions, and cerebral bleeds mostly and these should be apparent on a non-contrasted study.

-Most of the Head CTs we order for trauma even in infants we manage to get without using sedation. There is some motion artifact but usually the technical quality is good enough to be diagnostic.

-Skull fractures in infants have a much higher risk of brain pathology than in adults so we do usually admit these children at least overnight (which usually allows for a repeat CT in the morning). There is also more of a role for surgical intervention in the younger age groups. Linear non depressed fractures can often be observed but most depressed fractures do require elevation for proper healing (although this is an area that is under study now and I think we may be approaching a time where we start observing some of the simple depressed fractures).

 

Of course none of this is a substitute for a physician who can actually see your child. You should definitely follow up with your pediatrician in the morning and if there is any further deterioration you should go to your nearest emergency department. Best wishes to you and your child!

 

 

Do you really think they will do all that? :confused:

 

You seem to be assuming that there's a good chance of a skull fracture or other serious injury here, and judging by Katie's posts, it doesn't sound like there is any obvious evidence of that (at least I'm not seeing any -- but I'm no doctor.)

 

What am I missing?

[Whereneverever]

My mom is an ER nurse and they had a baby come in who had a fall and a spongy spot. It was a fracture and the baby stayed for a little while, but she told me the baby was completely fine.

 

:grouphug:

 

 

[LMV]

Do you really think they will do all that? :confused:

 

You seem to be assuming that there's a good chance of a skull fracture or other serious injury here, and judging by Katie's posts, it doesn't sound like there is any obvious evidence of that (at least I'm not seeing any -- but I'm no doctor.)

 

What am I missing?

 

With the disclaimer that I am not actually seeing the child and thus I am NOT offering medical advice, if this child presented to our ED with this story I would order a Head CT. It is pretty much accepted practice in our ED and considered the standard of care in the field of emergency medicine in general. In children under 2 years roughly 10% of kids with intracranial pathology (noted on CT) will appear normal and have normal neurologic exams. The younger the kids the more difficult it is to get a good neurologic exam and there is a lot of developmental variability which can confound the clinical picture as well. Thus there is good rationale for this approach. Additionally children in this age group (and even more so in children <1 year) skull fractures after even relatively minor head trauma can be common. Studies of pediatric head trauma have identified scalp hematomas (which sounds like what the OP is describing) as a positive predictor in this context. Am I certain that this child has a skull fracture or some other intracranial pathology based on what has been posted? No, but I am not certain that everything is fine either. If I apply an evidence based approached (which I really try to do in general) then I'm going to order the Head CT and go from there (unless of course my exam identifies other problems that need to be addressed first of course).

 

Our youngest daughter is almost six months. If she was in this situation I would certainly expect our pediatrician/ ED physician etc to order the Head CT.

[Parrothead]

When dd was 2 she did a header so bad I took her to the ER. The doc said that slight or localized swelling was okay. It is the dents that don't pop back out that are worrisome.

 

Hugs.

[Catwoman]

 

With the disclaimer that I am not actually seeing the child and thus I am NOT offering medical advice, if this child presented to our ED with this story I would order a Head CT. It is pretty much accepted practice in our ED and considered the standard of care in the field of emergency medicine in general. In children under 2 years roughly 10% of kids with intracranial pathology (noted on CT) will appear normal and have normal neurologic exams. The younger the kids the more difficult it is to get a good neurologic exam and there is a lot of developmental variability which can confound the clinical picture as well. Thus there is good rationale for this approach. Additionally children in this age group (and even more so in children <1 year) skull fractures after even relatively minor head trauma can be common. Studies of pediatric head trauma have identified scalp hematomas (which sounds like what the OP is describing) as a positive predictor in this context. Am I certain that this child has a skull fracture or some other intracranial pathology based on what has been posted? No, but I am not certain that everything is fine either. If I apply an evidence based approached (which I really try to do in general) then I'm going to order the Head CT and go from there (unless of course my exam identifies other problems that need to be addressed first of course).

 

Our youngest daughter is almost six months. If she was in this situation I would certainly expect our pediatrician/ ED physician etc to order the Head CT.

 

Thanks for the explanation -- I appreciate it! :)

[melissad2]

My ds once flipped a chair backwards at a restaurant with a tile floor. Smacked his head and had a huge knot...I took him right in to the pediatrician (they told me to come there instead of the ER), he did a complete neuro exam and told me to watch him closely for the next 24hrs. Ds was around 18 months old...he was fine. No X-rays or CT's needed. Im not saying that your ds doesn't need one but I am saying if you go to the ER they will most likely order one because they don't want the liability of "what if".

[ktgrok]

thanks all. The swelling is less this morning, and he is happy as a clam. I slept half the night with him in my arms, but that's typical for us. He's a snuggler :)

 

I will call the pediatrician when they open and get in to see the doctor. I have total faith in him, and he has seen us through several other issues.....dd's broken elbow at 7 months old, ds's broken finger that was missed by the ER, ds's broken vertebrae...you get the picture. I swear I'm wrapping all the kids in bubble wrap!!!! I said the other day they are almost never sick, and hardly ever have "sick" visits at the doctor. But accidents? Oh yeah, we got that covered. I should switch to an insurance that just covers trauma!

 

I am calmer now that it is morning. And I realized that the ped can send us for imaging without going to the ER, so that helped. But seirously people, the 13 year old has a neurosurgeon already, i do NOT need another kid with one!!!!!

 

And me, I NEVER hurt myself as a kid, never had a broken bone, anything. This is crazy.

[stripe]

Oh, no! I didn't realize it was you whose daughter had the broken finger! Yikes!

 

When my kid fell down, I did call the doctor on duty after hours, who, given my description of now totally normal behavior (walking, talking, remembering things, no weird pupils, etc) said to continue to ice the head, as I had been doing, and keep my eye on the situation, and that head injuries are very common but usually the kid is okay, and everything was okay in that case. It is so stressful being a parent! I feel like someone is either sick or injured at my house, too.

[Sisyphus]

Well in my defense, my kids are much older now, but am I the only one reading this, remembering my kid falling off a couch/bed/table headfirst, having a big bump...and never taking them to the dr or worrying particularly?

 

The totally normal behavior makes me think he is just fine, though. Poor you, that is a lot of health issues recently!

[Paige]

I wouldn't take him in. Since you sort of broke his fall and prevented him from getting the full impact, and because changing tables are not usually all that high, I doubt he ht with enough force to do any real damage. Add that to the fact that he didn't cry for long and seems fine.....I wouldn't think twice. He probably doesn't have a goose egg because the impact was not bad- not because he has a fracture.

[ktgrok]

Oh, no! I didn't realize it was you whose daughter had the broken finger! Yikes!

 

\

oh, no...my son had a broken finger a few years ago, when we first moved here. The ER said it wasn't broken but I was sure it was. The pediatrician agreed with me and sent us to an orthopedic clinic..and yeah, it was broken.

[ktgrok]

I wouldn't take him in. Since you sort of broke his fall and prevented him from getting the full impact, and because changing tables are not usually all that high, I doubt he ht with enough force to do any real damage. Add that to the fact that he didn't cry for long and seems fine.....I wouldn't think twice. He probably doesn't have a goose egg because the impact was not bad- not because he has a fracture.

 

That was my first thought. But I do have to consider that my kids have stupid high pain tolerances. My son didn't cry, and rated his pain at a 4, when he fractured 2 vertebrae recently. sigh.

[TexasRachel]

When one of my boys fell off the bed and we thought his pupils were different sized we took him to the children's hospital ER. They told us they didn't worry unless the kid was throwing up. Probably not the only thing to base head trauma on, but it's making me feel better with all the knocks the baby is getting as he's becoming mobile.

[Meriwether]

Dd pulled herself over the crib railing when she was less than a year old and landed straight on her head with nothing to break her fall. She was acting odd for a few minutes so I called the doctor. They told me to bring her in, but by the time I'd gotten our shoes on and was ready to leave, she seemed fine. I called back. The doctor said that if she was acting normal she was probably fne. I just watched her carefully for a few days.

[ktgrok]

Thank you all for your stories! They really are helping. I also remembered that my sister fell straight onto her head as a baby, into a pile of glass, onto a terrazzo floor. And although we often diasagree I don't think I can say she has permanent brain damage, lol. They sutured her up and kept her one night and that was it, no fractures. My mom says I was more traumatized because I witnessed it happen.

 

He has an appointment at 10:45, we will see what they say. REALLY hoping they think I'm overreacting and send me home, as I have a LOT to do today, lol.

[ktgrok]

UPDATE!!!

 

He's FINE! Doctor checked him out really well and said it's just a hematoma and will go away in a few days. Not to worry :)

 

He also made me feel better by telling stories about his kids falling.

 

I feel SOOO much better. I barely slept last night. Of course, when I called to tell dh the news he didn't know why I was calling. He'd forgotten about the head injury, forgotten I was taking him to the doctor, etc. I made the appointment this morning standing in front of him. sigh..MEN!

[Catwoman]

:hurray: :hurray: :hurray:

 

I'm so glad he's OK!!!

 

:party:

[ChristusG]

So glad he's okay! And your DH sounds like mine.... Typical for mom to do all the worrying!