[ak93-feua] WHAT TO DO WHEN YOUR CHILD BUMPS HIS HEAD

WHAT TO DO WHEN YOUR CHILD BUMPS HIS HEAD
http://www.askdrsears.com/html/8/t082300.asp

    * Don't panic. Stay calm. If your child sees you remain relaxed,
he is more likely to calm down.

    * 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 consol him.

    * 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.

    * 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.

    * If there is a cut over the bump, wait for the bleeding to stop,
then examine in closely. Click here on Cuts, Scrapes & Stitches to
help you decide if it needs stitches.

    * Acetaminophen. When your child has calmed down, you may want to
give a dose to relieve the headache that might start. Click on
Acetaminophen for dosing.

    * 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.

    * 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:

    * 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.
    * 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.
    * 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.
    * 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
    * 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.
    * Severe headache. If a child continues to complain of a very
severe headache you should consult a doctor immediately.
    * 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:
          o Crossed eyes or rolling eyes
          o One pupil larger than the other
          o Behavior such as tripping or running into things that
indicates baby's vision is diminished
          o In the older child, add complaints of seeing double and
blurred vision to the worry list 
    * 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:

    * Change in color. From pink to pale or, even more alarming, blue.
    * 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).
    * 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.


SHOULD I WAKE MY CHILD UP DURING THE NIGHT?

While it's standard advice to awaken the child frequently after a head
injury, in practice this advice is confusing. Children normally
retreat into sleep after any upset. In fact, because of new insights
into the management of head injuries it is no longer standard practice
for an ER physician to advise waking a child up, if the ER physician
has thoroughly examined the child and found no evidence of internal
injury. Studies of children seen in an ER for a head injury show that
if a child has a normal neurological exam and normal CAT scan there is
very low risk of that child deteriorating and therefore it is not
necessary to wake that child up. A more practical approach is to
observe a change in your child's color and breathing patterns. If your
child looks pale and shows very irregular or very shallow breathing
that is very different from his usual patterns awaken him for a more
complete evaluation. Your doctor will advise you whether or not to
awaken your child.


WHAT ABOUT SKULL X-RAYS?

Except for severe head injuries or obvious fractures, skull x-rays are
seldom helpful; nor is it necessary to rush a happily playing child to
the hospital for an x-ray. First, try a period of observation; next,
call your doctor; then comes the advice on whether or not to take baby
to the hospital for x-rays. A CAT scan, a series of cross-sectional
x-rays of the brain, has nearly replaced the plain skull x-ray. In
most cases if a child warrants an x-ray at all, he merits a CAT scan.
This technological breakthrough reveals much more about an injury,
such as whether there is bleeding or swelling of the brain, than a
simple skull x-ray. On a softer note: In the life of a child,
considering the many times little heads meet hard floors, injuries to
the brain are uncommon.
                        


  

-- 
Terima Kasih.

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