Kids fall and bump their heads commonly, and luckily the vast majority of these injuries are minor. A child’s skull is more flexible than an adult’s, and can therefore tolerate more of a bump without breaking. All head injuries are potentially serious however, due to the possibility of internal bleeding in the brain. Sometimes this may not start until many hours after the event, so a child who looks fine even to the doctor may suddenly deteriorate later. Because of this children deserve careful watching by their parents after a bump on the head of any sort – the longer they remain well the less likely anything bad will occur.
Generally head injuries which are sustained while moving on/in a vehicle (auto, bicycle, sled, skateboard, skates) or in a fall from some height (window, stairs, porch) are far more likely to be significant than those that occur while running or just “horsing around”. A child will surely need to be examined if there is any immediate loss of consciousness or seizure (convulsion). A child who has difficulty with memory for the event or the period just before or after may have a concussion and should also be seen. Otherwise it is safe for a parent to keep the child quiet and observe for the following:
Lethargy, disorientation, vomiting, visual disturbance, unequal pupils, severe headache, profuse watery nasal drainage (not present before), bleeding from ears, stiffness, convulsions, dizziness or clumsiness, stiff neck, or irritability.
Should any of the above occur you should call 911 immediately. While it is OK to let a child go to sleep (a child who is sleepy and oriented is probably OK), you should wake them every 2-3 hours and check for these things.
Finally, it is normal for a large bump to appear on the head quite rapidly after a fall. This will be tender to touch and appear bruised. It should feel hard initially. This should not concern you too much. If the “bump” feels soft or has “give” to it, however – or if there appears to be more of a “dent” than a bump – you should call.