Head Injuries in Children: When to Watch at Home and When to Seek Care

What is a concussion?

A concussion is a mild traumatic brain injury caused by a bump, blow, or jolt to the head or body that makes the head move quickly back and forth. It changes how the brain works. Most children recover fully.

A child does not have to be knocked out to have a concussion. Most concussions happen without loss of consciousness.

What causes head injuries at different ages?

Common causes change as children grow:

• Babies and toddlers: Falls, including off furniture, down stairs, or from a caregiver's arms.
• School-aged children: Falls, being struck by or against an object, playground injuries, and sports.
• Teenagers: Sports, motor vehicle crashes, bicycle falls, and assaults.

Sports and recreation are important settings for head injuries in school-age children. A concussion can happen even when a child is wearing a helmet.

Symptoms to watch for

Symptoms can appear right away or may not become noticeable until hours or days after the injury.

Physical symptoms

• Headache
• Dizziness or balance problems
• Nausea or vomiting
• Blurred or double vision
• Sensitivity to light or noise
• Feeling tired or low energy

Thinking and mood—“mental fog”

• Trouble concentrating, remembering, or following instructions
• Feeling slowed down, confused, or “not right”
• Being more irritable, sad, or emotional than usual

Sleep

• Sleeping more or less than usual, or trouble falling asleep

In a young child who cannot describe how they feel, watch for excessive crying, a change in feeding or play, unsteadiness, or simply “not acting like themselves.”

Teach your child to tell a coach, teacher, or you right away if they feel any of these after a hit. Children may hide symptoms because they want to keep playing.

A child with a possible concussion should be assessed by a health care provider. Do not wait for a routine appointment if any emergency signs below are present.

When to get emergency care right away

Seek emergency evaluation if your child has any of the following after a head injury:

• Loss of consciousness—passed out—even briefly
• Repeated vomiting
• A seizure or convulsion
• Worsening or very severe headache
• Increasing confusion, extreme drowsiness, or difficulty waking
• Slurred speech, weakness, numbness, or new clumsiness
• Unequal pupils or double vision
• Clear or bloody fluid draining from the nose or ears
• Bruising behind the ears or around both eyes
• Unusual or increasing agitation, restlessness, or combativeness
• For a baby: a bulging soft spot, a large or growing scalp swelling, inconsolable crying, or refusal to feed

Also seek prompt medical advice for an infant under 1 year with more than a trivial head bump, a significant fall or high-impact injury, a child with a bleeding disorder or taking blood-thinning medication, or any injury you are worried about.

A scalp bump alone does not tell you how serious the injury is. Your child's age, the mechanism of injury, symptoms, and examination all matter.

When can a head bump be watched at home?

After a light bump, a child who remains alert, behaves normally, and has no concerning symptoms may be able to stay home with a responsible adult watching closely. For anything more than a light bump—or if you are uncertain—call your child's doctor for advice.

• Use a cold pack wrapped in a cloth for short periods to ease scalp swelling. Do not put ice directly on the skin.
• Have an adult stay with your child for the first 24 hours and follow any monitoring instructions from the clinician.
• Watch for new symptoms or changes in behavior. Seek care if symptoms appear or worsen.
• Avoid rough play or activities that could cause another head injury.

Can my child go to sleep?

Once your child has been assessed as safe to observe at home, normal sleep is generally okay. You do not need to keep a child awake simply because they bumped their head. Follow the clinician's instructions about checking on them; routine repeated waking is not always necessary.

Difficulty waking is different from normal sleep and needs emergency care. Do not assume increasing drowsiness, confusion, or unusual behavior is just tiredness.

How doctors evaluate a head injury

A concussion is usually diagnosed from the story of what happened plus an examination. There is no single routine blood test or scan that confirms it. Trained clinicians may use standardized, age-appropriate assessment tools such as the SCAT6 or Child SCAT6.

Most children with a concussion do not need a CT scan. Doctors use validated clinical decision rules, the examination, and sometimes a period of observation to decide whether imaging is needed.

A CT scan looks for problems such as bleeding or a skull fracture; it does not diagnose the functional changes of concussion. The decision balances the risk of a serious injury against unnecessary radiation. Warning signs, the child's age, and how the injury happened all influence that decision.

Treatment and recovery

The first steps

If a concussion is suspected during sports, remove the child from play immediately. Do not allow a same-day return to play. Any serious head, neck, or eye injury must be ruled out first.

Rest, then gradually get moving

The old advice of complete “cocooning”—total rest in a dark room until all symptoms are gone—is no longer recommended and can slow recovery.

• First 1–2 days: Relative rest. Limit demanding schoolwork, screens, and vigorous activity. Gentle activity such as a short walk may be appropriate if tolerated.
• After the first couple of days: Gradually add light aerobic activity, such as walking or a stationary bike, following the clinician's plan and avoiding activities with a risk of another head injury.
• A brief, mild increase in symptoms can happen with activity. If symptoms worsen substantially or do not settle, stop or reduce the activity and ask your clinician for advice.

Ask your child's clinician which medicines are appropriate for headache or other symptoms. Do not use medicine to mask symptoms so your child can return to sports.

Return to school

Most children can return to school within 1–2 days of a concussion, even if some symptoms remain. Temporary supports may include shorter days, rest breaks, reduced work, or extra time. Waiting until every symptom disappears is usually unnecessary.

The school and health care team should help adjust the plan to your child's symptoms. Full return to usual schoolwork should come before unrestricted return to sports.

Graded return to sport

With the health care provider's approval, children progress through a stepwise return-to-play program. Each step generally takes at least 24 hours. If symptoms return, stop that activity and contact the clinician before progressing.

Early, low-risk activity can overlap with the return to school. However, the child should be back to regular non-sports activities without support before completing the sports progression.

Medical clearance is required before returning to activities with a risk of contact, collision, or falling.

What recovery looks like

Most children and teens feel better within about 2 to 4 weeks. Some have symptoms that last longer and benefit from additional treatment. Recovery varies; a calendar date alone does not mean a child is ready for sports.

Recovery can be slower when initial symptoms are severe, when a child keeps playing after the injury, or when care is delayed. Schedule follow-up, and contact the clinician sooner for worsening symptoms. Symptoms lasting beyond 2 to 4 weeks may warrant referral to a clinician experienced in concussion care.

Preventing head injuries

• Use a properly fitted helmet appropriate for biking, skating, skateboarding, skiing, or the sport being played. No helmet is concussion-proof, but helmets help reduce the risk of serious head injuries.
• Use age-appropriate car seats, booster seats, and seat belts every trip.
• Prevent falls with stair gates, window guards, and supervision around furniture and on playgrounds.
• Support safe sports through proper technique, rule enforcement, and limiting unnecessary head contact.
• Take every suspected concussion seriously: when in doubt, sit them out.

The bottom line

Most childhood head bumps are minor. Learn the warning signs, seek emergency care for the red flags above, keep your child out of play after any suspected concussion, and allow a gradual, guided return to school and sports.

When you are unsure, call your child's doctor. Our Pediatrician, Urgent Care, or ER? guide explains how to choose the appropriate level of care.