While it’s normal to worry, most minor head bumps aren’t a cause for concern. Know the signs you should call the pediatrician or seek emergency care.

You see baby teeter, then totter, and then — in a “Matrix”-like moment that somehow occurs both in slow motion and in the blink of an eye — they tumble. Oh, the screams. The tears. And a big goose egg that’s growing by the second.

We know how scary it can be when your precious baby bumps their head. And if you’re living this right now — icing your little one’s knot while searching for what to do next — you’re in the right place.

First, take a deep breath and try to remain calm. Most of the time, fall-related bumps to the head are minor and don’t require medical attention.

In fact, this 2015 study concluded that fall-related head injuries in young children don’t usually cause serious harm.

At the same time, the Centers for Disease Control and Prevention states that falls are the leading cause of traumatic brain injury-related emergency department visits up in children up to age 4. Keep in mind that this is rare.

So in the rarer case, there are a few cues that should alert you to seek emergency medical help.

First, some reassuring stats: According to one study on short falls in young children, only about 2 to 3 percent of falls lead to a simple linear skull fracture, and most of these don’t cause neurological problems. Only about 1 percent of skull fractures related to accidental falls cause moderate to severe brain injury.

That said, it’s still important to be aware of the symptoms of a traumatic brain injury, including concussions, which usually present within 24 to 48 hours of the accident.

If your baby is showing any of these symptoms after experiencing an injury to their head, call 911 or take them to the nearest emergency room immediately:

  • uncontrolled bleeding from a cut
  • a dent or bulging soft spot on the skull
  • excessive bruising and/or swelling
  • vomiting more than once
  • unusual sleepiness and/or difficulty staying alert
  • loss of consciousness or not responding to voice/touch
  • blood or fluid draining from the nose or ears
  • a seizure
  • a suspected neck/spinal cord injury
  • trouble breathing

Accidental bumps to the head are one of the most common injuries among infants and toddlers. But this fact alone might not stop you from continuously replaying the scene in your head while thinking about how you would rewrite the ending.

But a fall-related knock to the noggin is often largely due to a baby’s physical stature and development — not your parenting. Babies’ heads are often proportionally larger than their bodies, making it easier for them to lose their balance.

In addition, babies’ physical strength and abilities are constantly changing, which affects their stability and coordination. The same adorable wobbly walk could put them in harm’s way when encountering a new, uneven surface or a fun object to run toward.

This, coupled with a baby’s tendency to engage in more daredevil acts that have them climbing, jumping, or trying to fly just for the thrill, can be the perfect equation for a nasty plunge. In fact, babies are notorious for these common head injury culprits:

  • slipping in the tub
  • falling backwards
  • falling off a bed or changing table
  • falling after climbing on furniture or up on countertops
  • falling in or out of the crib
  • tripping over rugs or objects on the floor
  • falling down steps or stairs
  • falling while using an infant walker (one of the reasons why such walkers are considered unsafe)
  • falling from playground swing sets

The height from which a baby falls is correlated to the severity of injury, so if your child fell from a higher distance (such as from a crib or countertop) they’re at a greater risk of serious injury.

The term “head injury” encompasses the entire range of injuries, from a small forehead lump to a traumatic brain injury. Most short fall-related injuries among babies fall under the “mild” category.

Mild head injuries

Mild head injuries are considered closed, meaning they don’t involve any skull fractures or underlying brain injury. In these cases, swelling and a large “bump” or bruise on the skin may appear without any further symptoms.

If your baby’s fall resulted in a cut or laceration, there may be significant bleeding that requires medical attention to clean and suture the wound, even if there’s no brain or skull injury.

After a bump to the head, babies can experience a headache and discomfort. However, at this age, it’s difficult for them to communicate this feeling. It might surface as increased fussiness or difficulty sleeping.

Moderate to severe head injuries

Moderate to severe brain injuries represent the minority of those related to infant falls. They can involve:

  • skull fractures
  • contusions (when the brain is bruised)
  • concussions (when the brain is shaken)
  • bleeding in the brain or around the layers surrounding the brain

Concussions are the most common and least severe type of traumatic brain injury. A concussion can affect multiple brain regions, causing problems in brain function. Signs of a concussion in children can include:

  • headaches
  • loss of consciousness
  • changes in alertness
  • nausea and vomiting

While super rare, more severe injuries can involve a fracture of the skull, which can put pressure on the brain and also cause swelling, bruising, or bleeding around or inside of the brain. These are the most serious circumstances that require emergency medical attention.

It’s critical that medical treatment is administered as soon as possible to reduce the potential for long-term brain damage and loss of physical and cognitive function.

In most cases, “watch and wait” (with lots of extra TLC) is the most appropriate course of action after a baby’s minor head bump.

Keep the symptoms of a more serious head injury in mind, watching for any changes in behavior or neurological deficits within 48 hours of the accident.

Other ways to care for your injured little one during the watch and wait period:

  • apply ice as tolerated by your baby
  • clean and bandage any minor cuts or abrasions to the skin
  • check for changes/consistency in the size of your baby’s pupils
  • monitor your baby while they’re sleeping during naps and at night
  • call your baby’s pediatrician for guidance if you’re concerned

When to call your child’s pediatrician

You know your baby best, so if you’re even remotely worried, don’t hesitate to call your child’s pediatrician for expert advice on what to do next. They might want to evaluate your baby out of precaution and to document the injury for their medical record.

To evaluate for a head injury, the pediatrician or emergency room doctor will likely ask you about how the injury occurred, what your baby was doing before the injury, and what symptoms your baby experienced after the injury.

They might also do a series of neurological exams — looking at your baby’s eyes and responses to voice and touch — and a general physical exam, too.

If something in this exam triggers concern of a serious brain injury, the doctor may order an imaging test such as a CT scan. CT scans are usually only performed when there’s evidence of a severe brain injury.

Although rare, the doctor may advise you to go to the nearest emergency room for more immediate evaluation, diagnosis, or critical care. Or, they may want to observe your baby for a few hours during a medically supervised “watch and wait” period.

Treatment for head injuries depend on the severity. In mild cases, ice, rest, and extra cuddles are the best medicine. (Not a bad treatment for adult head bumps, either.)

After a concussion, frequent monitoring might be advised by your baby’s pediatrician, as well as activity restrictions.

For more serious injuries, it’s important to follow a doctor’s direction. Usually, only severe traumatic head injuries require critical hospital-based intervention that can include medical and surgical treatments as well as physical therapy.

Most minor bumps to the head in young children don’t pose any risk of long-term complications, thank goodness.

But there is a body of research that does bring to light long-term concerns with even minor traumatic brain injuries. A 2016 study that followed a Swedish cohort concluded a possible correlation between a traumatic brain injury (including mild concussions) in childhood with an increased risk for mental health problems, disability, and even mortality into adulthood. As you may expect, children with multiple head injuries had even greater long-term risks.

The American Academy of Pediatrics echoes this with research presented at its 2018 national conference. In the study of children diagnosed with a traumatic brain injury from mild to severe, 39 percent developed neuropsychiatric symptoms up to 5 years after the injury, such as headache, mental disorder, intellectual disability, depression/anxiety, seizure, or brain damage.

This message is empowering to help prevent more serious accidental falls that could affect your little one’s health, growth, and development.

While a minor head bump is bound to happen from time to time, here are a few tips to help keep your baby out of harm’s way.

  • Install and secure baby gates on the top and bottom of stairs.
  • Watch for wet areas on hard floors (especially around pool and bath surfaces).
  • Install non-skid mats in the bathtub and rugs on the bathroom floor.
  • Firmly secure furniture to walls.
  • Keep young children away from dangerous things to climb.
  • Don’t sit or leave your baby up on countertops.
  • Avoid using infant walkers with wheels.
  • Remove tripping hazards.
  • Be cautious at playgrounds that don’t have softer surfaces.

There’s no doubt about it — when your baby takes a tumble, their tears can equal fears and tears of your own. It’s normal to worry, but rest assured that most minor bumps to the head don’t cause a serious brain injury or require emergency medical attention.

However, there are rare instances where a more serious traumatic brain injury can result. In this case, know the symptoms to watch for and always call your child’s pediatrician or seek emergency medical care if you feel it’s necessary.

Read this article in Spanish.