When Does a Head Bonk Demand a Trip to the ER?

headbonkIs there a mother on earth who hasn’t run to the side of a wailing toddler with a growing egg on his forehead and wondered “OH NO, is this going to be our first visit to the ER?”

There are some comforting guidelines that can help you decide when it’s safe to stay home with an icepack, and when you need to check it out, but rest assured that Mother Nature knows they’re called toddlers for good reason.  She made that frontal bone (the forehead) thicker and stronger than most other bones in the body.

  • Did you see it happen? If so you have a good chance of knowing which body part landed on which immovable object. Less worry about hidden injuries, or problems you might be missing because the golf ball size bump on the head is getting your full attention.
  • Did he cry immediately? Most kids this age will react as soon as they realize what’s happened. This might take a few seconds, but not much longer. If you didn’t witness the fall, and there was a sizable gap between the crash and the shriek, there’s a possibility that he was knocked out, if only for a few moments. Loss of consciousness ALWAYS calls for medical attention. It’s the dividing line most doctors use between ‘small chance of worrisome injury’ and ‘we’d better take a closer look’.
  • Which part of the head took the hit? Like I said, that frontal bone can take a lot. Most toddlers fall forward from a height of less than 3 1/2 feet. A knock like this may cause a bump that looks humongous to you, but it’s unlikely to cause serious damage. You’ll be surprised how fast it comes down with a bit of ice and lots of kisses. The side of the head, the temporal bone, isn’t as tough, and a bonk against a hard object may call for a closer look.
  • How is he acting? Did he calm within 5 or 10 minutes? After 20 minutes is he playful again? Willing to drink some juice or suck on a popsicle? Is his behavior normal — and I mean, normal for him? Here’s where things you’ve heard might get confusing. You may get worried if an hour after the fall he starts to get cranky and tired, but if he fell at noon and it’s now 1 PM and his usual nap time, that’s normal for him. Not to worry.
  • Is he vomiting? More than once? Lots of kids this age will get so upset, and cry so hard that they’ll make themselves throw up. But if the vomiting continues that’s a warning sign that something may be wrong. Let the ER doc decide. Inside info: the threshold for most physicians is 4 episodes of vomiting before they get worried, but let’s get real. What mother is going to wait for that 4th time?

Bottom line? Most head bonks are just part of learning to navigate upright and those little noggins are designed to take a lot. But if you’re worried and your gut tells you something’s really wrong, high-tail it to medical attention.

And don’t ever forget the magical healing powers of a band-aid. Whether they need it or not.

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?


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One response to “When Does a Head Bonk Demand a Trip to the ER?”

  1. Top 5 Kid Emergencies … Call 911!

    […] behaving normally (even crying normally) is less likely to need emergency treatment. Take a look at this Mamas’ article for more head bonk […]

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