After a head injury, call 115 immediately for unconsciousness, difficulty waking, seizures, breathing difficulty, weakness, abnormal speech or walking, or rapid deterioration. Repeated vomiting, worsening headache, confusion or marked behavior change also need emergency assessment. After a high-impact incident or possible neck injury, avoid moving the child unless needed for immediate safety or instructed resuscitation. Do not wait to see whether the bump shrinks.
The short version
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Neurological signs and how the injury happened matter more than bump size.
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Young children may show changes through feeding, crying, play and interaction.
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When home observation is appropriate, an adult stays; sleep is allowed, but difficulty waking is a danger sign.
Jump to the part you need
Give the first moments to the child, not the photograph
Approach, check response to your voice and normal breathing, and notice any continuing environmental danger. Do not shake the child to test alertness. If unresponsive and not breathing normally, call 115 on speaker and begin dispatcher-guided or trained resuscitation. With two adults, one stays beside the child while the other calls and directs help to the location.
After a vehicle incident, substantial fall or neck pain, do not immediately lift the child upright to test standing. Keep them still and follow emergency guidance unless the location presents immediate danger. For a minor bump with full alertness and no warning signs, comfort and brief applications of a wrapped cool pack can help swelling. Cooling provides comfort, not a test for brain injury.
Tell the mechanism and the sequence
The clinician needs the mechanism, landing surface, any loss of consciousness, vomiting episodes and subsequent behavior. Record timing as accurately as practical without delaying first aid to reconstruct everything. If unwitnessed, distinguish observations from assumptions. Include age, existing conditions, medicines and relevant previous head injuries. Uncertainty about the incident is something to report, not something to fill with a confident guess.
A visible lump can pull attention toward the scalp while a child with little external marking may still need assessment. A helmet or immediate crying does not exclude every injury. Do not compare photographs with a friend's child to judge seriousness. Ask instead whether the child is returning to their usual responsiveness, movement and feeding or becoming progressively less like themselves.
Unconsciousness is not the only warning sign
CDC lists repeated vomiting, worsening persistent headache, confusion, unusual behavior, seizures, slurred speech, weakness and poor coordination among emergency warning signs after head injury. Double vision or unequal pupils also matter. Do not wait until morning or for another vomiting episode to be certain. Call 115 when the condition is severe or safe transport is not possible.
In infants and toddlers, CDC also identifies inconsolable crying or refusal to nurse or eat as possible danger signs. Notice how the child seeks comfort, plays, balances and responds to familiar things. Seek early assessment for very young babies or a marked change you cannot neatly describe. Do not invent performance tests, make the child run around or shine bright lights to prove alertness.
Assessment does not mean every child needs a scan
RCH explains that assessment often involves history, examination and observation, with investigations chosen for the overall situation. CT can help identify bleeding or injuries needing intervention, but concussion is not necessarily visible on a scan. Not receiving a scan does not automatically mean being overlooked, and a normal scan does not authorize strenuous activity while symptoms persist.
Ask what makes discharge appropriate, who should stay with the child and which changes require return. Explain distance from care or difficulty arranging overnight supervision before leaving. The feasibility of observation is part of the practical plan. Request written instructions where available. You do not need to master a head-injury scoring system; you need to understand this child's next steps.
Sleep is allowed; supervision still matters
When home care is appropriate, NHS advises an adult staying for at least the first 24 hours; RCH highlights observation over 24 to 48 hours and awareness of later symptoms. Normal sleep is allowed. Do not force wakefulness or repeatedly wake the child unless specifically instructed. Difficulty waking, abnormal responsiveness or inability to stay awake is an emergency sign, not simply catching up after crying.
Keep a brief record of feeding, vomiting, pain and behavior so the next caregiver knows the baseline. Do not give sedating medicines to make rest easier, and use pain medicine only as advised for the child. Observation does not mean staring at the bump all night: it means a responsible adult, recognizable action triggers and access to care. Contact the treating service if those conditions cannot be met.
Return to routine without proving toughness
For suspected concussion, stop sport and do not return to play that day; obtain professional guidance before activities risking another head impact. RCH recommends initial relative rest followed by tolerable light activity, not confinement to a dark room with all activity forbidden. Ask separately about school, screens, physical play and follow-up because each child's needs and recovery can differ.
Tell teachers or caregivers what happened, which symptoms are being monitored and which activities are temporarily restricted. Later, address a specific hazard such as climbing access, slippery surfaces or protective equipment rather than merely asking the child to be more careful. A head injury deserves attention without becoming a story about weakness. The child needs protection during recovery and someone able to notice a changing course.
Practical checklist
- Check alertness, breathing and neurological warning signs.
- Record mechanism, time and subsequent changes.
- Ask about sleep, observation and review before discharge.
- No same-day return to sport with suspected concussion.
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General health information · Checked against official sourcesFor symptoms or treatment decisions, confirm with an appropriate health professional.Next review · Dec 5, 2026
