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Bump on head,vomiting,pain.Head injury?

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Practicing since : 2001
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My 2 year old son fell getting into shower around 4:30PM last night and hit the back of his head on a marble foot slab. He did not pass out with the fall. He immediately had a huge knot come up(biggest he's ever had). He cried for awhile but seemed okay. He took Motrin afterward and ended up eating dinner and showed no signs of changes in his behavior. He went to bed around 7:30pm and I checked on him until around 11PM. He awoke 30 minutes ago and vomited quite a bit and was chilled looking and told me his head hurt. He's now trying to go back to sleep. I do not know if I should take him to the ER now or wait until my pediatrician office opens in the morning at 9 to call while I continue to watch and assess him. I don't want to jump the gun but also do not want to cause any other problems waiting if it is serious enough to get checked out now. Any advice on what I need to be concerned about for head injury or what I should do at this moment? Thanks! ( I am XXXXXXX 35 yr old concerned mother)
Posted Mon, 16 Apr 2012 in Head Injuries
Answered by Dr. Rakhi Tayal 53 minutes later
Thanks for writing to us.

After a fall with a suspected injury to the head followed by vomiting indicates that the intracranial tension is raised. This is a warning symptom and indicates that the injury is not mild in nature.

Immediate medical attention is needed.

I would advise you to not to wait till morning and immediately take your child to ER for proper investigations.

Earlier the diagnosis, better will be the treatment and prognosis.

The bump that has appeared on his head is probably a hematoma which can be reduced till you reach ER by giving a cold compress by wrapping ice cubes in a towel.

Head and neck injuries can be external or XXXXXXX

Children exhibit screaming and crying if they feel pain in the neck area. They may rub at their necks, especially the back of the neck. They may complain of neck pain or cry when you touch their neck.

Then other symptoms observed are shallow breathing, trouble taking a breath or trouble taking XXXXXXX breath, difficulty for the child to move his neck, nausea and vomiting, pupils may become dilated or one pupil may appear larger than the other in a serious neck injury.

Children may also become highly irritable or inconsolable. Then there may be unconsciousness and seizures, bleeding or clear fluid from the nose, ear, or mouth, feeling anxious or irritable for no apparent reason and sensitivity to light as well.

In such a case, it is always better to get a physical examination and a CT/ MRI head done to rule out any subdural hemorrhage. Symptoms of subdural hemorrhage have a slower onset than those of epidural hemorrhages because the lower pressure veins bleed more slowly than arteries. Thus, signs and symptoms may show up within 24 hours but can be delayed as much as 2 weeks.

I hope my answer and recommendations are adequate and helpful. Waiting for your further follow up queries if any.
Above answer was peer-reviewed by
Follow-up: Bump on head,vomiting,pain.Head injury? 2 hours later
He has since woken up and acts fine and wanting to eat. If he isn't vomiting anymore does that mean probably okay or can just the one incidence of it happening in the night still mean everything you just answered could be the case?
Answered by Dr. Rakhi Tayal 31 minutes later

Thanks for writing again.

Vomiting even once after the head injury is a warning sign and needs to be investigated. The vomiting could happen out of fear or gastric disturbance also but it is always best to rule out any serious head injury before it is too late.

Wishing your son an early recovery.

Above answer was peer-reviewed by
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