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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Infant Had Hit On The Back Of Head, Hard Bump On The Site, No Bleeding, Feels Relieved With Ice Application. What Else Can Be Done?

My 11 month old fell and hit the back of his head very hard last night. He immediately cried and has shown no symptoms of concussion or serious injury and has been acting normal. Although, he has an extremely large (like the size of a golf ball) and very hard bump where he hit, there was never any external bleeding from the fall. I put ice on it for as long as he would let me about 5 minutes after the fall. Is there anything else I can do to help the bump go down faster? In your opinion, is there risk of serious damage to the brain? Do I need to seek medical help?
Mon, 17 Sep 2012
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Pediatrician, Cardiology 's  Response
Hello
Thanks for the query
Scalp hematoma in a child less than 2 year old following fall needs a neuroimaging. If trauma is associated with loss of consciousness that is uncertain or very brief( few seconds only), irritability( now resolved), behavioral changes if any, scalp hematoma( particularly nonfrontal), the risk of clinically important traumatic brain injury is approximately 1 percent for a child with at least one of these criteria. Multiple or worsening symptoms or signs likely put the child at greater risk than an isolated finding. If immediate CT is deferred for these patients, we suggest observation for four to six hours to ensure no progression of clinical findings that warrant CT.
So as even after 12 hours if there is no deterioration of condition there is no need of neuroimaging.
Apply Thrombophob gel over the area this will help in reducing the size of swelling. A skull radiograph may be neede to rule out any fracture.
I hope this answers your query well
Wish you and your family good health
With regards

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Emergency Medicine Specialist Dr. Dr. R.A. SINGH's  Response
Dear Heatherandkairi, hello.
First of all be at ease because it is good that the injury is only external and no internal damage is present and the baby is behaving normal. Cryotherapy or putting ice is benefecial at the time of soft tissue injury. The structure of the scalp area is such that swelling appears immediately after hitting a hard object. Don't be afraid of the bump. It will go by itself in few days to week time.
You should seek medical help in case of baby is contiously crying, irritability,seizures, vomitting, confusion state,etc.
Thanks.
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General & Family Physician Dr. Kulbir Singh's  Response
Hello and thanks for the query
According to your mail, it seem everything normal with your child. But if you notice any drowsiness, ENT bleed, vomiting or loss of conciseness, than immediately rusk to ER and get CT head done. It may be a matter of concern.
Now about the bump, its good you have done cold fermentation at the site. Rest it will resolve by its own. But keep a check on fever and raise in temperature at the site. If you feel anything abnormal, please consult your doctor.
Best Wishes
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Infant Had Hit On The Back Of Head, Hard Bump On The Site, No Bleeding, Feels Relieved With Ice Application. What Else Can Be Done?

Hello Thanks for the query Scalp hematoma in a child less than 2 year old following fall needs a neuroimaging. If trauma is associated with loss of consciousness that is uncertain or very brief( few seconds only), irritability( now resolved), behavioral changes if any, scalp hematoma( particularly nonfrontal), the risk of clinically important traumatic brain injury is approximately 1 percent for a child with at least one of these criteria. Multiple or worsening symptoms or signs likely put the child at greater risk than an isolated finding. If immediate CT is deferred for these patients, we suggest observation for four to six hours to ensure no progression of clinical findings that warrant CT. So as even after 12 hours if there is no deterioration of condition there is no need of neuroimaging. Apply Thrombophob gel over the area this will help in reducing the size of swelling. A skull radiograph may be neede to rule out any fracture. I hope this answers your query well Wish you and your family good health With regards