Head Bonks
Kids bump their heads a lot. As frightening as some bumps appear, the great majority do no lasting harm. Nevertheless, most parents would like to know how to tell worrisome head bonks from non-worrisome head bonks.

First, some background is in order. Babies and toddlers have unusually large heads. Whereas an adult’s head from crown to chin measures about 1/10 to 1/12^th his total height, for a toddler the proportion is closer to 1/4th. With a large heavy head on top of her body, it’s natural that a toddler would bump her head first during a fall.

Another difference between toddlers and adults is that the brains of toddlers are cushioned much more effectively than ours. That’s a good thing. If we bonked our heads with the intensity and frequency of toddlers, we would give ourselves concussions all the time! Happily, this doesn’t happen to the little ones nearly as often.

Telling good bonks from bad bonks
If your child bonks his head very hard, how can you tell if he really hurt himself? There are several ways to tell:

First, if she cries immediately, it suggests that she wasn’t knocked unconscious by the blow. Any head bonk that results in unconsciousness deserves an immediate call to the doctor. Second, if she cries immediately, but nevertheless begins throwing up, there is an increased chance of her having hurt herself badly, and you should call her doctor immediately. Finally, goose-egg sized bumps are okay: cuts in the skin that are either deep, or widely separated, or won’t stop bleeding are not okay. Those cuts need to be sewn up. Once again, call the child’s doctor! Other worrisome signs include: crying that won’t stop, even momentarily, for one full hour; in children who walk; dizziness or inability to walk normally; and altered states of consciousness such as confusion or inability to stay awake.

Some head bonks may be assumed to be serious because of the way they occur. Any child who injures her head as a result of being involved in a motor vehicle accident, either as a pedestrian or as a passenger, is assumed to have a serious head injury until proven otherwise. Likewise, a child who has fallen 10 feet or more onto his head is assumed to have suffered a serious injury. These children require emergent attention.

Treating head bonks
Some experts recommend applying ice to infant or toddler heads, particularly if there is a noticeable bruise. However, I don’t find that ice provides any relief. To the contrary, in my experience most children would prefer to be dropped on their heads a second time rather than endure the unpleasantness that icing brings. I recommend ibuprofen (Motrin or Advil) for children who are not allergic to it.

What about sleep?
Very often, a tired toddler will trip and bonk his head just before bedtime. He’ll be tired and want to go to sleep because it was bedtime! I do not recommend waking a child at regular intervals to see if the child is behaving normally. Most assuredly, a child will not behave normally when awakened from deep sleep in the middle of the night! The maximum I would recommend is checking on a child to ensure that she is breathing normally and moves in her bed normally.

Stitches
As mentioned above, cuts that are deep, wide, or don’t stop bleeding need to be sewn up (or “sutured”). But where they get sewn up, and by whom, depends on a few factors. Some pediatricians place sutures in their offices. But even if the pediatrician does not, if the cut is not actively bleeding, and the injury occurs during office hours, it may be worthwhile to have the pediatrician see the cut to determine whether stitches are necessary.

Cuts on the lip deserve special mention. If the cut crosses the line between the “pink” part of the lip and the skin of the face proper (the so-called “vermillion border”), the cut should probably be repaired by a plastic surgeon. This is a very cosmetically important part of the anatomy. If the edges of the cut are not brought together precisely, the child may be left looking odd permanently! A plastic surgeon is best able to do the job.

The Bottom Line on Bonks
If the child has not been involved in a serious accident, and you aren’t sure whether the bonk is something you should worry about, the best course of action is to call the child’s pediatrician and describe what happened and how the child is behaving.