Galveston County Daily News, March 15, 2007

By Sally Robinson and Keith Bly

In a continuation of our discussion on sports injuries from last week, we need to remind parents that there are other more serious types of injuries that occur in sports-related accidents; these are head injuries and blunt trauma injuries to the abdomen. These types of injuries require a very different type of immediate attention.

According to the Academy of American Pediatrics, injuries to the head can be divided into two categories; external and internal. External, while frightening to see, usually just involves a scalp injury. While seeing your child's scalp bleeding may cause your heart to skip a beat, internal head injuries are far more serious because of the implications of a life threatening brain or skull injury.

Some blows to the scalp may cause swelling below the skin from the blood leaking into the scalp, this called a "goose egg" and may take days or weeks to disappear depending on the amount of fluid/blood that leaked.

Below is a list of what to do and what to look for if a scalp injury occurs.

If the infant or child loses consciousness, even for a brief moment; does not stop crying; complains of head or neck pain; or is not walking normally; call your pediatrician immediately.

If your child is not an infant and has not lost consciousness, but is behaving normally after a blow to the head or a fall, apply an icepack to the injured site for no more than 20 minutes at a time to reduce swelling. (Wrap the bag of ice or frozen vegetables in a washcloth. Do not apply the ice directly to the injured area as this will cause damage to the skin.)

Observe your child for 24 hours for any change in behavior. If you see any reason for concern, call the child's pediatrician immediately, this may be a sign of internal injury.
If the trauma occurs near bedtime, check the child every few hours for twitching legs or arms and change in color or breathing.
If color and breathing are normal, and you observe or sense no other abnormalities, let your child sleep (unless your child's doctor has advised otherwise).

If color and or breathing are not normal, or if you aren't comfortable with your child's appearance (trust your instincts), arouse your child partially by sitting him or her up. Your child should fuss a bit and attempt to resettle. If he or she doesn't protest, try to awaken your child fully. If your child can't be awakened or shows any signs of internal injury (see below), call your child's doctor or an ambulance.

Of a more serious and life-threatening nature are internal injuries to the head and or abdomen. Call for emergency medical attention if any of the following symptoms occur after a head or abdominal injury. For either type of injury:

· Loss of consciousness.
· Neck pain.
· Pupils of unequal sizes.
· Pale clammy skin.
· Bleeding from the nose, ears or eyes.
· Abnormal or rapid shallow breathing.
· Weak pulse, which may be evidence of shock.
· And for the abdomen, a guarded curled-up position.
Concussions are also considered a type of internal head injury. A concussion is the temporary loss of normal brain function as a result of an injury. If your child sustains an injury to the head, watch for the following signs that indicate that he or she may have a concussion:

Feels dizzy, or light-headed.

  • Trouble remembering things that have happened immediately before or after the accident.
  • Nausea or vomiting.
  • Headaches.
  • Blurred vision and sensitivity to light.
  • Slurred speech or saying things that don't make sense.
  • Difficulty concentrating, thinking, or making decisions.
  • Difficulty with coordination or balance.

If you suspect a concussion, contact your pediatrician or take your child to the nearest ER.

While it is impossible to prevent all childhood injuries, there are ways of helping your child in avoiding them. Some of the ways to minimize the chances of injury are to childproof your home; make sure that your child wears protective headgear and equipment when participating in sports activites; always have your children wear safety belts in the car or use an age appropriate safety seat. If your child is injured, make sure that he/she takes it easy and do not allow them to resume playing sports until the injury has healed completely.

Sally Robinson is a professor of pediatrics at UTMB Children's Hospital, and Keith Bly is a hospitalist and assistant professor of pediatrics. This column is not intended to replace the advice of a physician. For information, contact your pediatrician. Or, contact Robinson and Bly at To view past articles, visit the UTMB Web site at