How worried should I be about head bumps as my infant learns to get around?

Question

We have hardwood floors in the house, and have made a little "play area" out of foam interlocking "tiles" for our 9 MO to play on. Of course, he's not content to restrict his explorations to the designated area (on the contrary - he loves dropping his blocks on the hardwood floor so that they make a more interesting sound!)

Naturally, as he learns to crawl, cruise and get about, there are bound to be spills, falls and other bumps - he seems to be particularly talented at bumping his head when he's sitting and turns around too quickly.

How much of a concern are these bumps to the head (I'm not talking about falling from a height - just falling from a crawl or sitting position)?

Should we be hovering and not letting him fall at all? Is falling a natural and reasonably safe thing that teaches children about cause and effect and hopefully to be less clumsy? Can they seriously injure themselves as the result of a bump to the head on a mat or the floor?

Answer 1

Toddlers happen to be "designed" with the right height and mass that they very rarely injure themselves when falling from their own height. Mostly what you need to worry about is them falling from higher than their own height, like from furniture or stairs, falling onto something sharp, or something heavy falling on them. Most of the falls you are worrying about now, you will notice shortly that your child looks to see if you're watching before deciding whether it's worth it to cry or not. My 18 month-old actually head butts things for fun now.

My 7 year-old has cerebral palsy from her skull getting a little squished during her premature birth, so we are well acquainted with the signs of brain trauma. Mostly what you need to look out for is a sudden change in typical behavior, like:

• Sluggishness
• Eyes looking glazed over
• Seizing
• Vomiting
• Dizziness
• Slurred speech
• Non responsiveness
• Being inconsolable after several minutes

If those things happen after a nasty fall, consult a doctor right away, or even get an ambulance depending on severity. Bumps and bruises are not fun, but are normal and nothing to worry about. They happen even to children of the most conscientious parents.

Answer 2

One day, your child is going to learn how to climb stairs safely, how to go down them safely (on his bottom at first, sitting down on the step and descending, sitting down, one step at a time), how to climb onto the couch and get back off, etc. He's going to fall quite a few times between now and when he will have mastered staying upright on two feet - and that's OK.

From a sitting position, when a toddler falls over, it's only a few inches to the floor and most of the impact is amortized by the fact that the toddler doesn't usually fall, but rather rolls over (tumbles). Even if they do fall, the impact is pretty small (small distance, little weight, no starting velocity) and the head being more or less round, it's practically designed to handle that kind of impact.

Once they get upright, they usually fall either forward, in which case they put their hands before their faces and the arms take most of the impact, or they fall backward, in which case they usually fall on their bottoms first (and the fall is cushioned by the diaper as well). Falling forward may cause a bit more crying because it's scary to see the floor coming at you all of a sudden! (And sometimes it hurts a bit).

If your 9 MO bangs his head turning around too quickly and it bothers him, he'll start turning around slower - becoming more careful. That's how we learn. If he starts to yank at power cords (fun until the TV falls to the ground) you might want to intervene before the TV falls to the ground.

Monitor your child's behavior without letting him know you're watching (e.g. drink a cup of coffee pretending to look the other way) and see if he takes any unnecessary risks. as long as he doesn't, let him explore. Keep a closer eye when he does take risks but try not to intervene unless there's a real hazard (like electricity, height, weight, etc.). Your child will use you as a secure base to explore the world. If he sees you as being confident in his capabilities, he'll become confident as well but will also become prudent not to break that trust.

Wikipedia has an excellent article on Attachment theory: http://en.wikipedia.org/wiki/Attachment_theory Under the headings "Behaviours" and "Tenets" there are quite a few references to studies that may interest you (and reassure you).

Answer 3

If the child falls and cries unusually then make sure to check. Otherwise we've generally taught our toddler to just get up again and get on with the show. As long as he doesn't learn that every small bump results in a panic reaction from the parents, he just gets up again. If he feels that he really hurts we always notice.

Falling is okay and usually safe as long as he lands on a reasonably flat surface, especially if it's not rock-hard (tiles etc.). The skin on the forehead is actually the thickest on the whole body - I don't think that's a coincidence.

Obviously avoid sharp edges, and put soft guards on corners. But hitting the head on the floor is not a big concern - remember that kids have learned to walk this way for thousands of years.

You can find all kinds of protection online, right down to baby knee pads. IMHO that's overkill and doesn't help teach the child (or the parents) anything useful, but you might feel differently.

Answer 4

For the most part, my wife and I have hovered over our kids until they we're old enough to stop with daring climbing and toddler clumsiness. As the kids get older, we maintain basic rules to minimize falls and head injuries in particular. For example:

• No sitting on tables or countertops
• No standing in chairs
• You must sit on your bottom in your chair, not on your feet or knees
• No toys can be left out in common walking areas (which could cause tripping)
• No standing or tricks on tricycles
• Always wear helmets when riding bikes
• No running or playing on the stairs
• Always hold handrails on the stairs
• Etc.

We have known several children who have had head injuries that seemed minor initially, but which turned out to have major impact on the child and the parents. One 3yo child hit his head and began losing his vision and ultimately went blind. A coworker's 2.5yo child went into a coma after falling off of a chair (luckily she's fine now). Another child 5yo lost parts of his memory.

The effects of head injuries could be a lot more subtle. From this article in the Journal of Pediatric Psychology:

Many children with head injuries are left with residual impairments, including seizures, speech and gait problems, hearing or vision changes, and memory or attention problems (Anderson et al., 1997, 2001). Children who suffer head injuries in the preschool years are at substantially greater risk for subsequent behavior disorders that interfere with school performance (Michaud, Rivara, Jaffe, Fay, & Dailey, 1993). McKinlay, Dalrymple-Alford, Horwood, and Fergusson (2002) found that children whose mild head injury, severe enough to be hospitalized, occurred before they were 5 years old were more likely to display hyperactivity/inattentiveness and conduct disorder when they reached 10–13 years old. Even in preschoolers with mild head injury not severe enough for hospitalization, Wrightson, McGinn, and Gronwall (1995) found deficits in solving visual puzzles by 6 months after injury and lower reading ability by 6.5 years.

If your child hits his head, this article from HealthyChildren.org says to watch for the following signs after head trauma and take your child to the doctor or hospital immediately if you observe any of them:

• A constant headache, particularly one that gets worse
• Slurred speech or confusion
• Dizziness that does not go away or happens repeatedly
• Extreme irritability or other abnormal behavior
• Vomiting more than 2 or 3 times
• Stumbling or difficulty walking
• Oozing blood or watery fluid from the nose or ears
• Difficulty waking up or excessive sleepiness
• Unequal size of the pupils (the dark center part of the eyes)
• Double vision or blurry vision
• Unusual paleness that lasts for more than an hour
• Convulsions (seizures)
• Difficulty recognizing familiar people
• Weakness of arms or legs
• Persistent ringing in the ears

Answer 5

The Canterbury District Health Board released Your Child after a Head Injury (pdf download) which includes information on symptoms of head injuries and recovery for parents and caregivers ("Your child has come to hospital because of an injury to the head.").

Since a previous answer already covers physical symptoms, I will cover emotional and cognitive symptoms.

Emotional symptoms

• Mood swings
• Outbursts of anger – verbal or physical
• Frustration
• Change in activity level – increased physical activity or alternatively very subdued and quiet.
• Changes in social interaction – difficulty getting on with siblings or friends.
• Lack of initiative
• Changes in personality
• Extra tearful/clingy

Notice the emphasis on change, e. g. when the child becomes silent.

Cognitive (thinking) symptoms

• Your child may have difficulty remembering things that happened during the day or things they are told.
• Concentration – it may be your child concentrates for shorter periods of time than normal. They mighty also be distracted by noise, movements, sights and may ‘flit’ from one activity to another
• Difficulty learning
• Confusion or disorientation

They also note that symptoms may be delayed - hours, or even days.

Further information from Head injuries in children of Healthinfo Canterbury / Waitaha:

If your child has bumped their head, you should take them to a doctor if they:

• are a baby
• have been knocked out (lost consciousness) even briefly
• won't wake up easily
• won't stop crying, become hard to settle, or vomit several times
• aren't walking or talking normally.

Answer 6

Infants & Toddlers learn by Experimentation, Trial & Error. This means that they will make a lot of failed experiments, and a lot of errors before they figure out what works.

As a parent your role is to make sure there are plenty of little bumps to learn from, but no bumps that are going to cause trauma/damage etc.

Also you should learn to recognise then your Infant/Toddler is crying for attention or reassurance, and when they are actually hurt.