Toddler head injury: first aid, red flags and where to go in Singapore

If your toddler has just hit their head, stay close and watch how they act. A toddler head injury is usually a bump and a fright, and the NHS says most head injuries are not serious. HealthHub says a child who acts, eats and plays as usual can be watched at home. Go to Children's Emergency or call 995 if your child passes out, has a fit, keeps vomiting or is hard to wake.

What to do after a toddler head injury, step by step

1. Stay calm and hold your child. HealthHub's first step is to hold and comfort them.
2. Call 995 if your child won't wake or respond, or has a fit. HealthHub lists these as signs of a serious head injury, and KKH says to call 995 in an emergency.
3. Check that your child is alert and responds to you. The AAP says that means the injury is mild, and crying from pain or fright should stop within 10 minutes.
4. Press firmly on any bleeding, then cover the cut with clean gauze, as KKH advises.
5. Hold a cold pack on the bump for short spells. The NHS suggests an ice pack or frozen peas wrapped in a tea towel.
6. Let your child rest for the next few hours, as HealthHub advises. A nap is fine: the NHS says they don't need to stay awake.
7. Keep an adult with your child for at least the first 24 hours, as the NHS advises. If a helper or grandparent is on duty, show them the warning signs below.
8. Watch your child closely for the next 72 hours. HealthHub says signs of a severe brain injury usually show within that time.
9. Give pain relief only if your child needs it, and only at the dose on the label. KKH says to avoid any medicine that causes drowsiness unless your doctor says so.
10. Note when and how it happened, and what your child did next. The AAP says the doctor will want to know.

Mild bump or urgent care: how to tell

Use this table as a guide to what you're seeing, not as a diagnosis. Only a doctor can say how serious an injury is. The signs come from HealthHub, KKH, the AAP and the NHS.

If your child looks well but you're still uneasy, HealthHub says your family doctor or polyclinic can review them. Our baby medicine and first aid kit checklist lists what to keep at home for the next bump.

Why toddlers bump their heads at home

For the youngest children, home is where most head injuries happen. KKH says that among children aged 2 and under who come to its Children's Emergency with a head injury, almost 90 per cent were hurt at home, and up to half in the bedroom. Falls from the adult bed are a common cause.

• Beds and cots: KKH says never to leave a baby alone on an adult bed, or in a cot without proper barriers, even for a few seconds.
• Stairs: HealthHub suggests a child-proof gate at the top and the bottom.
• Baby walkers and sarong cradles: KKH advises against both, and says falls from them have caused head injuries.
• Playgrounds: KKH says to supervise closely and stop children climbing unstable or high structures.
• Windows: KKH says to fit grilles on all windows and keep them locked.

For prevention room by room, use our baby-proofing checklist for Singapore homes. If your toddler has just left the cot, the cot to bed guide covers guard rails and bed height. Walkers and sarong cradles are also on our list of first year baby mistakes.

Sleep, rest and the next few days

Your child can sleep. The NHS says children don't need to stay awake after a head injury, and the AAP says it's okay for them to go to sleep. Your doctor may ask you to check on them every 2 to 3 hours. If so, make sure they wake enough to recognise you and respond.

KKH lists two sleep signs that mean Children's Emergency straight away: you can't wake your child, or they seem unusually drowsy, sleepy all the time.

Keep the next few days quiet. The NHS says children should avoid rough play for a few days and shouldn't go back to school until they feel better. Ask your doctor before your child goes back to infant care or preschool.

Shaken baby syndrome, and what to do when crying feels like too much

Shaken baby syndrome is a brain injury caused by forcefully shaking a baby, NUH explains. A baby's neck muscles are weak and the head is heavy, so shaking makes the head whip around. NUH says this can tear blood vessels and brain tissue, and cause permanent brain damage or death.

NUH also says it is entirely preventable. It often happens when a carer, frustrated by crying that won't stop, loses control for a moment. So the safest plan is a plan for the crying.

Things to try first, from NUH's list:

• Hold your baby against your chest and gently massage them.
• Rock, walk or dance with them.
• Turn down the noise and the lights in the room.
• Breathe deeply, and count to ten.

If you feel annoyed or angry, put your baby down safely in the cot and leave the room until you're calm. NUH suggests calling a trusted relative or friend and taking a break. Walking away for a while is the safe choice.

Never shake a baby, whatever the reason. KKH warns that shaking can cause severe and fatal bleeding inside the head. HealthHub says rocking a child too violently can burst blood vessels in the brain too. Make sure everyone who holds your baby knows this. That includes your helper and the grandparents.

If the crying is wearing you down, you can call national mindline 1771, which MSF lists as a 24-hour line. For low mood after birth, see our guide to postnatal depression in Singapore. For exhaustion, see new parent sleep deprivation.

Think a baby may have been shaken? Go to Children's Emergency now and tell the doctor what happened. NUH says early treatment matters. To report a worry about a child's safety, call MSF's National Anti-Violence and Sexual Harassment Helpline (NAVH) on 1800-777-0000. It runs 24 hours.

When to see a doctor

Go straight to Children's Emergency at KKH or NUH if your child has any of these signs after a head injury:

• Passes out or stops responding (HealthHub)
• Has a fit or unusual movements (HealthHub)
• Keeps vomiting (HealthHub)
• Is unusually drowsy, or you can't wake them (KKH)
• Acts unlike themselves, or is confused about familiar names and places (KKH)
• Cries and can't be settled, or is very irritable (KKH)
• Has a severe headache, or one that gets worse (HealthHub)
• Walks unsteadily or has blurred vision (HealthHub)
• Has blood or clear fluid coming from the nose or ears (HealthHub)
• Has pupils of different sizes (AAP)
• Is under 1 year old and has a bruise, a lump or a large cut on the head (NHS)
• Fell from higher than 1 metre, or down more than 5 stairs (NHS)

Call 995 for an ambulance if your child is unconscious or can't be woken, or has a fit. KKH says to call 995 in an emergency, and lists a fall from a height among the reasons to come to its Children's Emergency.

If your child seems fine but you want a check, HealthHub says your family doctor or polyclinic can review them, and KKH sends minor injuries to the family doctor too. Our paediatrician map helps you find a clinic near you.

Blood from the nose after a knock to the head needs Children's Emergency. For an ordinary nosebleed with no head injury, see what to do when your child has a nosebleed.

Frequently asked questions

Can my toddler sleep after hitting their head?

Yes. The NHS says children don't need to stay awake after a head injury, and the AAP says it's okay for them to sleep. Your doctor may ask you to check on them while they sleep. If you can't wake your child, KKH says to go to Children's Emergency at once.

How long should I watch my child after a head injury?

Watch closely for 72 hours. HealthHub says signs of a severe brain injury usually show in that time, and KKH says that watching still matters even if a skull X-ray was normal. The NHS says an adult should stay with your child for at least the first 24 hours.

Does my toddler need an X-ray or CT scan after a head injury?

Usually not. KKH says skull X-rays are seldom needed, and they show fractures but not bleeding or injury to the brain. If the doctor suspects bleeding inside the skull, your child will need an urgent CT scan.

What are the signs of shaken baby syndrome?

NUH says the first signs are often vague: poor feeding, vomiting, unusual sleepiness, irritability, trouble breathing or seizures. If you notice these, or think a baby may have been shaken, go to Children's Emergency straight away and tell the doctor everything you know.

How do I prevent shaken baby syndrome when my baby won't stop crying?

Try holding and rocking your baby in a quiet, dim room first. If you feel angry, NUH says to put the baby safely in the cot and leave the room to calm down, then call someone you trust. National mindline 1771 is open 24 hours if you need to talk.

When can my toddler go back to preschool after a head bump?

When they feel better. The NHS says children shouldn't go back to school until they're feeling better, and should avoid rough play for a few days. If your child saw a doctor, follow the return advice they give you.