head injury

Definition:

* Vomiting is the forceful emptying (throwing up) of a large portion of the stomach’s contents through the mouth

* Nausea and abdominal discomfort usually precede each bout of vomiting

Causes:

* Main Cause: Stomach infection (gastritis) from a stomach virus (eg, rotavirus). The illness starts with vomiting but diarrhea usually follows within 12 to 24 hours.

* Food poisoning from toxins produced by bacteria growing in poorly refrigerated foods (eg, Staphylococcus toxin in egg salad, Bacillus cereus toxin in rice dishes)

* Serious Causes: If vomiting persists as an isolated symptom (without diarrhea) for more than 24 hours, more serious causes must be considered. Examples are appendicitis, kidney infection, meningitis, and head injury.

* Vomiting can also be triggered by hard coughing. This is common, especially in children with reflux.

Severity of Vomiting:

Te following is an arbitrary attempt to classify vomiting by risk for dehydration:

* Mild: 1 to 2 times a day

* Moderate: 3 to 7 times a day

* Severe: Vomits everything or nearly everything, or 8 or more times a day

* Severity relates even more to the length of time that the particular severity level has persisted. At the beginning of a vomiting illness (especially following food poisoning), it’s common for a child to vomit everything for 3 or 4 hours and then become stable with mild or moderate vomiting.

* The younger the child, the greater the risk for dehydration

Return to School: Your child can return to child care or school after vomiting and fever are gone

Call 911 Now (Your Child May Need an Ambulance) If:

* Unresponsive or difficult to awaken

* Not moving or too weak to stand

Call Your Doctor Now (or in Alberta, canada call 780-408-LINK) If:

* Your child looks or acts very sick

* Confused (delirious)

* Stiff neck or bulging soft spot

* Headache

* Signs of dehydration (very dry mouth, no tears, and no urine in more than 8 hours)

* Blood in the vomit that’s not from a nosebleed

* Bile (bright yellow or green) in the vomit

* Abdominal pain is also present (EXCEPTION: Abdominal pain or crying just before and improved by vomiting is quite common)

* Appendicitis suspected (eg, pain low on right side, won’t jump, prefers to lie still)

* Diabetes suspected (excessive drinking, frequent urination, weight loss)

* Poisoning with a plant, medicine, or other chemical suspected

* Child is younger than 12 weeks with vomiting 2 or more times (EXCEPTION: spitting up)

* Receiving Pedialyte (or clear fluids if older than 1 year) and vomits everything longer than 8 hours

* High-risk child (eg, diabetes mellitus, abdominal injury, head injury)

* Weak immune system (eg, sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids)

* Vomiting an essential medicine

* Fever above 104°F (40°C) and not improved 2 hours after fever medicine

* Child is younger than 12 weeks with fever above 100.4°F (38.0°C) rectally (CAUTION: Do NOT give your baby any fever medicine before being seen)

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

* You think your child needs to be seen

* Has vomited longer than 24 hours

* Fever present for more than 3 days

* Fever returns after gone for longer than 24 hours

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Vomiting is a recurrent chronic problem

Parent Care at Home If:

* Mild to moderate vomiting (probably viral gastritis) and you don’t think your child needs to be seen

Home Care Advice for Vomiting:

1. Reassurance:

* Most vomiting is caused by a viral infection of the stomach or mild food poisoning

* Vomiting is the body’s way of protecting the lower intestinal tract

* Fortunately, vomiting illnesses are usually brief

2. For Bottle-fed Infants, Offer Oral Rehydration Solution (ORS) for 8 Hours:

* ORS (eg, Pedialyte, store brand) is a special electrolyte solution that can prevent dehydration. It’s readily available in supermarkets and drugstores.

* For vomiting once, continue regular formula

* For vomiting more than once, offer ORS for 8 hours. If ORS is not available, use formula.

* Spoon or syringe feed small amounts of ORS —1 to 2 teaspoons (5 to 10 mL) every 5 minutes.

* After 4 hours without vomiting, double the amount

* After 8 hours without vomiting, return to regular formula

* For infants older than 4 months, also return to cereal and strained bananas

* Return to normal diet in 24 to 48 hours

3. For Breastfed Infants, Reduce the Amount Per Feeding:

* If infant vomits once, nurse 1 side every 1 to 2 hours

* If infant vomits more than once, nurse for 5 minutes every 30 to 60 minutes. After 4 hours without vomiting, return to regular breastfeeding.

* If infant continues to vomit, switch to ORS (eg, Pedialyte) for 4 hours

* Spoon or syringe feed small amounts of ORS —1 to 2 teaspoons (5 to 10 mL) every 5 minutes

* After 4 hours without vomiting, return to regular breastfeeding. Start with small feedings of 5 minutes every 30 minutes and increase as tolerated.

4. For Children Older Than 1 Year, Offer Small Amounts of Clear Fluids for 8 Hours:

* Water or ice chips are best for vomiting in older children (Reason: water is directly absorbed across the stomach wall)

* ORS: If child vomits water, offer ORS (eg, Pedialyte). If child refuses ORS, use half-strength Gatorade

* Give small amounts —2 to 3 teaspoons (10 to 15 mL) every 5 minutes

* Other Options: Half-strength flat lemon-lime soda, popsicles, or ORS frozen pops

* After 4 hours without vomiting, increase the amount

* After 8 hours without vomiting, return to regular fluids

* CAUTION: If vomiting continues for more than 12 hours, switch to ORS or half-strength Gatorade

* Solids: After 8 hours without vomiting, add solids

– Limit solids to bland foods. Starchy foods are easiest to digest

– Start with saltine crackers, white bread, cereals, rice, and mashed potatoes

– Return to normal diet in 24 to 48 hours

5. Avoid Medicines:

* Discontinue all nonessential medicines for 8 hours (Reason: usually make vomiting worse)

* Fever: Fevers usually don’t need any medicine. For higher fevers, consider acetaminophen (eg, Tylenol) suppositories. Never give oral ibuprofen (eg, Advil); it is a stomach irritant

* Call your doctor if your child is vomiting an essential medicine

6. Sleep: Help your child go to sleep for a few hours (Reason: sleep often empties the stomach and relieves the need to vomit). Your child doesn’t have to drink anything if she feels very nauseated.

7. Contagiousness: Your child can return to child care or school after vomiting and fever are gone.

8. Expected Course: Vomiting from viral gastritis usually stops in 12 to 24 hours. Mild vomiting with nausea may last up to 3 days

9. Call Your Doctor If:

* Vomiting becomes severe (vomits everything) longer than 8 hours

* Vomiting persists longer than 24 hours

* Signs of dehydration

* Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt

Types of Head Injuries:

* Scalp Injury: Most head injuries only damage the scalp (a cut, scrape, bruise, or swelling). It is common for children to fall and hit their head at some point while growing up. This is especially common when a child is learning to walk. Big lumps (bruises) can occur with minor injuries because there is a large blood supply to the scalp. For the same reason, small cuts on the head may bleed a lot. Bruises on the forehead sometimes cause black eyes 1 to 3 days later because the blood spreads downward by gravity.

* Skull Fracture: Only 1% to 2% of children with head injuries will get a skull fracture. Usually there are no other symptoms except for a headache at the site where the head was hit. Most skull fractures occur without any injury to the brain, and they heal easily.

* Concussion: A concussion is a mild injury to the brain that changes how the brain normally works. It is usually caused by a sudden blow or jolt to the head. Many children bump or hit their heads without causing a concussion. The most common signs of a concussion are a brief period of confusion or memory loss following the injury. Other signs of a concussion can include a headache, vomiting, dizziness, acting dazed, or being knocked out. A person does NOT need to be knocked out (lose consciousness) to have had a concussion. Following a concussion, some children have ongoing symptoms such as mild headaches, dizziness, thinking difficulties, school problems, or emotional changes for several weeks.

* Brain injuries are rare but are recognized by the presence of any one of the following symptoms: – Difficult to awaken or keep awake – Confused thinking and talking – Slurred speech – Weakness of arms or legs – Unsteady walking

Call 911 Now (Your Child May Need an Ambulance) If:

* A seizure (convulsion) occurred

* Knocked unconscious for longer than 1 minute

* Not moving neck normally (CAUTION: Protect the neck from any movement.)

* Difficult to awaken

* Confused thinking, slurred speech, unsteady walking, OR weakness of arms or legs present now

* Major bleeding that can’t be stopped

Call Your Doctor Now (or in Alberta, Canada call 780-408-LINK)) If:

* You think your child has a serious injury

* Your child is younger than 1 year

* Neck pain

* Knocked unconscious for less than 1 minute

* Had confused thinking, slurred speech, unsteady walking, OR weakness of arms or legs, BUT fine now

* Blurred vision persists for more than 5 minutes

* Skin is split open or gaping and may need stitches

* Bleeding that won’t stop after 10 minutes of direct pressure

* Large swelling (larger than 1 inch or 2.5 cm)

* Large dent in skull

* Injury caused by high speed (eg, auto accident) or blow from hard object (eg, golf club)

* Fall from a dangerous height (more than 3 feet [1 m] if child is younger than 2 years, and more than 5 feet [1.5 m] if child is older than 2 years)

* Vomited 2 or more times within 3 days of injury

* Watery fluid dripping from the nose or ear while child is not crying

* Severe headache or crying

* Can’t remember what happened

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

* You think your child needs to be seen

* Headache persists more than 3 days

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* No tetanus shot in more than 5 years for DIRTY cuts (more than 10 years for CLEAN cuts)

Parent Care at Home If: Minor head injury and you don’t think your child needs to be seen

Home Care advice for Scalp Injuries:

1. Wound Care: If there is a scrape or cut, wash it off with soap and water. Then apply pressure with a sterile gauze for 10 minutes to stop any bleeding.

2. Local Cold:

* Apply a cold pack or ice bag wrapped in a wet cloth to any swelling for 20 minutes. Reason: prevent big lumps (“goose eggs”). Also, reduces pain.

* Repeat in 1 hour, then as needed.

3. Observation:

* Observe your child closely during the first 2 hours following the injury.

* Encourage your child to lie down and rest until all symptoms have cleared (Note: mild headache, mild dizziness, and nausea are common).

* Allow your child to sleep if he wants to, but keep him nearby.

• Awaken after 2 hours of sleeping to check the ability to walk and talk.

4. Diet: Offer only clear fluids to drink, in case she vomits. Regular diet OK after 2 hours.

5. Pain Medicine:

* Give acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil) as needed for pain relief

* EXCEPTION: Avoid until 2 hours have passed from injury without any vomiting.

* Never give aspirin to children and teens (Reason: always increases risk of bleeding).

6. Special Precautions at Night:

* Mainly, sleep in the same room as your child for 2 nights. Reason: if a complication occurs, you will recognize it because your child will first develop a severe headache, vomiting, confusion, or other change in behaviour.

* Optional: If you are worried, awaken your child once during the night. Check the ability to walk and talk.

* After 48 hours, return to a normal routine.

7. Expected Course: Most head impact only causes a scalp injury. The swelling may take a week to resolve. The local headache at the site of impact usually clears in 2 to 3 days.

8. Call Your Doctor If:

* Pain or crying becomes severe

* Vomiting occurs 2 or more times

* Your child becomes difficult to awaken or confused

* Walking or talking becomes difficult

* Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt

The Pediatrician's Files

Tag Archives: head injury

Vomiting without Diarrhea