As much as we would like to wrap our children up in cotton wool we can't and bumps and bangs happen, often to their head.  What would you do if your child fell and banged their head?

​One key thing with head injuries is that it’s important to be able to determine between when you need to call 112, seek medical help or when you can care for them at home.   


Any knock to the head is considered a head injury and classified as either mild, moderate or severe.  Many head injuries are mild, and simply result in a small lump or bruise.  If your child doesn't have signs of a serious head injury and remains alert, moves normally and responds to you, the injury is probably mild and usually doesn't need further testing.  Mild head injuries can be managed at home, but if your child has received a moderate or severe injury to the head, they need to see a doctor.

Seek help immediately by calling an ambulance if:

• your child has had a head injury involving high speeds or heights greater than a metre, for example, car crashes, high-speed skateboard accidents or falling from playground equipment
• your child loses consciousness (passes out)
• your child seems unwell and vomits more than once after hitting their head.

Moderate to Severe Head Injury

Occasionally, a blow to the head may be severe enough to cause bleeding in or around the brain.  With a severe head injury they may have:

• a deteriorating level of response
• loss of responsiveness
• leakage of blood or blood-stained watery fluid from the ear or nose
• unequal pupil size
• been knocked out and has not woken up
• difficulty staying awake or keeping their eyes open
• a fit (seizure or convulsion)
• problems with their vision
• bleeding from their ears or bruising behind their ears
• numbness or weakness in part of their body
• problems with walking, balance, understanding, speaking or writing
• be dazed or shocked
• has something stuck in their head, or a cut causing bleeding that is difficult to stop, or a large bump or bruise on their head
• Vomit more than once
• In younger children if they do not cry straight after the knock to the head

Clearly if your child is experiencing any of these severe symptoms call 112​

If the head injury is bleeding heavily then apply pressure to the wound to stop or slow down the flow of blood and call 112. 

Mild Head Injury

A mild head injury or concussion is when your child:

• may display altered level of consciousness at the time of the injury
• is now alert and interacts with you
• may have vomited, but only once
• may have bruises or cuts on their head
• is otherwise normal.

You should seek medical advice if your child has any of the above symptoms of mild head injury, and you are worried about them. Otherwise, continue to observe your child for any of the signs and symptoms listed under care at home.

Care at home

If you do not need to go to hospital, you can usually look after your child at home.  Don't leave your child alone for the first 48 hours!  

To help recovery you can hold an ice pack (or a bag of frozen peas in a tea towel) to the injury regularly for short periods in the first few days to bring down any swelling. 

​Children and adolescents with concussion can take up to four weeks to recover, but most concussions will get better on their own over several days.  Following a mild head injury, your child will need to get plenty of rest and sleep, particularly in the first 24 to 48 hours.

Your child may have a headache after a head injury. Give them paracetamol (not ibuprofen or aspirin) every six hours if needed to relieve pain.

There is no need to wake your child during the night unless you have been advised to do so by a doctor. Call an ambulance immediately if you have any difficulty waking your child.

Children who have had a head injury may develop symptoms at various times. Some of the symptoms may begin minutes or hours after the initial injury, while others may take days or weeks to show up.
 
If your child experiences any of the following symptoms, take them to the doctor or nearest hospital emergency department immediately:

• vomiting more than once
• bleeding or any discharge from the ear or nose
• fits/seizures/twitching/convulsions
• blurred or double vision
• poor coordination or clumsiness
• any new arm or leg weakness, or any existing weakness that gets worse or does not improve
• difficulty swallowing or coughing when eating or drinking
• sensitivity to noise
• slurred or unclear speech
• unusual or confused behaviour
• severe or persistent headache that is not relieved by paracetamol.

If your child has had a head injury, they should return to school and sport gradually. For moderate to severe head injuries, your doctor will advise you.

Can you let your baby or child go to sleep after a head injury?

YES - you can let them sleep if it is their normal time to sleep and they are not showing signs of serious head injury.  If they seem unusually drowsy they may have a serious head injury and you should seek urgent medical attention.

Cognitive fatigue

Cognitive fatigue is a common problem that can happen after a head injury. When a child has cognitive fatigue, it means their brain has to work harder to concentrate on tasks it used to be able to do easily, for example watching TV, playing computer games, or having a long conversation. Cognitive fatigue is not related to a child’s intellectual capacity or physical energy levels. It can lead to behavioural problems, mood swings and educational difficulties.  Your child may experience some or all of the following symptoms of cognitive fatigue:

• slowness when thinking, understanding and responding to questions or commands
• problems concentrating
• difficulties with memory
• difficulty thinking of the right words to say
• being more demanding than usual, and become easily frustrated
• being more fearful and anxious
• changed sleep patterns
• mood swings and irritability

If your child’s cognitive performance or behaviour is very different to normal, or it is getting worse, take them back to the doctor or your nearest hospital emergency department.
Children experiencing cognitive fatigue should have complete rest – for their brain and body. This means no watching TV or playing on mobile electronic devices. Allow your child to gradually return to reading and other activities that require periods of greater concentration or thinking.
​
Key points to remember!

• Head injuries can be mild, moderate or severe
• Call an ambulance if your child has had a head injury involving high speeds or heights, or if after a knock to the head they lose consciousness or vomit more than once
• Your child may develop a number of different symptoms in the weeks after a head injury. Many of these require immediate medical attention
• Children with cognitive fatigue need complete rest to recover

For more information:
www.headway.org.uk/about-brain-injury/individuals/types-of-brain-injury/minor-head-injury-and-concussion/ ​

​Life First provides this information for guidance and it is not in any way a substitute for medical advice. Life First is not responsible or liable for any diagnosis made, or actions taken based on this information. It is strongly advised that you attend a First Aid course to understand what to do in a medical emergency.

Summer is just around the corner so time to give some thought to how you are going to protect your baby from the sun and heat. This article will provide clear information to enable you to make the best decisions in protecting your baby from sun and heat.

Is it safe for my baby to go out in the sun?
Whilst babies are under six months old, they are advised to be kept out of strong direct sunlight. Babies’ skin is much thinner than children or adults, so UV rays can cause sun damage in a very short space of time. Babies are also more susceptible to heat, thus increasing temperatures can make them seriously unwell and has been linked to Sudden Infant Death Syndrome (SIDS).

• Risks

The two main concerns are:

1. Overheating.
2. Sunburn.

Sunburn at a young age has been demonstrably linked to a higher rate of skin cancer – a US study found that severe burns at a young age increased chances of melanoma (a form of skin cancer) by 80%.

• Timings

If possible, avoid going out during the hottest hours which are from 10am to 3pm.  This is because the UV levels and temperatures are highest during this time.

• Choose a breathable and UV protecting buggy cover

When travelling with the baby in a pram, ensure you have an adequate and safe cover, to protect your baby from the harmful UV rays whilst allowing:

• Easy accessibility to facilitate regular checks on your child and,
• Sufficient air circulation within the pram which will help regulate the temperature for your child.

The Lullaby Trust (www.lullabytrust.org.uk) has warned covering your pram or buggy with blankets (or cloths and covers) can lead to heat being trapped within the buggy and could cause your baby to dangerously overheat.  They recommend attaching a clip-on sunshade or parasol to a pram or buggy and checking if baby is getting too hot by feeling their tummy or the back of their neck. They advise to keep babies out of direct sunlight as much as possible.

• Can I use a parasol?

Parasols will not block air circulation, however they only shade a small area. The area they shade will shift as the sun moves or as you travel. This means your baby might suddenly be sitting in direct sunlight without you noticing. Also, not all parasols are UV resistant.

If you decide to use a parasol, ensure you choose a UV resistant version and that you consistently check that your baby remains shaded by the parasol.

• Can I use a muslin cloth?

Many parents choose to clip a muslin nappy across the buggy to shade their little one from the sun. This is not the worst solution, but muslin is not UV resistant so it cannot protect your baby from the sun’s most harmful rays.

• What’s the safest option?

My personal preference would be to use a buggy cover made of UV resistant but fully breathable material, that covers the whole opening of the buggy, but allows the air to circulate. The best of these have zips to enable the parents to quickly and easily check on their babies to ensure they are not getting too hot.

• Parking your buggy

Remember that the sun will move and so if you have parked your buggy in the shade, you need to continually check that your baby remains out of direct sunlight.

• Regular checks

It is important to regularly check on your baby to ensure they are not getting too hot. As babies are so sensitive to temperature, remember that even on overcast or lower temperature days, your baby could still overheat.  You should regularly:

1. Check if your baby is sweating.
2. Feel their tummy – it should be warm but not hot.
3. Check for flushed or red cheeks.
4. You could carry a thermometer with you. A specific baby digital thermometer can be purchased and should be used in the baby’s armpit or ear. A healthy temperature hovers around 36.4 degrees centigrade.

Further protection for your baby:
Babies over six months old can enjoy a limited amount of sunlight, providing they have been protected by the appropriate measures.

• Skin colour – Babies with very pale skins are most at risk from burning, however, babies with darker skin are still susceptible to sun damage and can burn.
• Shade – UV rays can still burn and overheat babies in the shade!

​Clothing:
Choose tight-weaved clothing that covers the baby’s whole body. Look for garments with a UPF of 50 which will block 98% of UV radiation. 

Choose wide-brimmed sun hats (not caps) which will cover your baby’s neck and ears too.

They should also wear sun glasses to protect their eyes. Sunglasses should meet the British Standard (BSEN 1836:2005) and carry the CE mark – check the label. This is because the UV rays can cause eye damage to a baby’s young eyes.
 
Sun Cream:
In the UK the general advice is that children under 6 months should not use sun cream.

Why?
Infants’ skin is thinner than adults, with a much thinner stratum corneum, the dead outermost skin layer. Therefore, an infant’s skin is less able to protect the body effectively against chemicals in sunscreen which could penetrate deeper into their skin, making newborn babies more vulnerable to allergic reactions such as contact dermatitis, inflammation or other harmful effects from chemical absorption. Newborn skin also lacks the film on the skin’s surface (known as the acid mantle) that protects the skin from bacteria viruses, and trans-epidermal water loss (TEWL), a condition that can lead to dehydration. The lack of the acid mantle could leave babies more vulnerable to the chemicals in sunscreen.
 
Babies also have a higher surface area-to-body weight ratio than older children and adults. A baby’s body surface area is about four times the body surface area-to-weight ratio in adults, which gives a far greater body surface area and leaves them exposed to far greater penetration by chemicals. In adults, most sunscreen ingredients don’t get absorbed systemically into the bloodstream — and those that do are absorbed in tiny amounts. However, for babies this is far more likely.
 
In addition, babies could try and lick sun cream from their bodies causing it to be ingested. This is another reason the Skin Cancer Foundation (www.skincancer.org) recommends delaying the use of sunscreen until your baby is at least six months old.
There has been very little research undertaken on sunscreens for babies, most studies have been done on adults.
 
Using Sun Cream
If your baby has reached over six months of age, they should be wearing sun cream from around April to October (use your judgement to decide – they may need it as early as March, weather dependent).

Babies and young children are more prone to rashes than adults. One fifth of adults report skin irritation from sun cream, so it is important to:
1. Choose a sun cream designed for babies.
2. Test the cream first.

• Choose wisely

Choose a hypoallergenic sun cream specifically designed for babies.
You should choose a high factor (SPF 50). For children the NHS recommend at least a factor 15. It should have at least a four-star UVA and UVB protection rating. There are specific sun creams created for babies which you can buy.
Check the expiry date and discard when out of date.
Some brands offer tinted versions of sun cream so that you can see where you have put the product.

• Do a patch test

We would always recommend trying sunscreen on a small area of your baby’s skin (doing a patch test) to make sure your baby can tolerate the product. Apply the small area before you need to rely on the sunscreen to protect them from the sun and check the area for signs of redness or allergy for the next few hours. If there is no reaction, you can then apply this to all exposed areas of their body. When trying a new brand, always patch test in this way too.

• How to apply suncream

Use enough! Many people do not use enough sun cream – so make sure that you use at least a tablespoon of sun cream if covering the legs and arms of a baby.

Apply sunscreen liberally to any area of your baby’s skin that isn’t covered up by clothes or a hat. Remember to include his hands and feet, and the back of his neck and ears.

• Pat, don’t rub!  It’s best to pat it on rather than rub it in. If you can, put sunscreen on your baby 15 minutes before they are exposed to any sun.

Cover exposed parts of your child’s skin with sunscreen, even on cloudy or overcast days. Apply sunscreen to areas not protected by clothing, such as the face, ears, feet and backs of hands. Be especially careful to protect your child’s shoulders and the back of their neck when they’re playing, as these are the most common areas for sunburn. 
 

• Reapplication

Reapply the sunscreen at least every couple of hours and after they have played in water, even if the sunscreen claims to be waterproof. Some water-resistant products may only protect your baby’s skin for up to 40 minutes of water play, while others may protect for up to 80 minutes.

Other tips for keeping your baby safe from the heat and sun in summer:

• Fluids

Fully breastfed babies should not need to be given extra water – but do check for any signs of dehydration. Otherwise, babies under 6 months should be regularly given cooled boiled water. Over six months of age, they can be given regular water.

• Sleep

In summer, it is best to create a cool sleeping environment for your baby. Place your baby feet to the foot of the cot, on a flat mattress without blankets or pillows.

When out and about in the summer with your baby in a buggy or pram, sleep can be more problematic. Don’t be tempted to put a blanket over the pram to block out the  sunlight as this can trap warm air within the buggy, causing the temperature to soar to dangerous levels.

Instead ideally opt for a mesh pram cover that will block out sunlight and allow air to circulate. Always ensure you park your buggy in the shade and keep checking to ensure it remains shaded and cool.

• Cloudy days

Remember, you can still get burned in the shade. Sun protection remains essential even on overcast days. If the temperature seems low to you, remember that it could still affect a young baby or child.

• The impact of water

Many people do not know that if you are on or near a body of water, this will dramatically increase the potency of the sun’s rays.  Sun cream should be reapplied after swimming.

If your baby has sunburn:
Firstly, don’t panic! 

• Do, however, treat the burn more seriously than you would an adult’s. Remove them from the sunlight immediately and take them indoors, preferably into a cool or air-conditioned environment.
• Shower the affected area for 10 minutes under tepid water, then apply neat aloe vera. Seek immediate medical advice if a baby or child has become sunburnt, particularly if their skin has blistered.
• Give them regular drinks of cool water to ensure they remain hydrated.
• If they show signs of heat exhaustion – hot, flushed, sweaty, unsettled, vomiting or diarrhoea – always get medical advice immediately.

With these tips in mind, enjoy the sunshine!

​Life First provides this information for guidance and it is not in any way a substitute for medical advice. Life First is not responsible or liable for any diagnosis made, or actions taken based on this information. It is strongly advised that you attend a First Aid course to understand what to do in a medical emergency.

Adapted from a post by Emma Hammett at https://firstaidforlife.org.uk/ Kate Ellwood (May 2019)