Head injury in babies: when to go straight to hospital
Most head bumps are minor, and that is normal
Babies and toddlers fall and bump their heads constantly. It is one of the most common reasons parents call 111 or visit A&E, and in the vast majority of cases, the outcome is fine. Babies have proportionally large heads and are still learning to balance, which means falls are simply part of early development. The skull provides good protection, and the brain has some natural cushioning from the fluid that surrounds it.
Even so, some head injuries do need urgent attention, and it is important to know which signs are concerning. This article tells you clearly what to look for and what to do. If you are reading this after a bump and are not sure which category your child falls into, the guidance below will help you decide.
Call 999 immediately for any of these signs
Call 999 without delay if your baby shows any of the following after a head injury. These are signs of a potentially serious brain injury and cannot wait.
Call 999 if your baby loses consciousness at any point, even very briefly. Call 999 if your baby cannot be woken or is very difficult to rouse. Call 999 if your baby has a seizure after the injury. Call 999 if blood or clear fluid is coming from an ear or from the nose. Call 999 if your baby's behaviour has changed dramatically and they seem very confused, very agitated, or unlike themselves. Call 999 if there is a very large lump on the head that is growing very quickly, is very tense, or is on the side of the head rather than the front or back. Call 999 if your baby has vomited more than three times since the injury. Call 999 if the fontanelle (the soft spot on top of the head) appears to be bulging after the injury. Call 999 if symptoms are getting worse over the hours after the injury rather than improving.
You do not need to wait to see if things improve before calling. If anything on this list applies, the right action is to call 999 now.
High-risk circumstances that always need A&E assessment
Even if your baby seems completely fine after the injury, certain circumstances mean the mechanism of injury itself is high risk and the baby needs to be seen in hospital.
Go to A&E if your baby fell from a height greater than 90 centimetres (approximately 3 feet), which is roughly the height of a typical sofa arm or a kitchen counter. Go to A&E if the injury involved a high-speed impact, such as a car accident or a bike fall. Go to A&E if the head was hit by a hard or heavy object. Go to A&E if your baby is under 1 year old and had any significant head impact, because the skull and brain are more vulnerable at this age and even seemingly minor injuries warrant assessment. Go to A&E if you have any reason to suspect the injury was not accidental.
NICE head injury guidelines and NHS guidance support these thresholds. When in doubt, it is always better to be seen and reassured than to stay home and worry.
When to call 111 or see a GP
If the circumstances were lower risk but you have some concern, calling 111 is the right step. Situations where 111 is appropriate include: your toddler over 1 year old had a minor fall from a low height onto carpet and seems well but you want guidance, your baby vomited once or twice after the bump and has now settled and is behaving normally, or there was brief apparent confusion immediately after the injury that resolved within a few minutes.
The 111 team will ask you specific questions and tell you whether A&E is needed, whether you need a GP review, or whether home observation is appropriate.
Watching safely at home
If the injury was minor and no high-risk features are present, you can monitor your baby at home. Here is how to do that safely.
Keep your baby awake for at least 2 hours after the bump. You need to be able to see how they are responding and behaving during that time. Talk to them, play with them, observe their colour and their movements. Look for any of the warning signs listed above.
After 2 hours of being awake with no concerning symptoms, you can allow your baby to sleep. You do not need to keep them awake all night, as this is not necessary and will leave you both exhausted. However, check on your baby more frequently than you normally would during the night. If you go to check and they feel harder to rouse than usual, or they do not respond to you the way they normally would during a night waking, seek help immediately.
If at any point over the 24 to 48 hours after the injury you notice new symptoms appearing, or existing symptoms getting worse, do not continue watching at home. Seek medical attention.
What a goose egg is and what it tells you
A goose egg is the informal name for a haematoma: a collection of blood and fluid that pools under the scalp after an impact causes small blood vessels to break. The lump can appear within minutes of the injury and can look alarming because of its size.
When a goose egg appears quickly after an impact, it is actually a somewhat reassuring finding. It means the swelling has gone outward under the scalp rather than inward toward the brain. The skull is intact and the body is responding normally to an injury of the superficial tissue.
A very large, very tense, or rapidly growing lump is a different matter and warrants assessment, particularly in a baby under 1 year. A lump on the side of the head (the temporal region) is also more concerning than one on the forehead, because the bone is thinner in that area. If you are unsure about a lump, call 111 and describe it.
Never shake a baby
Shaking a baby is a completely different and extremely serious mechanism of injury. When a baby is shaken, the brain moves violently back and forth inside the skull, causing tears to blood vessels and brain tissue. This is not a bump and is not caused by a fall. Shaken baby syndrome, also called abusive head trauma or non-accidental head injury, causes severe brain damage and can be fatal.
There are no safe circumstances under which shaking a baby is acceptable, even gently, even in frustration. If you feel you might harm your baby, put them down safely in their cot and step away for a few minutes. If you suspect your baby has been shaken, go to A&E immediately and tell them.
Frequently asked questions
My baby fell off the sofa. Do I need to go to A&E?
It depends on the height of the fall and what happened afterwards. A fall from a low sofa onto carpet, with a baby who cried immediately and is now behaving completely normally, is generally low risk. A fall from over 90 cm, any fall onto a hard floor, any loss of consciousness however brief, or any of the warning signs listed in this article all warrant A&E assessment. If you are unsure, call 111 and describe exactly what happened, including the height of the fall and the surface the baby landed on.
How long do I need to watch my baby after a head bump?
Keep your baby awake and observe them closely for at least 2 hours after the injury. After 2 hours with no concerning symptoms, they can sleep. Check on them more frequently than usual during the night, and if they are harder to rouse than normal, seek medical help immediately.
Is a goose egg lump dangerous?
A goose egg is a haematoma, meaning blood or fluid collecting under the scalp. When it appears quickly after an impact, it is actually a reassuring sign because it means swelling has gone outward rather than inward. A very large, very tense, or rapidly expanding lump, or a lump in the temple area, still needs medical assessment, especially in a baby under 1 year old.
What symptoms should I watch for in the hours after a head bump?
Watch for vomiting more than twice, unusual sleepiness or difficulty waking, a high-pitched or unusual cry, a bulging fontanelle, seizures, loss of coordination or balance, blood or fluid from an ear, or any symptoms that are getting worse over time rather than improving. Any of these mean you should seek immediate medical attention.
When can my baby sleep normally after a head injury?
After 2 hours of staying awake with no concerning symptoms, your baby can sleep normally. You do not need to wake them at intervals throughout the night. Do check on them more often than usual, and if at any point they feel harder to rouse than they normally would be, seek help immediately.
What is a goose egg and should I ice it?
A goose egg is the common name for a haematoma, a lump of blood and fluid that forms under the scalp after impact. You can apply a cool damp cloth or an ice pack wrapped in a cloth to the area for comfort and to help reduce swelling. Limit ice application to 10 minutes at a time and never apply ice directly to bare skin. The lump itself is not the main concern; it is the symptoms that matter.
Keep track of symptoms in one place
Cubby lets you log what happened and note any symptoms, so you have a clear record to share with your doctor or the 111 team.
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