The vast majority of knocks to the head in children are harmless: the child cries, gets a bump and is playing again within half an hour. Call 112 if your child has been unconscious, vomits repeatedly, is hard to wake, has a seizure, is confused or has weakness in an arm or leg. Call 1177 (the national healthcare helpline) if your child is under one, has fallen from more than a metre, has a headache that is getting worse or simply is not themselves. Keep an eye on them for the next 24 hours.
Saturday morning at a playground in Årsta. Your four-year-old is climbing on the outside of the slide, loses her grip and lands head first on the gravel. Twenty seconds of silence, then a scream that can be heard across the whole park. That scream is a good sign. A child who cries straight away is awake and in pain, not unconscious. Here is how to assess the next few minutes, hours and the day ahead, and which signs mean you stop waiting.
The first few minutes
- Look before you lift. If your child is crying and moving arms and legs, it is fine to pick them up. If they are unconscious or limp, or have fallen from a height and complain about their neck: do not move them unnecessarily, call 112.
- Comfort them and keep them still for a few minutes. Children who have just hurt themselves often want to run straight off again, which is good, but wait until the crying has settled.
- Look at the head. Bump, cut, bleeding? If it is bleeding: press with something clean for ten minutes, the head bleeds a lot even from small cuts.
- Something cold on the bump, wrapped in a jumper or towel, for ten to fifteen minutes.
- Talk to your child. Do they know where you are, what their name is, what happened? Are they answering as usual? That is the most important check.
- Take it a bit easier for the rest of the day. No trampoline, no football, home for some peace and quiet if your child seems tired.
Normal, call 1177 or call 112
| Normal after a knock | Call 1177 | Call 112 |
|---|---|---|
| Cries straight away and can be comforted | Your child is under one year old | Your child was unconscious, even briefly |
| A bump or a cut that stops bleeding | A fall from more than a metre, or from a changing table or sofa for a baby | Vomits more than once |
| Tired, wants to sit on your lap | Vomits once | Very drowsy, hard to wake, slurring |
| A mild headache that fades | A headache that does not ease off | Seizures |
| Pale for the first few minutes | Your child is whiny and not themselves for several hours | Confused, does not recognise you, cannot remember |
| The bump hurts when pressed | You are unsure | Blood or clear fluid from the nose or ear |
| Pupils of different sizes, trouble seeing, weakness in an arm or leg | ||
| Neck pain after a fall from a height, or a large soft swelling on the head |
The next 24 hours
Serious injuries after a knock to the head almost always show themselves within 24 hours, and usually within the first few hours. Keep your child at home and quiet, watch them and ask how they feel. They can eat and drink as usual, and they can sleep. Tiredness after a fall and a big crying fit is normal, it is not in itself a sign of brain injury. What counts is whether your child can be woken and responds as usual.
At night: check on your child a couple of times. Calm breathing, normal colour, normal sleeping position. If you are worried, wake them enough that they respond and recognise you, then let them go back to sleep. If your child cannot be woken properly or responds strangely: call 112.
Concussion: what it is and what to do
Concussion is a temporary disturbance of how the brain works after a knock, with no visible damage on scans. The signs are headache, nausea, dizziness, tiredness, sensitivity to light, irritability, trouble concentrating and sometimes not remembering the fall itself. Symptoms can appear a few hours after the knock and usually last a few days to a week. It passes on its own, but the brain needs rest.
- Days one and two: rest. No screens, no homework, no parties. Sleep, eat, stay at home.
- Day three onwards: build back up. Förskola (municipal preschool, from age one) or school for half days if the headache allows, then full days.
- Sport and play with a risk of new knocks: wait until your child has been completely symptom-free for a few days, and start gently. A second knock to a brain that has not healed is worse than the first.
- Pain relief: in a dose for age and weight on advice from the pharmacy or 1177, but not so that you mask symptoms before you have assessed your child.
- If it gets worse instead of better, or lasts more than a week or two: call 1177.
Babies and toddlers: different rules
Children under one can have serious injuries without clear signs, because the skull is soft and the child cannot tell you. A baby who has fallen from a changing table, a sofa or out of your arms should be assessed via 1177 even if they seem fine. Signs that mean you call 112: the baby is drowsy, vomits, cries inconsolably and shrilly, develops a soft swelling on the head, or the fontanelle on the top of the head bulges. The changing table is the most common fall in the first year. One hand on the baby, always, even when the phone rings.
How to reduce the risk without stopping the play
- A helmet on bikes, scooters, skates and on the sledging hill, from the very first time. How to teach your child to cycle safely is in Teaching a child to ride a bike without stabilisers.
- Window locks, stair gates and furniture anchored to the wall, see Childproofing your home.
- Trampoline: one child at a time, a net all the way round, and no adults bouncing with small children.
- Bunk beds: the top bunk from six at the earliest, with a guard rail.
- The playground: children under three on the toddler equipment, not on the climbing frame for school-age children.
And take a course in Paediatric CPR. That is where you learn what to do if your child is unconscious, while you wait for the ambulance.
How we do it with our families
Children hit their heads with us too, you cannot look after children for years without it happening. The rule for our nannies is to always ring the parents straight away, even for a bump that looks harmless, and to write down the time and what happened on the note. Sanna had a three-year-old in Spånga who fell off a bench in the yard one Thursday at four o'clock and hurt his forehead. She cooled it, rang his mum, and then sat with him on the sofa reading for an hour with her eyes on him: was he answering as usual, did he want to play, was he vomiting. He fell asleep on her, and she woke him gently once to see that he was himself. When his parents came home they knew everything, and they knew he was fine.
This text is general information and does not replace advice from BVC (the child health clinic every family is enrolled in), your vårdcentral (local health centre) or 1177. If you are worried about your child, call 1177. In an emergency, call 112.
Would you like a nanny who knows your child, knows how things usually are and notices when something is different? Book a free first meeting with the nanny in your home.
Read more: Teaching a child to ride a bike without stabilisers · Wound care for children · Paediatric CPR · Fever in children
Frequently asked questions
Can my child sleep after hitting their head?
Yes, if your child is awake, responding as usual and has not vomited, they can sleep. Tiredness after a knock and a cry is normal. Check on them a few times during the night: breathing should be calm and they should look as if they are sleeping normally. If you are unsure, wake them and see that they respond and recognise you.
How long should we keep watch?
The next 24 hours matter most, and the first few hours most of all. Symptoms of a serious injury almost always appear within a day. Headache, tiredness and mild nausea can linger for a few days after a concussion, but should get better day by day, not worse.
Should we put something cold on the bump?
Yes, something cold wrapped in a towel against the bump for ten to fifteen minutes soothes it and reduces the swelling. A big bump does not mean a serious injury, it is blood under the skin. Your child should be assessed, though, if the bump is on a baby or if it is soft and the size of an egg on the side of the head.
What is concussion?
A temporary disturbance of how the brain works after a knock, with headache, nausea, dizziness, tiredness and sometimes memory gaps or confusion. The child needs a couple of days' rest from screens, homework and sport, and then to build back up at their own pace. If the symptoms get worse instead of better, call 1177.
My baby fell off the changing table, what do we do?
Call 1177 for an assessment even if the baby seems fine, and always if the baby is under one and has fallen from table height or higher. Babies can have injuries without clear signs. If the baby vomits, is drowsy, cries inconsolably or develops a soft swelling on the head: call 112.