As a parent, you can look for bleeding, marked redness, impaired vision, or an inability to move or open his eye. If the area around the eye [the brow bone or the lid] looks like it might need stitches, apply direct pressure to stop any bleeding and then call your pediatrician, who will likely advise you to go to the ER. [If it's determined that your child does need stitches, you may want to ask if a plastic surgeon is available.]
Q: Your 2-year-old topples out of the shopping cart and hits his or her head. He or she has a huge goose egg and is hysterical. Head to the ER?
Dr. Savard: No ER. Screaming is a perfectly healthy reaction.
Recent guidelines released this summer on when to do CT scans suggest that it's OK to not do it as long as a child is acting normally and you don't see bruises other than on [the] forehead/frontal.
The vast majority of kids with head injuries -- on the forehead -- are fine. The size of the bump rarely has anything to do with the extent of the injury. There are loads of blood vessels in the head and face, so the swelling can be dramatic.
The exception: Any child under a year of age who experiences head trauma should always be checked out by a physician, because signs of injury are harder to detect in a young infant.
If your child is crying but can get up on his own and is moving about, he's probably just fine. Just keep an eye on him for the next few hours to make sure he doesn't limp or favor one arm, or become sleepy or irritable. If you see any of those signs, call your doctor.
And of course, if your child is motionless or unconscious, or refuses to move after his fall, you should call an ambulance right away.
For more tips on how to deal with children's common health emergencies, visit www.parenting.com.