Kid fell off bike: what would you anticipate?

Well, I think number one is clearly the correct answer, although I think some docs might opt for number 2. Head CTs cause 3000 X the amount of radiation as an x-ray and have been shown to greatly increase cancer in children. The kid had a very unimpressive story. However, this was an actual case I had. I was working with a great pediatric ED doctor who was also a peds intensivist. The kid showed up with the above story. After some observation the doc was literally walking over to get discharge instructions when the kid vomited on the floor. So he said, "Okay we should probably do the CT now." Can you believe this kid had a skull fracture and a bleed! I could not believe it, like another nurse said, I probably would not have even taken my kid to the ED for this (until he vomited). The bleed was small, but still, I've never seen one with such an unimpressive story and clinical findings.

What do you think is the proper course of action for the following scenario:

A 7 year old was on the bike with his brother and they both fell off. His older brother had abrasions to both legs. The 7 year old had an abrasion to the the hand and occipital area of the head. There was no bleeding and no hematoma. The kid ambulated into the ED. He was awake, alert and acting appropriately as per the father. There was no loss of consciousness. No nausea, no vomiting, his gait was steady and his pupils were PERRLA. What do you think the treatment should be?

1) Neuro exam, observation and discharge

2) Neuro exam and head x-ray

3) Neuro exam, IV and Head CT

4) Trauma Code

I'd say #3. We would do Xrays if the kid was c/o pain in the legs or arms. Probably do a CT of the head just to cover our a$$es. Maybe a line depending on the doc. It is all about covering the behind. If this were my kid I probably wouldn't have even presented to the ED.