Neuro checks for every single bump on the head?


I'm a sub school nurse and last week I had a student who was in Elementary school bump his head on the sliding board at recess.

No visible injury, he was laughing and carrying on, V/S WNL, and so on. I then proceeded to do neuro checks and observe for 30 min. due to the policy.

I'm just curious if you all have to do the same thing. Kids are going to bumped their little heads at times. Especially at recess, do you honestly think we should be doing neuro checks for every bump on the head?


309 Posts

Has 10 years experience.

Something happened at my school before I worked there, regarding a bump on the head. Therefore, the teachers are very diligent about this, and know what to look for. I also remind them during my yearly inservice. I do the initial check, apply ice etc, and let them hang out for 10-15 mins. If during that time they are joking around, asking me ????s, waving to their friends in the hall, I send them back where they came from. I ALWAYS send home a note that I made for my health room. If I know for a fact that a parent wants to be called, I call or have student call. (some parents want a phone call q time) In general I call parents when I feel like I would have been wanted to be called. That is the way I do it. BTW, there really is no set policy where I work. This is year 3 for me, new grad, first job, so there has been a HUGE learning curve.

Purple_Scrubs, BSN, RN

2 Articles; 1,978 Posts

Specializes in School Nursing. Has 8 years experience.

For no visible injury and the cause of injury was unlikely to result in a major head injury, I do a quick neuro check, ice, observe for 15 minutes, then send a note and usually a phone call informing parents regarding head injury s/s. I don't keep them for 30 minutes generally. If I have concerns that make me think I need to keep a close eye on them, I'd rather just refer them for a medical evaluation.

In reality, no, every bump at recess does not need a neuro check. They would not be getting one if it happened at home, and I would not be doing it for my own kid's minor bump. But, since we are taking care of other people's kids, and we DO have the knowledge and expertise to assess for head injuries, I feel like it is my responsibility to assess every single potential head injury to rule it out. I would rather do neuro checks on 10,000 that turn out fine than to assume one is a minor playground injury and miss an actual concussion. So yes, I do a basic neuro check on every little bump that comes my way :)

KelRN215, BSN, RN

1 Article; 7,349 Posts

Specializes in Pedi. Has 16 years experience.

I originally trained as a neuro nurse and I can say that most bumps on the head without a doubt do not require neuro checks. If the child lost consciousness or begins to vomit or complains of visual changes, then a more complete neuro assessment and a visit to the MD/Emergency Room would be warranted.

NutmeggeRN, BSN

8 Articles; 4,596 Posts

Specializes in kids. Has 40 years experience.

There is great information on the CDC website re head can send away for handouts. I check and ue further checks based int he severity of the injury....I always let a contact know and email them the info as well as email the teachers of it looks likes a concussion. (it is critical fo r the head to rest so I educate re the nedd to avoud electronics texting compouter ipod use...sort of like performing an amputation on HS aged kids!!!!

All kidding aside, use you nursing assessment skills and follow your gut!