Pediatric Head Injuries

[Mistify]

I am a surgical nurse(at home mom right now) and a friend of mine that is a pediatric nurse we were discussing the issue of pediatric head injuries and we have heard different opinions on the issue. Should a child that takes a major impact to the head be allowed to sleep before getting a neuro exam, a med/surg nurse told us it is just an old wives tail, but I know when I worked ER we never let a patient sleep before getting a neuro exam after a head injury, who is right here? I have been a stay at home mom for the last year but I did not think things had changed that much. Any help would be appreciated. Thanks

[NotReady4PrimeTime, RN]

The answer depends on a few variables. How hard was the bonk to the head? Was there LOC? Are the pupils equal and reactive? Is the child behaving normally? Any vomiting? If the bonk on the head didn't break skin or bone, the kid has been alert and oriented appropriately for age, their pupils are equal, reactive and midline, the kid is acting like himself and there hasn't been any vomiting, they're likely safe to go to sleep. But I'd be waking them up every so often to assess their alertness and orientation. If any of my parameters changed, off we'd go to the ER. If they're sleeping, they will wake up when you bug them; if they've lost consciousness, they won't.

Major blows to the head usually produce alterations in one or more of the items I've listed above. Obviously, if there's a bleeding scalp laceration or depressed fracture, any loss of consciousness, pupil changes, extreme irritability, and/or vomiting without nausea, one would seek urgent medical attention.