A: Dear Ms. Mckee, The answer to your question is quite complex since there are so many variables involved. It’s always the hardest situation to deal with when your child does suffer one of these injuries. I remember several years ago, when my daughter first started to walk, like all new toddlers she wanted to walk without any help and always on the hardest possible surfaces around. Imagine my shock when she fell forward onto the concrete sidewalk without even being able to brace herself. First came a hollow coconut sound, followed by what seemed like a very long, quiet pause. Then she let loose howling and screaming and crying. But within minutes she became distracted by a couple of kids riding their bikes, and she completely forgot the head injury. Aside from a few scrapes on her nose and forehead, everything was fine.

What makes head injuries hard to figure out is that the brain is surrounded in its own “space capsule.” As a result, you don’t always see the signs of danger until it’s very late. The hard bones of the skull offer the first line of protection, and the fluid and sacs the brain floats in help absorb the shock from the impact. What typically causes the most concern with parents is the copious amount of bleeding and/or the size of the goose egg on the head. These are usually minor and stop or go away by themselves. The bigger concern is what is going on inside the brain. The types of injuries are either minor or serious.
Patients who have minor head injuries almost never lose consciousness, but may have mild headaches or dizziness lasting a day or two. There should not be any other neurological/behavioral change with that person.

Severe head injuries involve loss of consciousness most of the time, and then the person will develop serious symptoms like: persistent vomiting, extreme lethargy or excessive irritability, loss of function of some body part, worsening loss of consciousness, straw colored fluid leaking from the nose or ears, problems walking or talking, and severe headache. Anytime you suspect someone just had a serious head injury, they should be taken immediately to a medical center for evaluation and treatment.
With a severe head injury, there may be bleeding in the brain or some other swelling. Then the protective “space capsule” becomes the problem. Since the brain is in an enclosed space, if any kind of swelling occurs, it will lead to some sort of brain damage or even death. This is why immediate medical care is important. A quick diagnosis will lead to quick treatment, which most often will save the patient’s life.
With minor head injuries, I advise acetaminophen and observation. I also have the parent wake the child once or twice during the night to see how they respond. Once a 24-hour period has gone by, then the danger risk is probably over.

In Natasha Richardson’s case, she probably had a very slow bleed, which unfortunately delayed the symptoms she eventually showed, and this in turn delayed her being diagnosed until it was too late. Other factors can also complicate head injuries if there are other problems like aneurisms, abnormal anatomy, or bleeding problems.

The best course of action is to seek medical attention immediately if you are uncertain of the extent of the injury. Hopefully this helps answer your question.

Dr. Bill