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Paediatric head injury and concussion
What is paediatric head injury & concussion?
Paediatric head injury in first aid ranges from minor bumps with brief crying to more serious trauma from falls, sport or road traffic collisions; the skull and brain are still developing, so swelling or bleeding can deteriorate quickly even when the initial impact seems trivial. First aiders must recognise red flag features, protect the airway and neck, and decide whether the child can be safely observed or needs emergency care.
Head injuries in children are common, but a small proportion involve brain injury or bleeding that may only become obvious over the following hours. Recognising concerning features such as loss of consciousness, repeated vomiting, worsening headache, behaviour change, seizures or difficulty walking, and acting on them promptly, is critical to prevent delayed deterioration and to justify decisions if they are later scrutinised.
Most childhood head knocks are minor, but red flags such as loss of consciousness, repeated vomiting, worsening headache, confusion or seizures require urgent assessment or 999 and must not be observed at home without advice.
Who needs this skill?
Health & Social Care
In health and social care, staff see head injuries in children with complex needs, seizures, frequent falls or safeguarding concerns; they must follow protocols that combine airway and spinal protection, neurological observation and escalation thresholds, and they must document and escalate any suspicion of non-accidental injury.Licensed venues & nightlife
Licensed venues hosting sports, rides or youth events add crowd, lighting and alcohol into the mix; staff need simple rules about when to keep a child lying flat, when to move them to a quiet area, when to suspect spinal injury and when 999 is mandatory rather than leaving with friends or family.Schools
Schools and early years providers are expected to follow NHS-aligned child head injury advice, including when to call parents immediately, when to insist on ED review and what written information and observation periods should be used after a bump at school.Workplaces
In workplaces and leisure settings, common scenarios include playground falls, collisions in soft play, sports impacts and slips; first aiders should use agreed head injury guidance to decide when to call 999, when to advise immediate ED assessment and when to recommend home observation with written red flag advice for parents or carers.How to manage paediatric head injury & concussion
- 1Assess the mechanism and initial responseConsider the height of the fall, speed, surface and what part of the head was hit, as well as whether the child lost consciousness or seems confused. Ask what witnesses saw and whether the child has other injuries or safeguarding concerns.Mechanism plus early symptoms is more predictive than the drama of the incident alone; serious mechanisms and altered response should lower the threshold for urgent review.
- 2Screen for red flag symptomsLook for repeated vomiting, worsening headache, drowsiness, confusion, seizures, difficulty walking, weakness, numbness, vision changes, unequal pupils or bleeding / clear fluid from nose or ears. Treat any of these as requiring urgent assessment, usually via 999 or emergency department.These red flags closely mirror NHS child head injury guidance and give first aiders defensible thresholds for calling 999 or insisting on hospital review.
- 3Position safely and protect the neckIf you suspect more than a trivial head knock, encourage the child to lie still on their back with the head in a neutral position; support the head and neck and avoid unnecessary movement. If they vomit or are at high risk of vomiting, log-roll them with help while keeping the head aligned, then return to a neutral position once the airway is clear.Safe positioning protects both the airway and the spine and is specifically highlighted in head injury guidance and first aid training.
- 4Decide between 999, urgent assessment and monitored observationCall 999 immediately for red flag features, serious mechanisms or a child who is hard to wake, has seizures, persistent confusion or obvious skull injury. For milder injuries without red flags, follow local guidance or NHS 111 advice about ED, urgent care clinic or home observation with clear safety-net instructions.Using explicit thresholds for each pathway reduces inconsistent decisions, unnecessary ambulance use and missed serious injuries.
- 5Monitor, document and give safety-net adviceStay with the child, monitor breathing, colour and behaviour, and record what happened, what you saw and what you did. If the child is discharged to parents, give clear written advice about red flags and how long to avoid sports, screens and vigorous play, and document that advice in case decisions are later scrutinised.Good records and safety-netting support continuity of care, safeguarding and regulatory scrutiny after paediatric head injury incidents.
This guide is a learning reference only. It does not replace attended, assessed first aid training.
Qualifying courses
Qualsafe Level 3 Award in Paediatric First Aid (RQF)
2 days
3 years
Common questions
Practical answers for employers, venue managers, and healthcare teams about paediatric head injury & concussion training.
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Head injuries with loss of consciousness, repeated vomiting, worsening headache, confusion, seizures, drowsiness, difficulty walking, bleeding or clear fluid from ears or nose, or serious mechanisms such as a road traffic collision or fall from height require urgent assessment or 999 according to NHS guidance.
Return-to-play and screen advice should follow current clinical guidance; many pathways recommend relative rest initially, then a gradual, stepwise increase in cognitive and physical activity only once symptoms have fully resolved. First aiders should signpost families to clinicians rather than setting their own timelines.