I was on-call on Tuesday night and the message came in around 8 PM. The text from my answering service read, “3 year old bonked his head, had a large goose egg on his forehead, do they need to go to the ER—Urgent.”

 

I immediately called the number and spoke with dad. After dinner, the parents were cleaning up the kitchen and the 6 year old and 3 year old sons were playing. In a frantic effort to escape his older brother, the 3 year old made a mad dash to get out of the kitchen and turned left but did not quite negotiate a tiled counter. He ran right into it hitting his forehead on the counter. There was a loud thud, a brief moment of silence and then the 3 year old screamed bloody murder. Both parents were there and saw it and heard it. He was not knocked down, but was standing there crying big tears. Mom scooped him up and he calmed down after a couple of minutes. Shortly thereafter he was playing with his big brother as if nothing had happened. The reason dad called was because about an hour later, the 3 year old had a large goose egg over his left forehead and it seemed to be a bit boggy. He was wondering if he needed to take him to the ER for this.

 

After a head trauma, the reasons to go to the ER would be if there was ANY loss of consciousness (even a second or two), if the pupils were not equal and equally reactive to a bright light, if there was any vomiting (especially if it was forceful or projectile), or if the child seemed somnolent and was not coherent.

 

We established that there was NO loss of consciousness, he checked the pupils and they were equal in size and reacted equally to light, and he seemed fine and was acting like his normal self. Given that, I told dad that there was no reason to go to the ER.
 

About the goose egg, I told dad that it would be ideal to try to put an ice pack on the area to keep the swelling down, but a 3 year old might think otherwise and if it came to a wrestling match, it was not worth it.

 

I also told dad that if he was fine by bedtime, that it was not necessary to “keep him awake”. He could go to bed at his usual time but that they should check on him before they went to bed to be sure he was sleeping comfortably and breathing normally. I also instructed him to try to elevate the head of the bed about 20 degrees to help minimize the swelling. If he slept flat, there would surely be more swelling when he got up in the morning.

 

I also told dad that after a head trauma like this, the child may be very upset and vomit once or twice within the first hour and that this was not particularly concerning.

 

I would be concerned if the vomiting was persistent or seemed forceful, or if it started hours after the head trauma.
 

As for the goose egg on the forehead, this is a hematoma which is a collection of blood.

 

I told dad that the blood has to go somewhere as it is being absorbed by the body. Over the next few days, by gravity, the blood may track down to the place of least resistance which would be around the orbits of the eye. He should not be alarmed if in a few days his son developed a black eye or a shiner.
 

Dad was very appreciative of the call-back and the information.

 

I did tell him to call the office in the morning with an update. Mom called the next morning and said that he slept all night and seemed fine when he got up. As expected, the goose egg had gotten bigger but he was acting as if it never happened. I was pleased but warned her that with 6 and 3 year old sons, this was probably not the last time that anything like this would happen. She laughed…and agreed.