By Jack Maypole, MD
Contributing Writer and Goddard School Educational Advisory Board Member
Gravity sucks (well, actually, it pulls). If you are an infant or toddler, anyway, it remains one of the greatest challenges you face. One does not need to be a phrenologist to know that the noggins of our littlest children get bumpy as they are knocked and bonked with zillions of pratfalls and tumbles each day. The question is: when is it serious? When should these kids be seen by a doctor?
To truly gain insight into this phenomenon, let us turn to the celebrated case study of the “Five Little Monkeys Jumping on the Bed.”
To the less initiated, this case presented as follows. Five infant and toddler primates were performing gymnastics in a bedroom. In succession, each individual was observed to fall, striking some aspect of his or her brainpan.
Their parents wisely and serially put the question to the on-call clinician: how will I know if my child has a concussion?
Five little monkeys jumping on the bed,
One four-year-old fell off and bumped his head
Momma called the doctor and the doctor said:
“Look at the bump: is it bleeding, swollen or red?
As for the kiddo, check STAT for these signs
(as a pediatrician and dad who’s done this a few hundred times):
Most worrisome is a child who is unconscious or seizes
Or who oozes blood or fluid from their nose, mouth or earses.
If that happens, it suggests urgency,
Call 911, or get the to a room of Emergency…
Or — think right away, did he cry right after?
Was he quickly recovering with grinning and laughter?
That’d be reassuring, to see a smiling squirt-
Headbonked, perhaps, but likely not badly hurt.
There are some things in which you can trust,
That’ll manifest sooner or later, in a littlun concussed.
But then four little monkeys were jumping on the bed,
The 3-year-old fell off and bumped her head. Papa called the NP and she said:
“Cried right away! Good, she’s awake, and again busy?
Ask her if she feels a headache, pukey, or dizzy.
She might feel funky, get crabby, or throw up in your flowers.
These symptoms usually show up in the first six to eight hours.
For toddlers and up a mild headache or single throw-up can be par for the course;
I’d consider a callback to the doc if you think it gets worse.
These could herald a mild brain injury, or concussion;
To the ER or clinic you’d best go, to have that discussion.
And soon three little monkeys were jumping on the bed,
Then the 2-year-old fell off and bumped her head. Zen-like, Momma called the on-call doc and he said:
“Thanks for calling, now ask me your questions.
I’ll ponder the story, and make some suggestions.
Can she sleep? Sure. That the concussed can’t is a myth. (Lethargy is the concern, and is hard to miss!)
Might she be crabby? Somewhat is okay,
but unceasing crankiness get check’d, forthwith!
Most kids should respond to “supportive care”-
Hugs, chilling out and Motrin work there.
And, on cue, two little monkeys were left on the bed,
and the yearling old rolled off and bumped his head.
Papa called the clinic and the care provider said:
“For these kids who cannot talk yet,
Our approach is as much doctor as it is vet.
Fortunately, we consider lower risk for the kids with lesser falls,
Like sliding off a couch, stumbling over their feet, or careening off walls.
These tend to be a bit more tame;
(though we take ’em all seriously in the head injury game!)
But folks should check ’em out, just the same.
And for all kids who fell farther, or with a ’worse mechanism of injury’
Like a car crash or sledding accident when do you worry?
We’re extra cautious for them, as for babies of six months or less.
Consulting a doc for all these may be best.
And do a headcheck as a part of routine:
Kids with scalp dents or babies with big bumps may need to be seen.
Ditto for headaches, copious vomiting, or confusion;
Your clinic’s contact info might need using!
And then there was a six-month-old monkey snoozing on the bed
While stirring, she slipped, and down to earth she sped.
Momma called the doctor and then Momma said:
“I have successfully prevented an injury to her head!
Carseats, bike helmets, and childproofing our homes
Will lower the rate of bonks to lil monkey’s dome.
Not leaving babies unattended up on high places,
Closing my windows against where they press faces,
Are steps on the road to safety, a trip I’m starting,
To avert the dangers of head injury, as research is imparting…
Concussions happen, and can be treated, ’nuff said.
Oh, and there’d best be no more monkeys jumpin’ on the bed!