A 15-month-old boy fell and has a small hematoma above the left eyebrow with no focal deficits. Which is the most appropriate management?

• A. Admit to hospital for observation
• B. Reassure the parents
• C. Order CT head
• D. Refer to neurosurgery

Answer: (B)

In young children with minor head trauma, the goal is to identify signs that would suggest intracranial injury. A small scalp hematoma above the eyebrow, in a 15‑month‑old, with no altered mental status, no vomiting, and no focal neurologic deficits, is considered low risk for serious brain injury. Imaging with a CT scan isn’t necessary because the likelihood of injury is very low and the risks of radiation exposure outweigh the benefits in this scenario.

The safest approach is to reassure the parents and discharge with clear return precautions. Provide instructions to monitor for red flags over the next 24–48 hours, and to seek urgent care if any of these occur: persistent or worsening vomiting, increasing sleepiness or unresponsiveness, new or worsening confusion, severe or escalating headache, any new weakness or trouble walking, seizures, or any signs of a deteriorating condition. If these symptoms develop, or if there are new concerning findings (such as repeated loss of consciousness, a severe mechanism with signs of skull fracture, or a large or expanding hematoma), then further evaluation would be warranted. Refer again if symptoms progress, but with no current red flags, reassurance and home observation is the appropriate management.