My wonderfully active youngster seems to always be "bonking" his head on something. I never know how to respond. Are there some general guidelines for when it is serious and when it isn't? I feel bad about calling my doctor for every little thing, but I certainly don't want to miss something important.

If only we could bottle kids' marvelous energy. It’s better than solar power! Still, their energetic exploration of life often results in head "bonks". Fortunately, most of these are not serious. Nevertheless, when we hear the awful thud of a child's head, our breath catches and for a moment...

A prompt cry after the injury is reassuring. It is normal for a child to feel sleepy after hitting his head, and is even O.K. for him to vomit once or twice. The following is a list of signals that tell you that you need to talk with your pediatrician.

If your child is (or has):

• Under six months of age
• Unconscious, even briefly
• Crying for longer than 10 minutes
• Vomiting repeatedly
• Bleeding or discharge from the ears or nose
• Rapid swelling just above the ear
• Unable to walk or talk normally
• Unequal pupil size or pupils that do not constrict to light
• Severe, worsening headache
• Neck pain
• Seizures
• Skull indentation or large bump
• Great force of injury (car accident, long fall, baseball bat, etc.)
• Visual changes
• Numbness or weakness

If any of these symptoms or situations are present, call your physician right away. Your son may be fine, but you should be in touch with an expert. If your son is unable to get up by himself immediately after the head injury, don't move him. Call 911 and wait for emergency help to arrive.

If none of these symptoms are present, it is fine to let your son sleep, as long as you wake him every half hour for the first six hours after the fall. After this, awaken your son at your bedtime and again four hours later to check on his status. The American Academy of Pediatrics recommends waking a child every 2-3 hours for the first 24 hours after a head injury. If at any time your child seems to develop a suspicious symptom, call your doctor.

After reading a list like this, it is tempting to try to protect your son from every situation that might result in an injury. It is appropriate to use good judgment in deciding which activities are safe for your child, but it is also important to allow him the opportunity to express himself through physical activity. Sometimes growth means taking risks, and appropriate risks are worth taking!

N.B. Stair gates and window guards for infants and toddlers, car seats, seat belts, and helmets for riding a bicycle, scooter, or roller-blades prevent many serious head injuries. Make sure your child is properly equipped for his activities.