Child Head Injury with Ear Pain: Emergency Evaluation Guide for Parents

Immediate action required: If a child falls from a swing and strikes the back of the head, then complains of ear pain, seek emergency medical evaluation immediately. This combination suggests possible skull base fracture or intracranial injury.

Why This Is Urgent

• Battle's sign: Bruising behind the ear (mastoid) indicates basilar skull fracture.
• CSF otorrhea: Clear fluid from the ear = cerebrospinal fluid leak (meningeal tear).
• Temporal bone fracture: Can damage the facial nerve (facial droop), cochlea (hearing loss), or vestibular apparatus (vertigo).
• Intracranial hemorrhage: Epidural, subdural, or subarachnoid bleed may present with delayed deterioration.

Red Flags – Call 911 / Go to ER Now

• Loss of consciousness (even briefly)
• Vomiting (>2 episodes)
• Severe or worsening headache
• Confusion, drowsiness, difficulty waking
• Unequal pupils, slurred speech, weakness
• Clear/bloody fluid from ears or nose
• Bruising behind ears (Battle's sign) or around eyes (raccoon eyes)
• Seizure activity

Do NOT Do

• Do NOT give food/drink (aspiration risk if surgery needed).
• Do NOT give aspirin/NSAIDs (bleeding risk).
• Do NOT let child sleep unmonitored before evaluation.
• Do NOT insert anything into the ear canal.

First Aid While Seeking Care

• Keep child calm, still, head slightly elevated.
• Apply cold pack (wrapped) to injured area for swelling.
• Monitor breathing, responsiveness, pupil size.
• Bring details: mechanism, height, surface, time, symptoms.

Even if the child seems fine initially, observation for 24 hours is standard after significant head trauma. When in doubt, get checked out.