The child should be seen immediately if one or more of the following is present:
(1) bleeding from a wound that does not stop after 10 minutes of direct pressure
(2) injury occurred following a high speed car accident, a long fall, a blow from a heavy object, or anything that suggests child abuse
(3) loss of consciousness
(4) seizure
(5) crying more than 10 minutes after the injury
(6) a severe or worsening headache that interferes with sleep
(7) vomiting 3 or more times
(8) swelling in front and above the outer ear (overlying the distribution of the middle meningeal artery)
(9) confusion or not acting normal
(10) difficulty in rousing from sleep
(11) difficulty speaking
(12) complaints of blurred or double vision
(13) unsteady gait
(14) difficulty using arms
(15) neck pain
(16) inequality in pupils
(17) a pupil that does not get smaller when a light is shined into the eye
Additional factors that may or may not be indications for immediate evaluation, depending on the circumstances:
(1) age of the child under 6 months (depends on circumstances and the reliability of the family)
(2) a lump in the scalp in the absence of neurologic findings
