What Are Brain Bleed Signs in a Toddler with Hemophilia?

If your toddler with hemophilia bumps their head, the safest course of action is to treat it as a medical emergency. Because of the risk of an intracranial hemorrhage (a brain bleed), prompt medical evaluation is necessary even if your child initially seems fine ^[1][2]. The risk is highest in early childhood and for those with severe hemophilia ^[3][4].

Immediate Action Plan

When a brain bleed is suspected, emergency medical guidelines state that factor replacement therapy must be given immediately. It should never be delayed while waiting for a CT scan or other imaging ^[1][2].

• When to call 911: If your child loses consciousness, has a seizure, cannot wake up, or is vomiting repeatedly, call for emergency medical services immediately. Do not delay transport to try to infuse at home.
• When to infuse at home: If your child is stable and you are trained to infuse at home, give the exact emergency dose prescribed in your child’s written hematology plan, then go to the emergency department ^[1]. (Children with inhibitors or those on therapies like emicizumab must follow their specific product plan to avoid dangerous complications).
• At the Emergency Department: Show the staff your child’s emergency letter and explain that they need factor replacement immediately while imaging and other assessments are being arranged ^[2][5]. Ask them to contact your hematology team right away ^[1][6].

Red-Flag Warning Signs

While older children can communicate that they have a headache, infants and toddlers under 3 years old often show more subtle signs of a brain bleed ^[7]. Seek emergency care immediately if you notice any of these symptoms:

• Loss of Consciousness: Passing out, even for a few seconds ^[8].
• Extreme Sleepiness (Somnolence): Unusually difficult to wake up or a sudden decrease in alertness ^[7][8].
• Behavior Changes: Prolonged, unusual crying, extreme irritability, or acting entirely unlike themselves ^[7].
• Vomiting: Throwing up, especially if it happens repeatedly ^[9].
• Eye Changes: Unequal pupil sizes, unusual eye movements, or staring blankly ^[7][8].
• Seizures: Jerking movements, stiffness, or convulsions ^[7][8].
• Weakness: Suddenly not using an arm or leg, loss of balance, or weakness on one side of the body ^[8].

A child who shows any of these symptoms will likely need urgent neuroimaging, such as a CT scan, though the emergency doctor will make the final decision ^[9]. However, even a child who looks completely normal still requires hematology-guided emergency assessment. A normal exam does not guarantee there is no bleeding, and the medical team will determine how long the child needs to be safely observed ^[9].

What to Bring to the Hospital

To help emergency staff treat your child quickly and safely, always bring:

• Your hematology team’s written emergency plan or letter.
• Your child’s factor product or treatment medications (but do not delay leaving if you cannot find them immediately).
• A list of all current medications, including inhibitor status.
• Information about when and how the head injury happened.

Even after you are discharged from the hospital, watch your child closely. Symptoms of a slow brain bleed can appear hours or days later. If any new or worsening neurological symptoms develop at home, return to the emergency room immediately ^[9].