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PubMed This is a summary of 7 peer-reviewed journal articles Updated
Pediatric Hematology

When Should a Child With Hemophilia A Go to the ER?

At a Glance

A child with Hemophilia A should receive prescribed emergency clotting treatment and be evaluated in the ER after any head injury, even without symptoms, because bleeding inside the skull can begin silently. Do not wait for a CT scan or symptoms before treating.

In this answer

4 sections

01

Immediate Emergency Steps

02

Why Immediate Treatment is Critical

03

Warning Signs of a Brain Bleed

04

What to Expect at the ER and Afterwards

If your child with Hemophilia A sustains a head injury, do not wait for symptoms to appear before taking action. Head trauma is a medical emergency because of the risk of an intracranial hemorrhage (bleeding inside the skull or brain). You must act immediately: follow your child’s personalized emergency plan to administer their prescribed clotting treatment and seek emergency medical care at the same time.

Immediate Emergency Steps

Do not delay emergency transport to attempt home treatment if you cannot do it quickly. Treat and call for help in parallel:

  • Call 911 immediately if your child loses consciousness, has a seizure, is vomiting, is confused, has trouble breathing, or if the injury was severe.
  • Administer prescribed treatment: If you are trained and have the supplies, give your child’s specific prescribed rescue medication (factor replacement or a bypassing agent) exactly as outlined by your Hemophilia Treatment Center (HTC). Do not self-calculate a new dose.
  • Go to the Emergency Room (ER): If you are not taking an ambulance, drive to the nearest capable ER immediately. Inform the medical staff that your child has Hemophilia A. Tell them the exact time and dose of the emergency medication you gave, and whether your child has a factor VIII inhibitor or uses prophylaxis treatments like emicizumab.

Why Immediate Treatment is Critical

The primary concern with any head impact is bleeding inside the skull. Because the skull is a closed space, any bleeding has nowhere to go; pressure can build up quickly and damage the brain.

Medical guidelines strongly recommend that hemostatic treatment (medication to help the blood clot) should be given before radiological imaging, such as a CT scan, and before waiting for specialist consultations [1]. Waiting for a scan to confirm bleeding before giving treatment can lead to dangerous delays. Prompt and intensive clotting-factor treatment improves the chances of preventing serious harm and lowering mortality [2].

Special Considerations for Inhibitors: Not all children use the same emergency treatment. If your child has a factor VIII inhibitor (antibodies that stop standard factor VIII from working) or uses non-factor therapies, standard factor VIII may not be effective. Children with inhibitors have a statistically higher risk of intracranial bleeding [3][4]. It is critical to use the exact bypassing agent or treatment plan prescribed by your hematologist and to ensure the ER is aware of your child’s inhibitor status.

Warning Signs of a Brain Bleed

Never wait for symptoms to appear before treating a head injury and going to the ER. A child can look perfectly fine initially but still have an intracranial bleed, and presentations can vary widely [5]. However, you should watch closely for these red flags that indicate a life-threatening emergency:

  • Neurological changes: Confusion, unusual behavior, trouble speaking, weakness, numbness, or loss of balance.
  • Headache: Especially a severe or worsening headache, which is common in children over 3 years old [6][7].
  • Vomiting: Persistent or forceful vomiting [7].
  • Seizures or convulsions: Uncontrollable shaking or staring spells [6][7].
  • Eye changes: Unequal pupil sizes or eyes not moving normally.
  • Unconsciousness: Passing out or being unable to wake up [7].

For babies and toddlers (under 3 years old), signs can be harder to spot because they cannot explain what they are feeling. Watch for:

  • Unusual sleepiness: Being extremely difficult to wake up (somnolence) [6].
  • Irritability: Constant crying or fussiness that cannot be comforted [6].

What to Expect at the ER and Afterwards

At the ER, the medical team will evaluate your child and should consult with a pediatric hematologist. They will determine if a CT scan is needed, which should only happen after your child has received their bleeding disorder treatment [1].

Even if the initial CT scan is clear, your doctor will give you strict observation instructions. A normal scan does not guarantee that bleeding won’t start later. Watch your child closely at home, and return to the ER immediately if any new or worsening warning signs develop.

Common questions in this guide

Should my child with Hemophilia A go to the ER after any head injury?
Yes. Any head injury can cause bleeding inside the skull, even when your child initially appears well or has no symptoms. Follow the prescribed emergency treatment plan and seek emergency medical evaluation without waiting for symptoms.
What should I do immediately if my child with Hemophilia A hits their head?
Arrange emergency care right away and call 911 for loss of consciousness, a seizure, vomiting, confusion, trouble breathing, or a severe injury. If you are trained and can do so without delaying transport, give only the medication and dose prescribed in your child's emergency plan.
Why should bleeding treatment be given before a CT scan?
A CT scan can help look for bleeding, but waiting for imaging or a specialist consultation can delay treatment. The prescribed bleeding-control medication should be given first when directed by the child's emergency plan, with imaging performed afterward if the medical team recommends it.
How do a factor VIII inhibitor or emicizumab affect emergency treatment?
A factor VIII inhibitor can make standard factor VIII less effective, so the child may need a prescribed bypassing agent instead. Tell the ER about the inhibitor, emicizumab or other prophylaxis, and the exact medication and dose already given.
What warning signs suggest a brain bleed after a child's head injury?
Warning signs include a severe or worsening headache, repeated or forceful vomiting, confusion, unusual behavior, weakness, numbness, trouble speaking, loss of balance, seizures, unequal pupils, or loss of consciousness. Babies and toddlers may instead be unusually sleepy, difficult to wake, or impossible to comfort.
Can a normal CT scan rule out a later brain bleed?
No. A normal initial scan does not guarantee that bleeding will not start later, so follow the discharge observation instructions closely. Return to the ER immediately if any warning sign appears or gets worse.

Related questions

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How Do Mild, Moderate, and Severe Hemophilia A Differ? Who Is Eligible for Hemophilia A Gene Therapy Treatment? Can Females Get Hemophilia A? Causes and Symptoms Explained Can a Hemophilia A Inhibitor Be Eradicated? ITI Explained Can You Get Hemophilia A Later in Life? What to Know What Does a Joint Bleed Feel Like in Hemophilia A? What Is a Factor VIII Inhibitor in Hemophilia A? Explained What Is a Hemophilia Treatment Center (HTC) and Why?

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References

References (7)
  1. 1

    Management of intracranial hemorrhage in hemophilia A patients.

    Aras M, Oral S

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2020; (36(9)):2041-2046 doi:10.1007/s00381-020-04528-3.

    PMID: 32025871
  2. 2

    Clinical Characteristics and Prognostic Factors in Hemophiliacs with Intracranial Hemorrhage: A Single-Center, Retrospective Experience.

    Cho JY, Lee WS, Park YS, et al.

    Indian journal of hematology & blood transfusion : an official journal of Indian Society of Hematology and Blood Transfusion 2016; (32(4)):488-493 doi:10.1007/s12288-016-0637-3.

    PMID: 27812261
  3. 3

    Inhibitor; An Uncommon But Vexing Challenge In North Indian Patients With Hemophilia A.

    Ray D, Kumar N, Hans C, et al.

    Indian journal of hematology & blood transfusion : an official journal of Indian Society of Hematology and Blood Transfusion 2022; (38(4)):703-709 doi:10.1007/s12288-022-01539-9.

    PMID: 36258733
  4. 4

    Diagnostic evaluation of our patients with hemophilia A: 17-year experience.

    Karaman K, Akbayram S, Garipardıç M, Öner AF

    Turk pediatri arsivi 2015; (50(2)):96-101 doi:10.5152/tpa.2015.2516.

    PMID: 26265893
  5. 5

    A proposed algorithm for evaluation and management of pediatric hemophilia patients who present to the emergency department with head trauma.

    Kracht MJ, Stein A, Knoll C, et al.

    Pediatric blood & cancer 2022; (69(9)):e29811 doi:10.1002/pbc.29811.

    PMID: 35709337
  6. 6

    A Retrospective Analysis of Intracranial Hemorrhage in Children with Hemophilia A.

    Hu Q, Zhang A, Liu AG, et al.

    Current medical science 2018; (38(5)):875-879 doi:10.1007/s11596-018-1956-4.

    PMID: 30341523
  7. 7

    Intracranial hemorrhage in congenital bleeding disorders.

    Tabibian S, Motlagh H, Naderi M, Dorgalaleh A

    Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis 2018; (29(1)):1-11 doi:10.1097/MBC.0000000000000660.

    PMID: 28901996

This page is for informational purposes only and does not constitute medical advice. After a child's head injury, follow the individualized Hemophilia Treatment Center plan and seek emergency care immediately.