Ice Packs and Head Bumps: Why We Need to Rethink a First Aid Habit

Written By Maxine Lock

Note - this blog post is about minor bruises to the body, including the head. It is not about more serious bumps or blows to the head which may cause concussion. For that I have written another blog post.  The premise of this blog is that we have created a habit of using single use ice packs when they are not actually needed.

Note 2 - Always follow your setting policies and procedures on head bumps and head injury. If the child is showing any signs of concussion as listed below seek further medical advice.

Disclaimer: I am a First Aid Trainer, any opinions written here are my own but based as far as possible on current thinking and available research evidence to support my thoughts. My main aim in this post is to reduce the waste caused by single use products.

Introduction: A Familiar Scene

A child in your setting takes a tumble. Within minutes there's a bump on their head, the classic "goose egg." A colleague, a parent, or maybe even you, instinctively reaches for the ice pack. It's automatic. It's what we've always done. But have you ever stopped to ask why? As someone who trains first aiders across schools, forest schools and early years settings, I found myself asking exactly that question and the answer surprised me.

Where Did "Ice It" Actually Come From?

As far as I can tell, the idea that ice is the answer to any bump, knock, or bruise traces back to a single source: Dr Gabe Mirkin, an American sports physician, who coined the acronym RICE (Rest, Ice, Compression, Elevation) in his 1978 book, The Sportsmedicine Book. It was written for treating sprains and strains in athletes; pulled muscles, twisted ankles, that sort of thing. It was never designed with a bumped head on a five-year-old in mind. Yet somewhere along the way, "ice it" became a catch-all instruction for almost any injury, head bumps included. It arose from the thinking of the time that swelling of an injury is bad.

The Man Who Invented RICE Changed His Mind

Here's the part that rarely gets mentioned when people repeat the advice: Mirkin himself retracted his own advice. In 2015, decades after coining the term, he wrote that both ice and complete rest may actually delay healing rather than help it. His reasoning was simple, inflammation is the body's essential first step in repairing injured tissue. Icing an injury slows that process down instead of speeding it up. The man behind the guideline effectively told the world to stop following it, but the practice had already become embedded within first aid, physiotherapy and medicine.


From RICE to PEACE & LOVE: What Sports Medicine Now Recommends

Sports medicine has since moved on. The current thinking, published in the British Journal of Sports Medicine in 2019/2020, replaced RICE with a new framework: PEACE (Protection, Elevation, Avoid anti-inflammatories, Compression, Education) for the first few days, followed by LOVE (Load, Optimism, Vascularisation, Exercise) for ongoing recovery. Notably, ice doesn't feature in either acronym. The researchers behind it were openly sceptical about routine icing, given how little solid evidence supports it.

But Wait - None of This Was Ever About Heads

It's worth pausing on this, because it's easy to miss: every stage of this story; RICE, PRICE, POLICE, PEACE & LOVE  is about soft tissue injuries. Sprained ankles. Pulled hamstrings. Twisted knees. None of it was ever developed for a bump on a bony part of the body like the skull. When we apply "ice it" logic to a child's head, we're not following evidence, we're borrowing a habit from an entirely different type of injury and hoping it transfers.

What NHS and NICE Guidance Actually Says About Head Bumps

So what does the guidance that's actually meant for head injuries say? In short, not much about ice. NICE guidelines focus on recognising the signs of a serious head injury and knowing when to seek medical assessment, not on icing protocols. Ice packs are not a treatment used by the NHS for bumped heads in ambulances, hospitals, GP surgeries, or minor injuries units. For a straightforward bump with no other symptoms, the guidance centres on watching and waiting, observing the child for changes in behaviour, alertness, or wellbeing, rather than applying anything to the injury itself.

What do we mean by Head Bumps?

This is the general term usually given when a child has banged their head on something such as the edge of a table or worktop or been hit by something such as another child waving a stick around. When I was a teacher I had two children bump heads under a table whilst trying to retrieve a stray pencil! It is these situations that I am referring to in this blog and to try and move away from using single use Ice Packs. The injury is some bruising (a capillary bleed under the skin) and/or a scalp haematoma where the blood and fluid leaks into the space between the bony skull and the skin forming a soft, egg-like lump. 

Why We Keep Reaching for the Ice Pack Anyway

If the evidence isn't there, why does the habit persist? A few reasons keep coming up from those working in schools and early years settings:

  • It feels like "doing something." Watching and waiting can feel uncomfortable, especially in front of an anxious parent.

  • Parental expectation. Some settings report real pressure from parents who expect to see an ice pack used, and complaints when it isn't.

  • Tradition. It's what we were taught, and what was taught to the people who trained us.

None of these are bad instincts, they come from wanting to reassure and to be seen to care. But none of them are evidence that ice actually helps.

The Hidden Risks of Single-Use Ice Packs

There's also a practical case against reaching for single-use chemical ice packs specifically:

  • Leak risk. These packs can burst or develop small tears. If the chemical contents touch a child's skin or eyes, especially awkward when applied to a head, the "treatment" causes a new problem.

  • Mild toxicity. The chemicals used to create the cooling effect can cause skin or eye irritation, and are unpleasant if ingested.

  • Cost. Single-use packs are an ongoing expense for settings already working with tight budgets.

  • Unintended consequences. Some staff report children coming to see ice packs as a way to get attention or a break from an activity, rather than as something used because it's clinically needed.

What to Do Instead

For a straightforward bump, no other symptoms, child alert and behaving normally, the priority is reassurance and monitoring, not treatment of an injury that doesn't need treating. If a child (or the adults around them) wants something cool and soothing for comfort, a reusable gel pack, kept in the setting's fridge or freezer or in an insulated lunch box in an outdoor setting.  Wrapped in a cloth and held gently to the area, it gives the same comforting sensation without the leak risk, chemical content, or ongoing cost of single-use packs and it doubles as part of your reassurance process, giving you time to properly observe the child while they feel looked after.

You could also use a damp flannel or paper towel. 

To be clear - using ice will not cause any further harm but it may delay the healing process, be costly and potentially cause harm from the single-use ice packs. 

So when should we seek further medical attention?

If any of the following are happening or start happening in the 48 hours following the head injury:

The head injury was high impact for example:

  • A road traffic accident

  • Fall from a height of more than 1 metre (more than the child’s own height, or more than 5 stairs)

You start to see any of the following signs and symptoms:

  • A bruise, swelling or cut more than 5cm on the head

  • Vomits 3 times or more (at least 10 minutes between each vomit)

  • Behaves oddly, becomes confused or unaware of their surroundings

  • Loses consciousness, becomes drowsy or difficult to wake

  • Has a convulsion or fit (uncontrolled jerking, twitching movements)

  • Has difficulty speaking or understanding what you are saying

  • Has weakness in their arms and legs or starts losing their balance

  • Has new problems with their eyesight

  • Has clear fluid coming out of their nose or ears

  • Bruising around their eyes or behind their ears

  • Does not wake for feeds, is irritable or cries constantly and cannot be soothed

  • Has memory loss of events before or after the injury

  • Takes blood thinners or has a bleeding or clotting disorder

References



Maxine Lock
Next

Empowering Young Lifesavers: First Aid Workshops in Schools and the National Curriculum