How to help with a concussion in a child

November 01, 2018

Averyanova Sveta

Active games, riding a bicycle or scooter are useful, but at the same time dangerous activities. Children collide and hit their heads. Often falls result in a concussion.

We will tell you in our article where to go for help, how to identify a concussion in a child, and what is useful for parents to know about TBI.

Important information

Concussions are a mild form of traumatic brain injury. The blood vessels of the brain are damaged. This type of injury can occur due to a strong impact or collision. Despite the apparent simplicity of diagnosis, concussion requires careful monitoring and treatment in a hospital.

Children, unlike adults, are protected from the serious consequences of falls and head impacts to a greater extent. The bones of their skull are harder and more mobile at the same time. There is fluid (CSF) between the brain and bones. It absorbs shock.

Infants are protected by a non-healed fontanelle for up to 6 months. For this reason, most slips and head injuries end without consequences for newborns and kindergarteners.

Injuries associated with damage to brain structures are usually divided into three types:

Brain contusion. The brain is compressed by the bones of the skull due to changes in the contour of the vault and bone fractures.
Brain contusion complicated by hematoma.
Hemorrhage is concentrated in the internal structures of the brain or between its membranes. The cause of the hematoma is rupture of the veins due to shaking of the skull, fractures of the head bones. Subdural hematomas (along with brain contusion) are very dangerous for young children. In this case, babies require urgent hospitalization and surgery.
Concussion. Due to the impact, the brain fluid suddenly shifts, a pressure drop occurs, and blood vessels burst or become deformed. Cell nutrition and communication between departments are disrupted. Therefore, the victim experiences vertigo, nausea, disorientation, and loss of consciousness.

Forecast and consequences

If, with a mild form of traumatic brain injury, the parents consulted a doctor in a timely manner, a full course of therapy using medications eliminates the risk of developing long-term consequences. A moderate to severe concussion can lead to:

senile dementia (dementia);
hypertensive crises;
threats of termination of pregnancy due to high blood pressure;
neuroses with tics, obsessive movements;
frequent dizziness;
memory impairment;
hallucinations;
insomnia;
seizures

An injury that occurs in childhood if not treated promptly can cause unpleasant complications in later life . Common consequences include:

weather dependence;
development of phobias;
decreased concentration;
post-concussion syndrome (contusion, prolonged symptoms);
increased emotional excitability;
vegetative-vascular dystonia;
asthenic syndrome (decreased performance, weakness);
tendency to depression;
sensitivity to the development of infections;
speech disorders;
headache;
anxiety;
migraine;
epilepsy.

Characteristic signs of a concussion

The cause of concussion at an early age is really strong impacts on a hard surface, falls from a height of more than a meter. The signs of a concussion in a child coincide with the symptoms of adults, but have several distinctive features. Let’s look at the external manifestations of head injuries in children of different ages separately.

Symptoms in infants

The difficulty in diagnosing the degree of head injury in newborns is that the infant cannot tell what he feels. Mothers have to rely on their own feelings, impressions and observations of the behavior of their babies.

Sound the alarm if, after a fall, an infant exhibits the following early clinical signs of TBI:

Lost consciousness for several minutes.
Refuses the bottle and mother's breast.
Spits up more than usual after feedings, like a fountain.
Twitches his eyes and limbs.
Cries incessantly.
Sleeps poorly, cannot lie down in bed or sleeps for a very long time.
He's being capricious.
Makes nervous movements with his head.
Resists motion sickness in arms.
He is breathing erratically.
The skin turns pale and turns sharply red.
The fontanel is swollen.
There is bleeding from the nose and ears.
The pupils are of different sizes and react slowly to light tests.
There is drowsiness.
Reflexes are reduced.
On the first or second day after the impact, the temperature increased.

Symptoms in children 1–2 years old

The signs of a concussion in a 2-year-old child and preschoolers are similar, but kindergarteners have difficulty explaining them. Close monitoring of a two-year-old child is required in the first to third days after the impact. If you notice three or four symptoms in combination, consult a doctor:

dizziness;
nausea;
diarrhea;
vomit;
pressure surges;
astigmatism;
maladjustment;
tremor of the limbs;
discomfort in the navel area;
pain in the neck, back;
insomnia, light sleep;
tearfulness;
irritability.

Signs in preschoolers

Ask a child 4–7 years old about his health immediately after the blow, every 2–3 hours on the first day, and the next morning. Symptoms indicating a concussion in a preschooler are as follows:

loss of consciousness, memory (short-term);
bleeding from the ears, nose;
vomit;
convulsions;
feeling of an unpleasant taste in the mouth;
headache;
pallor of the skin of the face, arms, legs;
slowness of speech;
inhibited reactions to questions, requests;
weakness;
decrease, increase in heart rate;
sleep disorders.

CCIs are diagnosed more accurately in a hospital. This will require pictures, ultrasound, MRI. But knowing how to check if a child has a concussion at home helps you not miss the important point of going to the hospital.

If you notice two or three symptoms of the consequences of a blow in a child of any age, or the slightest suspicion of a brain injury, play it safe and show the baby to a traumatologist.

This video gives simple tips on how to check for a concussion if a child hits his head:

First signs and symptoms

Symptoms of concussion in children vary according to the severity of the injury. Injury to brain tissue in children most often occurs as a result of a fall or traffic accident.

Injury level:

Lightweight;
Average;
Heavy.

Signs of a concussion in children depend on the severity of the injury and also have age-related characteristics. The mild degree is the most dangerous, since there are almost no symptoms and parents do not seek medical help.

General symptoms depending on severity:

Degree - loss of consciousness occurs for a fraction of a second, which is not always possible to understand. Clarity of consciousness after the blow is not impaired, and impairment of brain functionality does not appear over time. The headache is mild and goes away within 30 to 60 minutes; nausea is possible.
Degree – loss of consciousness lasts up to 5 minutes, the child, after regaining consciousness, is disoriented in space. Consciousness is confused, the moment of trauma falls out of memory. There is dizziness and nausea (vomiting is possible). The symptoms do not go away over time.
Degree – prolonged loss of consciousness, brain functionality is impaired after the impact (speech, hearing, vision). Uncontrollable vomiting appears, which does not bring a feeling of relief. Symptoms are constantly increasing.

Signs – a concussion in a child can be suspected a few hours after the injury. Children under three years of age cannot accurately describe what is bothering them, so parents need to monitor for changes in behavior after the child hits his head. Loss of consciousness is not always expressed in the form of fainting; there may be lethargy for a certain time.

How to determine that a child has a mild form of injury (concussion) - he becomes apathetic, drowsiness and weakness are present. Bright lights or loud noises cause irritation, and there is no appetite. Restless night sleep or insomnia.

Manifestations of brain symptoms during a concussion may differ depending on age and may not have any signs on the first day (in mild cases). Complaints of poor health (in children over three years old) or obvious changes in behavior may begin after a few days.

The younger the child, the more difficult it is to identify the symptoms of a concussion. In newborns, the symptoms are quite specific and parents do not always correlate the cause of the baby’s anxiety with a traumatic brain injury.

Falling of newborn children is not uncommon, and with a mild form of concussion, increased excitability occurs - causeless crying, sleep alternates with bouts of crying, frequent regurgitation. The reaction can also be the opposite - lethargy, during the day there are more periods of sleep (long, the baby does not wake up to feed) than wakefulness.

Severe injuries in newborns are expressed by vivid symptoms:

Refusal to eat (or profuse vomiting immediately after feeding);
Sleep disturbance;
Strabismus (after a blow to the back of the head);
Rhythmic vibrations of the eyeballs that occur involuntarily (nystagmus);
Reflexes are reduced and asymmetrical;
The skin is pale;
Hyperthermia (low-grade fever).

Concussion in children during the neonatal period (mild degree) can also occur from intense motion sickness (shaken baby syndrome). The neck muscles are quite weak and do not support the head, resulting in damage to the meninges (hemorrhage).

Signs of a concussion in infants under 1 year of age are similar to newborns. Parents note sudden mood swings and disturbances in sleep and wakefulness. Memory is not impaired, and the baby recognizes close people. Severe damage to brain tissue is reflected by a symptom in the form of a change in the diameter of the pupils - in one eye the pupil is narrowed or, on the contrary, dilated.

Damage to brain tissue affects the functioning of the autonomic nervous system (innervates internal organs and blood vessels), and the pallor of the skin increases over several hours. The color of the whole body becomes marbling (pallor, capillaries appear), and heavy sweating occurs, which occurs at rest.

In children from one to two years of age, the general symptoms include poor coordination of movements (frequently stumbling and falling). Apathy sets in (toys that previously evoked emotions become uninteresting), all actions are inhibited.

Children from 3 to 5 years old already have sufficient speech skills and are able to describe all the symptoms. With a concussion, it is possible that a complex of symptoms or only one of the signs may be present; this depends on the individual characteristics of the body and the plasticity of the child’s brain.

Children aged 10 years and older describe in detail the changes in their body, which form a complete clinical picture of a concussion. The child complains of tinnitus and constant dizziness, movements of the eyeballs become painful.

Teenagers are more likely than young children to suffer severe head injuries and lose consciousness. Violation of the functionality of the central nervous system during a concussion can be expressed in inappropriate behavior.

The structure of the brain in infants up to one year old has physiological characteristics that make it possible to protect the organ structures from damage to the greatest extent. The bones of the cranial vault have high plasticity, which allows them to perform the function of shock absorption and temporarily change their shape upon impact (passing through the birth canal) - this is possible with the help of soft shells in the places where the sutures are located.

Diagnosis of concussion in children begins with an assessment of the neurological status and consultation with an ophthalmologist to measure intracranial pressure (through the fundus). A physical examination by a neurologist reveals an asymmetry of the knee reflex, which suggests a concussion. The patient cannot focus his gaze, the nasolabial fold is smoothed.

It is impossible to make a diagnosis using additional diagnostics (CT, MRI); the main goal is to exclude severe damage to brain tissue and skull fractures. Children under 1 year of age are required to undergo neurosonography; an open fontanelle allows visualization of brain structures and pathological changes (in severe cases).

Brain functionality in all children is assessed using an EEG, which records the impulses of every brain cell.

Degrees of concussion

Traumatologists distinguish three degrees of severity of TBI:

Easy. After the impact, you experience tinnitus and dizziness for no more than 15 minutes. In the evening the head may hurt a little, the child will fall asleep faster than usual. The injury does not cause serious damage to health.

Average. The obvious effects of the impact are observed within 20 minutes to several hours. They are expressed in the fact that the child becomes maladapted in time, space, feels nausea and weakness. You may feel achy and dizzy. Mild and moderate severity are not accompanied by loss of consciousness.

Heavy. Occurs due to a powerful blow, fracture of the skull bones. An infant or preschooler loses consciousness. Fainting lasts 2–20 minutes. After the brain starts working, children feel very weak, they may not remember what happened, they do not immediately answer questions, their pupils dilate, and blood oozes from the wound. In this case, children need emergency help.

Important! It is impossible to determine the severity of the impact based on the first symptoms. Immediately the child may feel satisfactory, but after a couple of hours the condition worsens. The conclusion is made on the basis of long-term observations and examinations.

TBIs are divided into 3 degrees of severity

Lightweight

These are minor injuries that are not particularly dangerous. Most often, your health improves after 20-30 minutes.

In newborns and infants: loss of consciousness is not observed, symptoms are visible in the first 15-20 minutes. Characteristics of TBI are increased body temperature, vomiting and regurgitation. After this time, the babies return to normal and calm down.
In children from one to two years: a short-term loss of consciousness may occur;
headache;
nausea;
Noticeable damage may appear (bruises, contusions, nosebleeds, etc.).

Average

In newborns and infants: the pulse may slow down or speed up; you should check every 15 minutes. Restless crying, vomiting, disorientation and loss of coordination lasting more than 25 minutes.
In children aged one to two years, loss of consciousness, disorientation in space, inability to give a clear answer, “rumbling” in the head, a feeling of weakness, nausea, the gaze cannot concentrate on a specific object, absent-mindedness, inhibited reaction.

Heavy

In newborns and infants: severe crying;
loss of appetite;
lack of coordination (on the one hand);
pallor;
sometimes blueness of the skin;
possible shortness of breath;
displacement, curvature, depression of the fontanel;
vomit;
sleep disturbance.

In children aged one to two years: loss of consciousness for a short period of time, the victim does not remember what happened:

blurred vision;

temporary blindness;

disorientation in space;

Strong headache;

increased sweating;

pallor;

nausea and vomiting.

Coordination and regulation in space are impaired, a feeling of squeezing of the head and slurred, meaningless speech may appear.

First aid

Before the ambulance arrives, adults need to provide first aid to the fallen child. The algorithm of action depends on the severity of the injury.

For a slight injury without loss of consciousness, you need to:

Place the baby on its side.
Examine the head.
If your condition allows, take yourself to the hospital.

A car ride should be slow and smooth; sudden movements and jumps are contraindicated for a child with a concussion.

First aid for moderate and severe injuries is as follows:

Lay the victim on his side, bend his arm at the elbow, and place his palm under his cheek.
Bend your legs at the knees.
Fix the position, do not stand up or make unnecessary movements.
Cover with a blanket.
Call an ambulance.
If vomiting begins, help your baby not to choke on the food that comes out.
Treat abrasions with Chlorhexidine.
Apply ice to bruises and bumps.
Stop the bleeding with a cotton swab.
After the child comes to his senses, ask about his well-being.
Don't let him fall asleep.

If the skull fracture is severe, the child may go into shock. In this case, it is important to provide first resuscitation aid:

Check breathing, pulse.
If necessary, perform artificial respiration and cardiac massage.
Examine the limbs and torso for other injuries.

Important! You cannot give any medications to a child after a fall or give painkillers. Wait for the doctors to arrive.

First aid, what should parents do?

Injuries in childhood cannot be avoided due to increased activity and inattention. Children have been improving coordination and neuromuscular absorption for quite a long time. Young children have not developed a protective reflex when falling (arms lunge forward), as a result of which the entire force of the impact falls on the head area.

Treatment of concussion in children, regardless of age, is carried out in a hospital setting. This measure allows the doctor to assess the general condition on a daily basis and prevent complications. Treatment at home is carried out after discharge from the hospital. Control examinations are carried out by a neurologist on an outpatient basis.

If parents have any suspicions that their child has a concussion, then first of all it is necessary to call an ambulance and provide first aid correctly.

Algorithm of actions:

Place on a horizontal surface, turning on the side (right), legs tucked to the stomach - prevention of aspiration of vomit. Babies are picked up, facing you;
Avoid taking any liquid or food;
Apply cold to the impact site (a towel soaked in cold water or ice, previously wrapped in a cloth);
Provide access to oxygen (open the window);
If the victim is conscious, do not let him sleep;
If the child is unconscious, do not move him to another place, bring cotton wool moistened with ammonia to the nasal passages. Raise the foot end to increase blood flow to the brain structures;
Eliminate bright lights and loud sounds, ensuring complete peace (including TV and gadgets);
It is prohibited to give the child any medications;
For open wounds on the head or abrasions, the surface must be treated with any antiseptic.

The important point is to prevent the child from falling asleep. Assessing consciousness after injury can determine the extent of damage to brain tissue. If there are no signs of breathing and heartbeat, then it is necessary to perform chest compressions (indirect massage). Rhythmic pressure simulates heart contractions, allowing you to restore blood circulation.

In childhood, heart massage is performed with one hand, in infants - with the tips of two fingers. The pushes should be quick; for children, pushes should not be made using full force. Artificial ventilation is performed together with massage. Cardiopulmonary resuscitation continues until a pulse appears and spontaneous breathing occurs.

Concussion in a child: symptoms and treatment - Komarovsky, a fairly well-known pediatrician, believes that the possibility of getting a concussion is exaggerated by parents. After an injury, it is first necessary to assess the child’s condition and observe him for several hours.

The blow itself often simply causes severe fear, both in the child and in the parents. If your behavior hasn't changed by the end of the day, don't panic. It is possible to conduct a self-diagnosis, periodically asking questions (what is the name, does he distinguish between loved ones) and offering games with concentration.

Lethargy or confusion will be one of the signs of injury. If at least one pathological symptom appears, then of course it is necessary to immediately show the child to a doctor and undergo a therapeutic course.

What not to do if you have a concussion

Childhood injuries have especially dangerous consequences. In order not to aggravate the situation, follow the recommendations of doctors while you wait for an ambulance:

Do not place the injured child on his or her back.
Do not lower your head below your body. You need to pick up the child so that the skull is in line with the neck.
Don't slap your face.
Don't shake your shoulders.
Do not treat wounds with alcohol.
Do not leave a fallen person unattended.
Do not panic.
Do not Cry.
Don't make sudden movements.
Don't let yourself rise on your own.

Remember! If you witness an accident and want to help people, do not move victims with visible head and neck injuries. The impact damages the vertebrae. Any movement of the body without fixing the spinal column worsens the condition. Call rescuers and wait for help without leaving the scene of the accident.

When to call an ambulance

You should definitely call an ambulance if:

The kid managed to fall from a height, hit a solid obstacle, and as a result lost consciousness.
There was blood, dents on the child’s head, bruises and brightly colored bumps quickly formed.
1-2 hours after what you think is a light blow, the baby vomits, he really wants to sleep, complains of a headache and nausea.
The children were hit hard during a walk in the preschool. It is important for kindergarten teachers not to forget this point.

In other cases, objectively assess the children’s well-being and contact the clinic for a consultation or examination to be on the safe side.

Which doctor should I contact?

A child with a mild head injury is being seen by a pediatrician. He can also diagnose complications and clarify the consequences of an impact using hardware studies. The pediatrician is obliged to refer parents and the baby to specialists:

Traumatologist. If the severity of the injury is assessed incorrectly by the parents. For example, a child has not stage I, but stage II concussion; the cervical spine is affected. An examination by a highly specialized doctor is required, along with a referral for x-rays, ultrasound, and MRI.
Lor. Takes part in the treatment of the victim if the blow is in the area of the ear, temple, ichor is released from the auricle, the child has difficulty hearing.
Oculist. Visual acuity is affected by blows to the back of the head, concussions of II–III degrees.
Neurologist. If the nerve endings are damaged. After the blow, the baby develops numbness in the limbs, tremors, increased excitability, and hypotension.

Note to strict parents! A small child can get a slight concussion due to a slap on the head or shaking of the shoulders. You can see what the brain looks like at the moment of agitation in the video.

Diagnostics

An additional examination of even a mild concussion in children under one year old will definitely not be superfluous. Parents should take care of this. Ask your pediatrician for the necessary referrals to rule out a misdiagnosis.

In cases of II–III severity of closed and open trauma, examinations are carried out in the hospital without fail. This:

X-ray.
It is always prescribed regardless of the baby’s condition. Helps recognize symptoms of strong impacts: cracks, broken bones.
Neurosonography. It is done for children from birth to the second year. The examination is carried out through the fontanel. Ultrasound can reveal hidden edema, hematoma, and disturbances in the structures of brain tissue.
CT scan of the skull and brain. With the help of computed tomography, it is much easier to identify the clinical picture. The result is processed by the program and does not require patient preparation. The image shows swelling, hematomas, and shifts of substance inside the skull.
MRI. Helps determine the nature of TBI and assess the state of brain structures. Consequences for the skull bones, the presence of small cracks will not be seen. It is rarely used for one-year-old children, as it requires the administration of anesthesia.
Puncture. Taking fluid from the spinal cord and brain is a painful procedure. Prescribed to detect cerebral inflammation, meningitis, hemorrhages. The examination requires special indications.
Echoencephalography, electroencephalography. Outdated methods for diagnosing the severity of concussions. They provide indirect information about the nature of the damage. They are rarely used if it is not technically possible to do an MRI or CT scan.

Features of concussion in children under 2 years of age

According to statistics, 9 out of 10 children with TBI are diagnosed with a concussion. The reason for this is that in children under two years of age the head is larger and heavier, and the coordination of the body does not allow it to react in a timely manner to a fall, so in infancy the child’s head is the first to suffer.
The harder the impact, the greater the likelihood of a concussion, despite the fact that the bones of the baby’s skull are strong, and the cerebrospinal fluid prevents the brain cells from colliding with the tissues of the skull.

Reference. Liquor is a fluid that circulates in the anatomical spaces of the spinal cord and brain.

In children under one year of age, the fontanel has not yet closed and with a sharp blow, it can easily become dislodged, which will lead to serious health problems in the future. You may also be interested in the reasons for the appearance of balls on the scalp in children.

Treatment methods

The injured child will complete the full recovery course in three to four weeks. Therapy is divided into two stages:

in the hospital immediately after injury;
at home.

Urgent treatment in hospital

Treatment of the second and third stages of TBI is carried out in a hospital. With moderate severity, the length of hospitalization varies from five days to a week. Being under the supervision of a doctor is necessary for the following reasons:

Concussions are dangerous due to the consequences that appear after the impact. This may be swelling, hemorrhage, deterioration, even coma.
The child needs rest and lack of activity. A 1-2 year old fidget will not be able to endure bed rest at home.
It is important for parents to receive complete information about the dosage of medications, diet, and regimen. The attending physician will tell you and show you what to do with the baby for further recovery.

To recover and maintain satisfactory well-being, young patients are prescribed medications:

Diuretics. Necessary for removing excess fluid from the body and protecting against edema. Children aged two years are prescribed Furosemide and Diacarb.
Sedatives to calm the nervous system and improve sleep. This is a tincture of valerian, Phenazepam.
To stimulate blood circulation, the child receives nootropics in tablets: Pantogam, Piracetam, Glycine.
Painkillers are taken until the migraine syndrome disappears. These are strong drugs “Baralgin” or “Sedalgin”.
For persistent nausea, Cerucal is prescribed.
To restore potassium levels in the blood and normalize the functioning of the heart and blood vessels, potassium preparations are prescribed: Panangin, Asparkam.
To restore pressure, the operation of blood vessels is carried out using magnesium droppers.
After a severe injury, a fever may persist for 1–2 days. You will need antipyretics.
Vitamins. The body needs glutamic, hopantenic, and ascorbic acids.

After the end of the acute period, it is useful to undergo physical procedures:

Hypothermia. Applying cold compresses to the site of bruise or swelling.
Inhalations with humidified oxygen.
Soothing aromatherapy, baths.

Therapy at home

After discharge from the hospital, parents must follow the following doctor’s recommendations for follow-up treatment of their sick baby. Care should begin immediately upon arrival home:

Provide emotional and physical rest for 2-3 weeks.
Do not allow watching TV or playing on the computer.
Follow a diet. Food should be light, in small portions four to five times a day.
Take medications in the prescribed dosage.
Seek help if symptoms return.
It is important not to hit your head again.