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Traumatic brain injuries in children are in the first place among all injuries requiring hospitalization. In addition, due to increased physical activity in childhood, concussion is observed much more often than in adults. During the year, doctors see up to 120 children diagnosed with concussion.
Traumatic brain injuries can be divided into:
Concussion of brain structures. This is the easiest injury a child can get.
Brain injuries. They may be accompanied by fractures of the bones that form the vaults of the skull or not.
Brain contusions, accompanied by the presence of a hematoma located inside the skull and a fracture of its vault. Such injuries are considered the most severe.
Among all injuries, the share of concussion in children is 90%. This is explained, firstly, by the fact that they have increased motor activity, are often restless and overly inquisitive. At the same time, the coordination and motor skills of children are far from perfect, and the feeling of fear of heights is often absent. Secondly, the head of a child has more weight than that of an adult, and they have not yet learned how to put their hands forward during a fall for safety net. Children fall most often upside down, and not relying on their upper limbs.
Slightly older children, namely under the age of one year, get traumatic brain injuries more often. They account for up to 25% of head injuries in the total mass of victims, and in 90% of cases the fall of the child from the changing table, bed, parental hands, strollers and other elevations is to blame. Therefore, constant vigilant supervision of an infant, which is becoming more and more active, is so important. You should not leave him alone, and if there is a need to leave the crumbs at a distance greater than the distance of an outstretched arm, then it is important not to be too lazy and put him in a bed with sides or in an arena. In order to get a traumatic brain injury, a child will only need 2 seconds of oversight.
When a child begins to walk and reaches the age of 1 year, the number of injuries decreases slightly and amounts to 8%. Most often, children get them when they fall from their own height, or from stairs, roofs, windows, children’s slides, etc. It is important to carefully look at the baby, who is under the supervision of third parties – relatives, neighbors, etc. After all, they may try hide the fact that the child was hit on the head.
Preschool children are injured in 20% of cases in the total mass of victims. Sometimes they themselves do not tell their parents about it. Among traumatologists, there is a term “shaken baby syndrome”, when he receives a concussion when exposed to a sharp force, accompanied by unexpected acceleration or deceleration. This is due to a rough attitude, intense swinging, jumping from a height.
The peak of injuries occurs at school age, the number of children among the total mass of victims is 45%.
Causes of concussion in children
Babies bruises are caused by falls from changing tables or strollers as a result of parental neglect. Such injuries are especially common among babies who are working out motor skills and coordination of movements. Later, falls from trees, slides, stairs are connected.
A concussion can occur as a result of sudden braking or acceleration (so-called “shaken baby syndrome”). It is observed in four-five-year-old children when jumping to their feet from a height or with rough handling, and in infants – even with severe motion sickness.
Symptoms of concussion in children
In infants, the symptoms of a concussion are difficult to identify. After a blow, vomiting, blanching of the skin, regurgitation after eating, restlessness, moodiness, sleep disturbances and prolonged crying may occur.
In older children, trauma is accompanied by headache and dizziness, nausea and vomiting, weakness, disorientation in time and space, inability to concentrate, and a change in pulse. A short-term loss of consciousness is possible. When the child wakes up, he is disturbed by a feeling of stupor.
Sometimes a concussion in children is diagnosed with post-traumatic blindness, which can develop both immediately and some time after the injury. It lasts from several minutes to several hours, after which it disappears by itself. The reason for this phenomenon has not yet been studied.
The effects of the injury may not appear immediately, but after a couple of hours. The condition worsens sharply: semi-consciousness, nausea and vomiting are observed. In this case, immediate medical attention is needed.
For a month or two after a concussion, the child will probably complain of motion sickness in transport, but gradually this symptom will pass.
A distinctive feature of childhood concussions is that immediately after the injury, there may be no symptoms. They appear after some time, their strength is growing rapidly, so it is so important to observe the child in the next few hours.
Other signs of a concussion in children
The main symptom of a concussion is a short-term loss of consciousness for a short period of time. There is a poor orientation in a familiar space, headache, weakness, dizziness, in some cases vision deteriorates.
Concussion symptoms also depend on the age of the child: infants with such an injury do not lose consciousness, but only often spit up (this fact may be ignored by parents), sleep poorly, are agitated or pale in the first minutes after the impact.
In school-age children, the initial symptoms of a concussion stop as early as on the 3rd day. There are a number of other signs that are insignificant at first glance: sweating, blood flow to the face, general discomfort. It happens that the condition of the child is rapidly improving. However, do not forget that the process of violations in the body has begun and can lead to further serious complications.
Obvious signs are frequent vomiting, pallor of the skin, anxiety, whims, poor appetite, less often – increased lethargy or poor sleep. Children of preschool age often lose consciousness, they experience nausea and vomiting, pulse and pressure “jumps”, they may complain of headaches. There are whims, mood swings, appetite and sleep disorders.
What should be done in case of a concussion in a child in the first place?
In case of a head injury, in the very first place, it is necessary to call an ambulance in order to immediately consult the victim with specialist doctors (neuropathologist, neurosurgeon). A timely diagnosis is an opportunity to avoid complications and serious consequences. After all, even small signs can conceal a serious concussion.
While waiting for the doctors, arrange the injured child so that he does not fall. Try to keep him awake for an hour. In case of loss of consciousness, it is necessary to turn the child on its side. You can not give painkillers, in addition, it is necessary to limit motor activity.
Upon arrival at the medical institution, the victim is examined by a traumatologist and a neuropathologist, the circumstances of the injury and complaints are clarified. In addition, reflexes, motor activity, sensitivity are checked. With the help of an ophthalmoscope, intracranial pressure is determined. As an additional examination, radiography, computed tomography of the brain are prescribed. An additional examination is used for severe craniocerebral injuries.
Even if the symptoms are subtle, and the child feels well, this is not proof that he did not receive a serious brain injury. Sometimes, which is especially often observed with cerebral hemorrhages, the child may not show signs of anxiety and not complain of pain for several hours or even days. However, this apparent well-being can abruptly turn into a clear malaise and quickly intensify. A complex of symptoms, such as: nystagmus, vomiting, depression of consciousness and increased drowsiness – arises and grows at lightning speed.
Nystagmus – involuntary oscillatory eye movements of high frequency (up to several hundred per minute)
Diagnosis of concussion in children
Doctors who should examine a child with a suspected concussion are a neurosurgeon, a traumatologist, and a neuropathologist. In order to clarify the diagnosis, an anamnesis and a general examination will be required.
After that, one or more additional research methods can be selected, among which the following can be distinguished:
Neurosonography. A simple and painless procedure to detect brain pathology in children under 2 years of age. The age limit is due to the fact that subsequently the bones of the skull become denser and the picture is not accurate. With the help of this method, both the ventricles of the brain and its very substance are visible. Thus, it will be possible to determine the presence of cerebral edema, hemorrhage in it, hematomas and foci of bruises. This ultrasound examination has no contraindications and is performed as soon as possible. Almost all children’s hospitals are equipped with devices for neurosonography.
X-ray skull is the most common way to determine the integrity of his bones. Therefore, if a fracture is suspected, this research method is used. If it is confirmed, then the injury is considered moderate or even severe. It all depends on the condition of the child. However, this method does not give a picture of what is happening with the brain and what state it is in.
Echo encephalography is one of the common, but very inaccurate methods for determining the state of the brain. The study is carried out in the shortest possible time, the data is easily deciphered. With it, you can determine the presence or absence of a shift in the midline of the brain. This will make it possible to determine the presence of a hematoma or other volumetric formation inside it. You can get some data about the state of the ventricles of the brain. If this method was previously widely used, now, with the advent of such examination methods as MRI, CT and neurosonography, it is gradually being abandoned.
Computed tomography – an effective method for determining the state of both the substance of the brain and the bones of the skull. With a traumatic brain injury, it is almost ideal, as it allows you to see the condition of the vault and base of the skull, the presence of a foreign body, brain damage, hematomas and hemorrhages. The only disadvantage of this method is that the apparatus for conducting the study can not be found in every hospital.
MRI. It is longer in time, when carried out in young children, they need prior anesthesia. This is required so that the child lies absolutely still for 20 minutes. To study the nature of a craniocerebral injury, this method is rarely used, since it does not allow one to discern the state of the skull bones with the necessary accuracy. This method is more suitable for examining the state of precisely the structures of the brain and the central nervous system.
Lumbar puncture, a method that is used only when there are special indications. Allows you to determine the hemorrhage in the brain, indicate the presence of inflammation and meningitis. It is carried out by taking liquor – a liquid that washes the back and the brain. To do this, a puncture is made in the lumbar region, it is worth noting that with traumatic brain injuries in children, puncture is very rare.
Electroencephalography – This is a method that allows you to explore the activity of the brain bioelectric. It makes it possible to assess the severity of the injury and provides information about where the foci of nerve cells with pathological epiactivity are located. There must be certain indications for this method.
Treatment of concussion in children
Until the doctor sees the child, you should not give him any medication. It is important to limit his motor activity, put the baby to bed. If the wound is bleeding, then the flow of blood should be tried to stop. To do this, it must be processed and bandaged.
After carrying out diagnostic procedures in a hospital, a decision is made on whether to hospitalize the child or not. Most often, preschool children are left in the hospital for observation and treatment. This serves several purposes. This, firstly, helps to prevent serious complications, such as cerebral edema, the development of hematomas inside the skull, the occurrence of epileptic seizures. Although the possibility of their appearance is not great, however, if this does happen, the parents will not cope with them on their own, and the baby’s well-being may deteriorate sharply. Therefore, a child diagnosed with a concussion is hospitalized for one week. In the event that CT or neurosonography was performed, and these research methods did not reveal abnormalities, then the length of the child’s stay in the hospital can be reduced to 4 days.
In addition, hospitalization allows you to create maximum psycho-emotional comfort for the child. This is achieved primarily by reducing the number of contacts with other people. The child will also be limited in motor activity, diuretic drugs will be prescribed, in particular Diakarb or Furosemide with the obligatory replenishment of the level of potassium in the body. For this, Asparkam and Panangin are used. This will help prevent cerebral edema. Naturally, it will not be possible to completely immobilize an overly active baby, however, noisy games and running are prohibited in the hospital, the ability to watch TV and spend time at the computer is limited. If necessary, the child takes sedatives, such as Valerian Root Infusion or Phenazepam. Sometimes the doctor prescribes antihistamines, Diazolin, Suprastin. With severe headaches, Baralgin and Sedalgin are indicated. If the child is sick, then Cerucal is prescribed to him. After the child is released from the hospital, he is prescribed nootropic drugs and vitamin complexes.
The child’s condition is constantly monitored by doctors and nurses. If deterioration is noticed, then an early re-examination and treatment based on the data obtained is indicated.
Staying in a hospital with a concussion in a child is, first of all, the prevention of severe complications that can develop against the background of the injury. If the child’s condition is stable, then the parents can go home with him a few days later, having written a receipt in advance.
Upon arrival home, you can not immediately return to your usual way of life: watch cartoons, spend time at the computer. You should not walk for a long time, actively move, visit friends. The child needs rest and continuation of the therapy prescribed by the doctor. It is important that the victim with a concussion adhere to bed rest for 2 weeks. If the condition begins to worsen, even slightly: nausea, vomiting, convulsions, regurgitation appear, then you should immediately inform the doctor about this and conduct an additional examination. Increased drowsiness, weakness of the arms and legs, and the occurrence of a headache should alert parents. All these signs indicate that the child is not all right.
Subject to all the doctor’s prescriptions, the child most often does not feel the consequences of the injury. The concussion passes without a trace after 3 weeks and the condition of the little patient returns to normal. After this time, the baby can return to kindergarten or school, start playing sports and lead his usual life.
Thus, it will be possible to avoid serious complications and maintain the health of the child. If the doctor suggests hospitalization, then it should not be refused, despite the seemingly normal condition of the child. This is done with a preventive purpose and avoids serious consequences that threaten the health and even the life of a baby with a concussion.