A concussion is a change in the mental status after a head trauma. A loss of consciousness may or may not have occurred. A sports concussion has made a lot of news recently.
Quickcare or ER
A child with a bump on the head is so common. It is almost impossible to prevent a child from getting a “goose egg” on the forehead.
Red Flags (concussion symptoms in children) that will send you to the ER:
- Loss of consciousness
- Mental status changes (not acting right)
A child with these head injury symptoms needs to go to the ER.
What will the doctor ask?
Your doctor will want to know your symptoms. A symptom is your description of your condition to your doctor. It is your story.
The most basic concern is if the child had lost consciousness. Was the child “out cold?” Or was the child just a little stunned.
Another important question is if the child has been vomiting after the injury.
In the extreme cases, seizures can occur.
I ask the child if he/she remembers the event. For example, when my niece bonked her head when she fell off a pogo stick, I carefully walked her through the sequence of events. The intention was to see if she could remember bouncing up and down before landing on her forehead. It concerned me when she could not even remember getting on the pogo stick. She suffered from post-traumatic amnesia.
For a mental status evaluation, I ask the mother. “How is your child acting?,” Mommas knows! She knows her child. If the child is “not quite right” per the mother, many times that is enough to set off warning bells.
What will the doctor look for?
Your doctor will look for signs. A sign is an objective finding that a doctor sees on examination.
The doctor will look at the wound, check for bleeding. Is there bleeding from the ears? Is there bruising signs at the back of the head or around the eyes. It is important to feel around the head to look for a skull fracture. Indentations of the skulls are a serious sign of potential inner brain damage.
At the same time, your doctor is getting a gestalt for the child. How does your doctor “see” the brain without physically looking inside? Careful observation is need. A few questions are rummaging through his head. Is the child active and engaged? (A smile would be great to see) Or is the child drifting off to sleep? Is he or she actively paying attention to our conversation or showing poor eye contact?
Upon further examination, the neurologic exam should look at the eyes to evaluate the pupil size and their accommodation to light. A complete neurologic exam will include an evaluation of focal paralysis (weakness) and appropriate reflexes.
What is your doctor thinking?
Your doctor will make a mental list of possible diagnoses for the injury.
This list is called a differential diagnosis.
If the child is active, smiling and playful, he/she may just have a simple bruise. This is a minor head injury. A little ice; A few kisses on the boo boo. Life goes on.
In contrast, a traumatic brain injury is always at the forefront of a doctor’s thinking.
After a head injury, a doctor is thinking whether to do a CT (Computerized Tomography) scan of the brain. This scan would check to see if the the child has bleeding in the brain. Such injuries need a neurosurgeon (brain surgeon) evaluation.
It has been reported that the radiation of a CT on a young child is not in their best interest. That is, a CT scan is not without its consequences. Such a substantial amount of radiation on a growing brain has led to academic deficiencies. On option is to simply observe the child for 24 hours in the hospital with specialty nurses at the bedside.
What is the treatment of head injuries?
With mild head injuries, there is no specific treatment. This can be frustrating since there may be headaches, blurred vision and dizziness. Patience. Time as a cure.
If a bleed is present, a brain surgeon would need to be involved. Not all bleeds need surgery, however. Again, observation under the guide of skilled neurosurgery team is warranted.
Recent studies indicate that a head injury followed closely by another head injury is detrimental to a young developing brain. Thus, after a concussion, I have my patients sit out of contact sports for at least 2 weeks and I obtain a neurologist consult. I write a note to their sports director to not allow play until cleared by a neurologist.
How long will you be sick?
I usually tell people after a bonk on the head that it is not uncommon to have dizziness, headache for up to two weeks after even a minor head injury. It is frustrating for both the doctor and the patient. There is no magic pill.
If symptoms persist, then I consult a nuerologist.
Traumatic brain injury may lead to a devastating, permanent long-term effects.
Let me tell you a story
Once there was a one year old named David. Like any boy, he loved to play rough. Climbing was one of his favorite activities. Chairs. Couches. Ladders. Unfortunately, his coordination was not fully developed. As soon as he reached the pinnacle, the following would be heard from his mother, “You’re going to fall!!”
Bang! Down again.
“Maybe we should buy him a helmet,” contemplated his mother.
Tuesday’s fall was different. While climbing up the bar stool, he fell backward on to the tile floor. This one made a ‘thud’ followed by a pause then,”Whaaaaa!!!!”
In David’s case, he did not lose consciousness and was not vomiting. He appeared slightly quiet but appropriate. There were no physically alarming signs such as bleeding from the ear or depressions of the skull.
Little David brushed himself off and went on with his journey. He soon found another chair to climb and tumbled over. This time he hit his knee….that is the subject of another story.
I hope this helps.
David Reyes, MD