How to determine if a child has a concussion: first signs

Children actively learn about the world, and therefore they often fall. At the same time, according to traumatologists, they usually hit the head and limbs, so a concussion in a child is a fairly common phenomenon at almost any age. In this article, we will tell you how to recognize the first signs of such an injury in a child and how to properly provide him with first aid.

What it is?

It is customary for doctors to call a concussion a trauma in which the tissues and structures of the brain do not change at the morphological level, but neurological disorders do appear. The concussion is temporary and usually short-term.

Almost 85% of TBIs in tender childhood are attributed to concussion. The cause and circumstances of injury are always approximately the same, and they are rooted in a mechanical effect on the skull: it can be either a blow to the head, or a blow to the head against something. Sometimes the cause is a violation of the axial load, for example, with a fracture of the spinal column, a sharp fall on the butt, jumping to feet from a great height.

A child can also get a concussion on children's attractions, for example, on a circular carousel or a trampoline - all movements, including a sharp acceleration, are associated with a reflex throwing back of the head, in which the brain "hits" the walls of the skull from the inside.

The fact is that the brain is in the cerebral fluid, and there is free space between the walls of the skull and directly the brain tissue. In situations where the brain hits the skull from the inside, they directly speak of the presence of a concussion. Some time after the impact, some functions and the coherence of different parts of the brain are temporarily disrupted.

Concussion is most often recorded in children over 3 years old. Until this age, the bones of the baby's skull are softer. In infancy, concussion is not a common diagnosis, as shock-absorbing properties are enhanced by more cerebral fluid inside the skull and “fontanelles” that allow the bones of the skull to move when struck or otherwise.

At 1-2 years, the fontanelles close, and the bones of the skull begin to rapidly harden. By the age of 5, they reach the strength of an adult, and from that moment on, a concussion is a very real threat.

According to pediatric traumatologists, concussion is most often recorded in children aged 7-9 years. A little less often - in children from 3 to 6 years old. More often parents of boys turn to doctors for help, because girls fall less often, fight less, do not seek to set a world record for jumping from the roof of a garage, etc.

First signs and symptoms

Because of the widespread prevalence of this type of trauma in childhood, every parent should be able to recognize and identify the first signs of a concussion in a child.

A concussion is a closed cranial injury, and therefore there may be no external injuries on the child's head. If a fall or hit to the head occurred in front of your eyes, and you are sure of the very fact of injury, there may be fewer questions than in situations where a small child hit, but cannot tell about it, and the moment of falling or hitting the parents for some then missed reasons.

One of the first symptoms may be loss of consciousness. With a concussion, it can last for several seconds or several tens of minutes. A child can faint immediately after injury and some time later. Many children have no such symptom as loss of consciousness at all. Only a certain lethargy and stunnedness are noticeable.

At home, it is not difficult to determine a concussion by this sign: the child behaves differently, he looks confused, responds slowly to words addressed to him. Young children under one year of age may experience either constant aching crying or unnatural drowsiness.

Children who, due to their age, are able to clearly explain and express themselves, may have impaired memory. Most often, children do not remember the circumstances of the injury, less often they cannot remember the events that followed their recovery after losing consciousness. It is difficult to say whether the lost fragment of memory will return. Amnesia in this case is quite understandable and often irreparable. The lack of recollection, however, will only apply to the event associated with the trauma. The child remembers mom, dad and himself very well, you don't have to worry.

At home, parents who suspect a child has a concussion can even establish the degree of injury:

first degree - there is no loss of consciousness, the child remembers everything well;
second degree - loss of consciousness did not occur, but it is confused, speech is impaired, the child cannot partially or completely remember what exactly happened to him;
third degree - there was a loss of consciousness, memory is impaired.

If the child did not lose consciousness, then parents can determine the concussion by the subsequent clinical picture characteristic of this type of injury:

the child becomes lethargic, complains of headaches;
there is nausea, and sometimes vomiting (usually single, but strong);
severe weakness, dizziness, tinnitus appears;
the child may sweat a lot (wet cold palms, damp scalp);
movements of the eyeballs in different directions become painful;
the eyeballs themselves may look unnatural (by the type of discrepancy), with a careful study of the child's eyes, you can notice a small nystagmus (twitching of the eyes);
sleep is disturbed (either the child cannot fall asleep, or he is sleeping and does not want to wake up);
nosebleeds appear (not always and not for everyone).

If at least 1-2 symptoms appear, it is imperative to measure the child's blood pressure several times per hour. With a concussion, the blood pressure is unstable.

The above symptoms are usually observed within the first days after injury. Then most of the signs disappear, only headaches, a feeling of increased fatigue, irritability and emotional instability can persist for a long time.

Parents should be aware that concussion in babies under 3 years old most often proceeds without loss of consciousness. The clinical picture in babies is rather poor. As a rule, with a concussion, they first cry for a long time, until exhaustion. Then they calm down and immediately fall asleep. They sleep for a long time, after which the child refuses food or eats little, neurological signs such as regurgitation may appear. After a few days, appetite is restored, sleep is getting better.

What is the danger?

A mild concussion is usually not harmful to the child. The child's body can quickly compensate for all neurological disorders without significant consequences in the future. However, repeated concussion, if the child has already suffered such a condition before, can cause the development of post-traumatic encephalopathy. With it, hand coordination may be impaired, and one foot is often slapped.

The development of such post-traumatic disorders does not depend on the degree of concussion in the previous time and what symptoms accompanied it and whether they were at all. The manifestation of such violations is very diverse: it can be outbreaks of unmotivated aggression, hysteria, neuroses, or, conversely, periods of deep inhibition. The child may become habitual headaches, intracranial hypertension, and problems with memory and remembering new information.

The danger of concussion also lies in the fact that other cranial injuries, which pose a more significant danger to the child, can be "masked". Therefore, only careful observation will help distinguish a concussion from a brain injury or other traumatic brain injury.

With a concussion, all symptoms disappear within 3-7 days after injury, with more severe brain injuries, the clinical picture does not change or is aggravated.

First aid - what should parents do?

If you suspect a concussion, the child should be placed in a horizontal position. You can put a small roller under your feet so that they are slightly higher in level. You can put a small pillow under your head.

If the child is at a conscious age, do not let him fall asleep by all means until the arrival of an ambulance, which should be called immediately after the characteristic symptoms of a head injury are detected. Sleep deprivation is essential for the initial assessment of confusion in order to determine the extent of the injury.

The child should lie on the right side. This is important in order to protect him from asphyxiation with vomiting, if it suddenly opens. The baby can be taken on the handles on the left maternal hand facing you and so hold it until the arrival of the team of doctors.

To avoid the consequences of sudden cramps, which can also occur completely spontaneously, it is better to bend the child's limbs at right angles - put your hands on the chest, bend your legs at the knees.

If the child's scalp has obvious consequences of a fall - bumps, swelling, ice wrapped in a towel can be applied to the injury site. If there is an abrasion or wound, treat it with hydrogen peroxide, apply cold and wait for a doctor. It is possible that the child may need stitches in a hospital setting.

With a large wound, you should not wait time to assess other symptoms - you should cover the edges of the wound with ice, without affecting it, and go to the emergency room.

In case of loss of consciousness, the child is placed on a flat and hard surface, raising his legs and head, and letting him smell the ammonia. If there is no breathing, parents should be able to perform pulmonary resuscitation, and when the baby comes to his senses, do not let him move, speak, drink liquid until the doctor arrives.

How is the treatment going?

At the stage of recovery, the child is shown rest, balanced nutrition, the absence of loud sounds, bright light, active movement. Rehabilitation usually takes up to 3-4 weeks. It is recommended to limit computer games, watching TV and reading books during this time.

The child is prescribed vitamin preparations, as well as often nootropics ("Pantogam", "Nootropil"). Uncommon, but may require an inpatient stay for 1–2 weeks. In the recovery period, a neurologist may prescribe massage and physiotherapy sessions for a child.

The opinion of Dr. Komarovsky

The well-known pediatrician Yevgeny Komarovsky, whose opinion is of great interest to parents, believes that the risk of a concussion should not be exaggerated. If we are talking about a small child, then with a high degree of probability, after falling, he will not have any concussion. But there will be a lot of screaming from fright and a lot of wasted parental nerves. If an hour or two after the injury the child is again cheerful and has already forgotten what happened, he plays, does his usual childish affairs and asks for food, he has no concussion. Parents need not panic.

Moms and dads know better than any doctors in the world the peculiarities of their child's development, and therefore they are the first to detect signs of a concussion from the child's changed behavior.

Komarovsky believes that in all cases, except for open trauma, observation tactics are the best.

If the baby fell asleep after the injury, he should not be disturbed, says Evgeny Olegovich. But once every two hours, mom should still wake up the child and check how well his thought processes are working. A simple question helps in this - where is the mother, what is the child's name, how many fingers do you show, etc. If there is no answer or the answers are more like delirium, you need to immediately call an "ambulance".

It is not difficult to treat a concussion, but it is still better to prevent injury. Komarovsky strongly recommends that parents monitor their children more closely during a walk, do not encourage pampering with swings and slides, use of attractions for other than their intended purpose, and it is also better to avoid trampolines.

At home, you need to make sure that there is a non-slip rug in the bathroom, and there are no puddles on the floor on the tiles.