According to the Centers for Disease Control and Prevention (CDC) in the US, falls are the leading cause of non-fatal injuries in children of all ages, and the number one cause of head injuries in children under the age of nine. However, the CDC also states children under the age of four are most likely to sustain head injuries. This is not surprising, considering children of this age are still finding their feet and are very inquisitive.
“Falls, from any height, with an associated injury are among the most common accident-related reasons people seek emergency medical care,” says Dr Bianca Visser, an emergency medicine practitioner at the emergency department of Netcare Umhlanga Hospital in KwaZulu-Natal.
She says most bumps to the head will require nothing more than an assessment and advice on home care. However, falls can sometimes result in more serious head injuries that need to be further investigated and managed.
Recognising a concussion
“We don’t look for symptoms of concussion when a child sustains a head injury. We look for symptoms of a significant head injury,” explains Dr Visser. “A symptom, or group of symptoms, does not diagnose any specific injury. But based on the history of the accident, examination of the patient and other additional risk factors, we then decide if we need to do a head CT scan to exclude the possibility of fractures and brain injuries. If the child is symptomatic, but the CT scan is normal (there are no broken bones, no brain bleeds, no brain bruises), we can then diagnose a concussion,” explains Dr Visser.
Common concussion myths busted
Myth 1: Bicycle helmets can’t help prevent concussions.
False. Bicycle helmets can help prevent brain injury or at least reduce their severity. “A major study of bike helmet use around the world from more than 64 000 cyclists has found helmets reduce the risks of a serious head injury by nearly 70% and fatal head injuries by 65%. The evidence remains clear that cyclists who wear helmets and have accidents are less likely to suffer brain injuries than cyclists who don’t wear helmets that have accidents,” says Dr Visser.
Myth 2: An MRI or CT scan is used to rule out a concussion.
False. “Many parents assume their child will undergo imaging tests after a head injury. The purpose of a head CT scan, is to determine if there is bleeding inside, or around, the brain, if there is a skull fracture, or if there are other serious brain injuries. Most children with a minor head injury do not require an imaging test because the risk of a serious brain injury is small,” says Dr Visser. She cautions that unnecessary CT scans should be avoided, and should only be performed if there is concern about a serious brain injury, as CT scans expose children to radiation.
Myth 3: The harder the blow, the worse the concussion will be.
True. Dr Visser says there usually is a correlation, as a bigger force may result in a greater injury. “It can be difficult to predict how patients will recover. However, a seemingly small injury can result in prolonged concussion symptoms − especially if the patient doesn’t rest as advised.”
Myth 4: If your child didn’t black out, he probably doesn’t have a concussion.
False. “After a concussion, less than 10% of children lose consciousness for a short time. It’s important to remember a child can have a concussion without losing consciousness,” says Dr Visser. She further explains a blackout, or period of unresponsiveness, is usually an indication of a more significant injury. Any person who experiences this should be assessed by a medical professional. However, it’s important to remember a person can still sustain a full spectrum of injuries, varying from mild to severe, without a blackout.
Myth 5: You shouldn’t let your child sleep after a head injury.
False. “Sleep is how the brain rests and recovers after a bump. Part of the advice we tend to give parents on discharge is to let your child sleep if he or she wants to. If your child falls asleep on the way to the hospital, that’s also OK, because we know how to assess for normal sleepiness or what we call an ‘altered mental state’,” explains Dr Visser.
Myth 6: Vomiting after a head injury is a definitive sign of a concussion.
False. Dr Visser says vomiting may occur with or without concussion. You could still have a concussion − even if you didn’t vomit.
Myth 7: Any blow to the head can cause a concussion.
False. “A child could also have an obvious external scalp injury (bruises, cuts, lacerations or swelling) that needs to be medically managed,” says Dr Visser. However, this doesn’t mean the child has a brain injury.
When to seek medical attention?
Many parents wonder if their child needs medical attention after a head injury. “Symptoms may not be present immediately. Sometimes, they may only come a few hours later, and very rarely days later,” says Dr Visser. The American Academy of Pediatrics recommends parents contact their child’s healthcare provider for advice if their child sustains anything more than a light bump on the head.
Children with any of the following symptoms need to be evaluated by a healthcare provider, as these symptoms may indicate a higher risk of complications.
- Recurrent vomiting
- Seizure or convulsion
- Loss of consciousness after the injury
- A headache that is severe or worsens over time
- Change in the child’s behaviour (lethargic, difficult to wake, extremely irritable, or exhibiting other abnormal behaviour)
- Stumbling, difficulty waking, clumsiness or lack of coordination
- Confusion or slurred speech
- Dizziness that doesn’t resolve or recurs repeatedly
- Blood or watery fluid oozing from the nose or ears
- If the child is younger than six months of age
- If a cut will not stop bleeding after applying pressure for 10 minutes
- If the child fell from a height greater than one to one and a half metres, was hit with a high-speed object, or was hit with great force
- If the parent or caregiver is concerned about how the child is behaving.
Depending on the particular circumstances, this may be done at the doctor’s consultation rooms, or in an emergency department. “The goal of the evaluation is to determine if there is a serious brain injury. The evaluation can also determine if the child needs immediate treatment, close follow-up, or further testing like a head CT scan,” says Dr Visser.
Signs of a concussion in babies:
- Poor feeding
- Inconsolable crying
- Change in sleeping habits.
“All babies under six months who have a significant fall or bump to the head should be evaluated,” says Dr Visser.
“Most children feel unwell for a while after sustaining a concussion, but recover quickly. However, every child is different and some take longer to get better than others,” says Dr Visser. She says most children stay home for a day or two after a concussion, but children with various symptoms may need more time at home and may need to return to school slowly − start attending for a few hours and if that goes well, increase school time to half a day, and then to a full day.
Dr Visser stresses full rest for the brain and body as this is essential for concussion recovery. “Taking a break from sports and other physical activities is not enough. Children also need brain rest, or cognitive rest, during the early stages of the recovery process. Academics and even seemingly relaxing activities, such as using social media apps, reading and playing video games can be taxing on the brain,” she concludes.
Xanet is an award-winning journalist and Living and Loving’s digital editor. She has won numerous awards for her health and wellness articles and was a finalist for the Discovery Journalist of the Year in 2009 and again in 2011 for the Discovery Best Health Consumer Reporting and Feature Writing category. She is responsible for our online presence across social media channels and makes sure our moms have fresh and interesting articles to read every day. Learn more about Xanet Scheepers.