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Childhood head injuries: When to seek medical attention

Parents urged to take bumps to a child’s head seriously

Monday, March 18 2019

Children are particularly prone to bumping or sustaining blows to their heads, whether caused by a fall or being hit by an object during play, participating in contact sports, or as a result of any other mishap such as a motor vehicle accident. Many parents are, however, unsure whether to seek medical attention if their child has sustained a blow to the head.

 “Sometimes it can be difficult for parents to judge when to seek medical attention when a child has suffered a blow to the head, especially in younger children,” says Dr Bianca Visser, an emergency medicine practitioner at the emergency department of Netcare Unitas Hospital, which is accredited by the Trauma Society of South Africa as a level 2 trauma centre.

“Children with bumps, lumps and cuts to the head are seen on a daily basis at medical facilities. Most of the time, parents simply want their children to be medically assessed as they seek assurance that their child is fine. Fortunately, this is most often the case, but it is always advisable to err on the side of caution, particularly when it comes to head injuries.”

According to Dr Visser, there is a commonly held, but incorrect, belief that it is only necessary to seek urgent medical attention if a child loses consciousness.
“A ‘black out’ after a head injury should not be considered as the only reason to take your child to the emergency department for a medical assessment. Children can have a severe concussion without losing consciousness. While some people will have obvious symptoms after a blow to the head, such as passing out or being unable to recollect what happened just before the injury, others may not display such symptoms. Symptoms of a concussion range from mild to severe and can last for hours, days, weeks, or even months,” she explains.
The reason that it is important to see a medical practitioner after a blow to the head is for the doctor to determine the extent of the injury.

“It is vital that a medical professional assesses the child to determine whether there are no symptoms of a concussion at all, a possible concussion or something even more serious like a broken bone in the skull, a bruised brain or a bleed in or around the brain. During the consultation, the child will usually also be assessed for external skin injuries that might require sutures, as well as for possible neck injuries.

Dr Visser explains that head injuries can be considered on a spectrum ranging from mild to severe.  “Fortunately, most bumps to the head are not serious and will require nothing more than an assessment and advice on home care. However, falls can sometimes result in more serious head injuries which may not be evident at a glance but need to be further investigated and managed,” she adds.

“My advice to parents is to contact your doctor and have a medical professional assess your child as soon as possible, if you are at all concerned about a head injury that your child has sustained. It is also important for parents to receive information on how to further manage a head injury such as a concussion at home, to prevent potential long term consequences,” recommends Dr Visser.

According to Dr Visser, falls are the most common cause of head injuries among children: “Falling is part of childhood and growing up. Children are learning to walk, run and climb. They are inquisitive and often fearless.”

Symptoms of a concussion fit into four main categories:

Thinking and remembering

  • Not thinking clearly
  • Feeling slowed down
  • Not being able to concentrate
  • Not being able to remember new information

Physical

  • Nausea and vomiting
  • Headache
  • Fuzzy or blurry vision
  • Dizziness
  • Sensitivity to light or noise
  • Balance problems
  • Feeling tired or having no energy

Emotional and mood

  • Easily upset or angered
  • Sadness
  • Nervous or anxious
  • More emotional

Sleep

  • Sleeping more than usual
  • Sleeping less than usual
  • Having a hard time falling asleep

According to Dr Visser, young children may have the same symptoms of a concussion as older children and adults, however sometimes it can be difficult to tell whether a small child has a concussion. Young children may also display the following symptoms:

  • Crying more than usual
  • Headache that does not go away
  • Changes in the way they play or behave
  • Changes in the way they nurse, eat, or sleep
  • Being upset easily or having more temper tantrums
  • Lack of interest in their usual activities or favourite toys
  • Loss of new skills, such as toilet training
  • Loss of balance and trouble walking
  • Inability to pay attention

“Whether the above symptoms are apparent or not, babies younger than six months or children who fell from a height should always be medically assessed.”

“Take note that symptoms may not present immediately – sometimes these only develop after a few hours or, in rare cases, days later. If any of these symptoms should arise it is advisable to seek medical attention immediately,” Dr Visser adds.

“A head CT (CAT scan of the brain) will only be done if there is a concern about a serious brain injury or fractured skull. We try to avoid unnecessary CT scans on children to limit their exposure to radiation and we use an internationally validated scoring system based on the child’s symptoms to decide if a scan is indicated or if the child only requires rest and observation,” she explains.

“If a child is symptomatic but the CT scan is normal, indicating that there are no fractures, brain bleeds or brain bruises, we then make a diagnosis of concussion.”

While a concussion is considered a less serious type of head injury, it can nevertheless cause serious long-term complications in certain cases. Dr Visser describes concussion as a type of traumatic brain injury that may result from a blow to the head or a jolt that ‘shakes’ the brain inside the skull. This could result in short-term disturbances in brain function.

Protecting children from head injury

  • Use child car seats and booster seats correctly and ensure that your child is correctly strapped in when travelling
  • Teach your child bicycle safety and the importance of wearing a helmet
  • Teach your child how to be safe around streets and cars
  • Teach your child playground safety to minimise the risk of them falling from heights

Tips to aid recovery from a concussion

  • Get plenty of sleep at night, and rest during the day
  • Only take medicines prescribed by the treating doctor
  • Avoid activities that are physically or mentally demanding (including schoolwork or sport)
  • Avoid TV, computers, video games, cell phones, texting, movies and loud environments

“Sometimes a seemingly small injury can result in prolonged concussion symptoms, especially if the patient does not rest as advised. This is because the brain is more sensitive to stimulation after a concussion. An initial concussion does not usually cause permanent damage, however repeated injuries can result in long-term neurological problems.

“Every potential head injury in children should be taken seriously. As parents we need to be aware of the risks of this common type of childhood injury so that we can ensure our children receive appropriate medical assessment and treatment in the event of a head injury,” Dr Visser concludes.

Ends

References and further reading

https://www.cdc.gov/traumaticbraininjury/get_the_facts.html 
https://www.cdc.gov/traumaticbraininjury/data/index.html
http://www.parents.com/toddlers-preschoolers/injuries/first-aid/how-to-handle-head-injuries/
Olivier, J. and Creighton, P. (2017) Bicycle injuries and helmet use: a systematic review and meta-analysis. International Journal of Epidemiology, Volume 46, Issue 1, 1 February 2017. Available at https://academic.oup.com/ije/article/46/1/278/2617198

Issued by:           Martina Nicholson Associates (MNA) on behalf of Netcare Unitas Hospital
Contact:               Martina Nicholson, Graeme Swinney, Meggan Saville, and Estene Lotriet-Vorster
Telephone:        (011) 469 3016
Email:                   martina@mnapr.co.za, graeme@mnapr.co.za, meggan@mnapr.co.za or estene@mnapr.co.za

 

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