Head Injury

Instructions for Care of a Child After Head Injury:

Head injuries are common and the vast majority of children does well and recovers quickly and completely.

It is important to observe children carefully after a head injury. We expect to see them get better after the initial event – even if it takes a little while.

We would be concerned about any significant worsening during the period of recovery, particularly if it occurs suddenly after an initial period of improvement.

Please notify the physician (or take the child to the Emergency Room) if the following signs should develop:

    1. Excessive Drowsiness:
      Your child may well be exhausted by the “ordeal” surrounding the injury but should be easily aroused by methods that you would ordinarily use to awaken him/her from deep sleep. During the first night following the injury you should make sure the child can be easily aroused from sleep several times (the number depends on the severity of the injury and would be every two hours for very concerning injuries and once or twice for less significant injuries).
    2. Persistent Vomiting:
      Children may vomit one or more times after a significant head injury; persistent vomiting or vomiting several times after it has initially subsided would be a cause for concern.
    3. Weakness of one Side:
      We would be concerned if the child does not use one arm or leg as well as the other or is unsteady walking.
    4. Unequal Pupils:
      The child’s pupils should be the same size; if one pupil appears larger than the other you should shine a flashlight into the eyes and expect both pupils to constrict to the same size.
    5. “Seeing double”
      The child may complain spontaneously about seeing things double or may squint or keep one eye closed to prevent seeing double; you may notice that the eyes are not trained on the same objects, particularly when looking side-ways.
    6. Difficulty speaking:
      The speech should not be slurred and the child should be able to express himself/herself as well as usually.
    7. Severe Headache:
      It is common for the head to hurt after a head injury; however, we would be concerned if the headache suddenly gets significantly worse. A headache after a head injury may or may not respond to Tempra®/Tylenol® (acetaminophen) or to Advil® (ibuprofen) and it is appropriate to administer either.

There are two main concerns after a head injury: intracranial hemorrhage (a bleed inside the skull) that can increase pressure around the brain, and concussions.

The intracranial bleed needs to be ruled out by an emergency CT scan if, after an initial window of recovery, the child’s condition worsens significantly, which is why we are watching carefully for the signs above to decide when we have to investigate further. Unless the injury is very severe (traffic accidents) it is very unusual to have an intracranial bleed – but we always want to err on the careful side.

Concussion is a mild to moderate trauma to the brain tissue that can cause swelling and transient (or, in rare cases, longer-term) functional impairment that presents with dizziness, a feeling of walking on clouds, changes of perception of reality, difficulties with short term memory, concentration and executive brain function and others. There is no specific treatment and it is important to give the body and mind enough time to heal and recover completely. Returning to sports while the patient is still symptomatic increases the risk that a second injury may cause more permanent and serious problems. Thus, children should not return to physical activity until they are completely recovered.

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