Everything Parents Should Know About Pediatric Head Injuries

Understanding Pediatric Head Injuries

You’ve been there and so have we. Head injuries–whether you had to show off for your friends or if you just happened to try to do a backflip on your futon and hit your head on the wooden armrest. These things happen. But back in the 1990s and 2000s, we didn’t really talk so much about serious traumatic brain injuries (TBIs). These are injuries that can occur due to falls, bike accidents, car crashes, sports injuries, or even (this sucks about life on Earth) child abuse. There’s a surprisingly good chance that at some point one of your kids is going to follow in our footsteps and end up with some injury of some sort. So as a dad, it’s so important to recognize the signs and symptoms of the different types of head injuries and know when to seek medical attention.

Dude–we’re not doctors here at NRFT, so while this advice is based on first aid certification classes and triple-confirmed with recommendations from hospitals and relevant organizations offering information about head trauma on the Internet, it’s not medical advice from a healthcare professional. You get that, right? It’s just for your knowledge. Medically speaking, if you even remotely think there’s a chance that a serious head injury has occurred, you need to contact a doctor’s office or visit an emergency room right away.

CRT6 Concussion Recognition Tool

Download this checklist for concussions. Print it. Share it with your school and the coaches of your kids’ sport teams. This is actually what you’re looking for in its most perfect form:

https://bjsm.bmj.com/content/bjsports/57/11/692.full.pdf

Types of Head Injuries (Not Just Concussions)

So you’re thinking that your kid has a concussion. But there’s more than just concussions out there, you know. So check this out, dads–here are the different types of common head injuries that you should be aware of:

1. Lacerations: Yes, those delightful cuts on the scalp that bleed like a faucet thanks to the human scalp’s copious blood supply. It looks like a scene from Friday the 13th, but fear not! Most of these are more bark than bite. Clean ’em up, slap on a bandage, and keep an eye out for any signs of infection. You know, the usual parenting stuff. You got this.
2. Contusions: Ah, contusions, or as we commoners call them, bruises. These are the scalp’s way of saying, “Hey, I got hit pretty hard!” and sometimes they swell up into those lovely “goose eggs.” Keep an eye on these too, just in case they’re hiding a deeper, darker secret . . . but generally you’re an ice pack and 48 hours away from this resolving on its own.
3. Concussions: A concussion is a type of brain injury that affects brain function. It can result from a blow, bump, or jolt to the head, causing symptoms like headaches, dizziness, confusion, and in some cases, loss of consciousness. As a dad, it’s important to monitor for delayed symptoms that might appear hours or even days after the injury.
4. Hematomas/Hemorrhages: These involve bleeding around or inside the brain and can be life-threatening. Hematomas are particularly dangerous because they can increase intracranial pressure, leading to severe complications if not treated promptly. This is serious shit stuff.
5. Skull Fractures: These are breaks in the skull bone, which may or may not be accompanied by brain injury. A skull fracture increases the risk of a brain injury and requires immediate medical evaluation to assess the extent of the damage.

Symptoms of Head Injuries

The symptoms of head injuries vary depending on their severity:

• Mild Head Injuries: Typically cause pain, swelling, bruising, or minor bleeding. Children might cry from the shock and pain, but these symptoms usually resolve with basic first aid.
• Moderate to Severe Head Injuries: These can cause more alarming symptoms, such as loss of consciousness, confusion, severe headache, repeated vomiting, dizziness, balance issues, slurred speech, weakness in limbs, or seizures. These symptoms indicate a need for immediate medical attention.

Suggestions On What to Do After a Head Injury

1. Initial Steps:
   • Minor Injuries: Clean any cuts with soap and water, apply a cold compress to reduce swelling, and monitor your kid closely for any changes in behavior or symptoms.
   • Serious Injuries: Call 911 immediately if your child loses consciousness, has a seizure, shows signs of confusion, has difficulty waking up, or exhibits any other severe symptoms. Throwing up is a sign of a serious injury.
2. Observation: It’s crucial to observe your child closely for the first 24-48 hours following a head injury. Look for any signs of worsening symptoms or new developments that could indicate a more serious condition.
3. Medical Attention: Seek medical attention if your child exhibits any severe symptoms. If your kid is throwing up (especially more than once), slurring speech, or acting funny, it’s time to go to the hospital. If he or she thinks they’re on the way to Disneyworld, it’s time for the hospital. And if he or she doesn’t remember anything about what just happened, (you guessed it!) it’s time for the hospital. If in doubt, it’s always better to err on the side of caution and consult a healthcare professional right away.

Concussion Management

A concussion is a type of mild TBI that disrupts normal brain function temporarily. Proper management is essential for recovery:

• Physical and Mental Rest: Encourage your child to rest both physically and mentally. Avoid strenuous activities and intense mental tasks like schoolwork or even smartphone games for the first 24-48 hours. It’s time to take a break here, dads.
• Gradual Return to Activities: After the initial rest period, gradually reintroduce physical and cognitive activities as symptoms improve. You’re going to need to get the help of a doctor to create a plan to ensure a safe return to normal activities, including sports.
• Monitoring: Keep a close eye on symptoms. If your child shows signs of worsening or new symptoms during the recovery process, seek medical advice immediately. And check in on them constantly–don’t just have them head up to bed and check on them the next morning.

Preventing Head Injuries

Prevention is key to reducing the risk of head injuries in children:

1. Home Safety: Childproof your home by installing safety gates, window guards, and anchoring heavy furniture. Ensure that play areas are free of hazards as best you can. Especially consider if there’s a fireplace or other counters that kids can fall and hit their head on. Watch kids playing on the bed or near windows.
2. Car Safety: Always use the appropriate car seat, booster seat, or seatbelt for your child’s age and size. Ensure that car seats are correctly installed. A car accident is one of the fastest ways to head injuries and a properly installed car seat that’s designed for your child’s size is the best you can do to prevent that.
3. Sports Safety: Equip children with proper safety gear, such as helmets for biking, skating, and contact sports. Teach them to follow the rules and play safely. They’re going to fight you like CRAZY over having to wear a helmet when they go biking. You’ll regret allowing them to skip it if they get into an accident. If anything, try to get the other parents to join you on the helmet thing–so that way all the kids are wearing them together.
4. Supervision and Education: Educate your kids about the importance of safety in various activities. It sounds stupid but you gotta do it–you’re a dad now. Supervise younger children closely, especially during potentially risky activities like running around a swimming pool, climbing walls, inflatable play equipment, and so on.

FAQ – Head Traumas with Children

Remember that part about us not being officially doctors? That’s still true no matter how long it took you to read down this far. So remember, this is our suggestion–but not medical advice. Contact a doctor or go to the ER if you have any indication that there is a serous head injury happening right now.

1. Q: Should I wake my child frequently after a head injury?
   • A: First, you need to evaluate them for a significant head injury (read below). If they seem to have no significant injury, it’s been debunked that kids will slip into a coma if they sleep (but note sleepiness is a sign of concussion). At this point, you can feel better about your decision to let your child rest and sleep as needed. However, monitor him or her closely for any concerning symptoms and check in periodically. And if you think he or she should be evaluated–take them to get checked.
2. Q: When should I call the doctor after a head injury?
   • A: Contact your doctor if your child has immediately bad symptoms or symptoms that aren’t improving, such as persistent headaches, confusion, throwing up, seizures, extreme tiredness, or if they are not back to normal activities within a five-day window. If you aren’t sure, call.
3. Q: What are the signs of a concussion?
   • A: Common signs include headaches, dizziness, confusion, balance problems, nausea, vomiting, sensitivity to light or noise, and changes in behavior or mood.
4. Q: How can I prevent head injuries in my child?
   • A: Use proper safety equipment, childproof your home, and ensure children follow safety rules in sports and recreational activities. Always use car seats and seatbelts.
5. Q: What should I do if my child loses consciousness after a head injury?
   • A: Call 911 immediately and seek emergency medical care. Keep the child still and monitor their breathing and responsiveness until help arrives.
6. Q: Can my child go back to school after a concussion?
   • A: Most children can return to school within a few days, but it’s important to communicate with teachers about any necessary accommodations for cognitive rest and gradual reintegration. A doctor can help you design a specific plan for your child.
7. Q: How long do concussion symptoms last?
   • A: Symptoms usually improve within a few days to weeks, but some children may experience symptoms for longer. Consult a healthcare provider if symptoms persist more than a few days.
8. Q: Is it safe for my child to play sports after a concussion?
   • A: Only after being cleared by a healthcare provider and following a gradual return-to-play protocol. Even if you are following the timeline, ensure the child is symptom-free before resuming full physical activities.
9. Q: What should I do if my child’s symptoms worsen at home?
   • A: Seek immediate medical attention if symptoms like severe headache, repeated vomiting, confusion, or difficulty waking up occur. These could indicate a more serious injury.
10. Q: Can a minor head injury cause long-term problems?
    • A: Most minor head injuries do not cause long-term issues, but it’s important to monitor and consult with a healthcare provider if you have any concerns about your child’s recovery.

A Dad’s Guidelines for Different Types of Head Injuries

Minor Head Injuries

For minor head injuries, the primary symptoms are pain and swelling. These injuries typically don’t involve loss of consciousness or confusion. Here are steps to manage minor head injuries at home:

• Initial Care: Clean any cuts or abrasions with soap and water. Apply a cold compress or ice pack wrapped in a cloth to the swollen area for 20-minute intervals. This helps to reduce swelling and provides some pain relief. Make sure not to apply the ice directly to the skin to avoid frostbite.
• Observation: For the first 24 hours following the injury, it’s crucial to keep a close eye on your child. Ensure they are responsive and behaving normally. Look for signs of worsening symptoms, such as increased drowsiness, prolonged crying, or any unusual behavior. It’s also helpful to keep a record of their symptoms and any changes, which can be useful if you need to consult a healthcare provider.
• Pain Management: If your child complains of pain, you can give them an appropriate dose of acetaminophen (Tylenol). Avoid giving aspirin or ibuprofen in the first 24 hours as these can increase the risk of bleeding. Follow the dosing instructions carefully and consider consulting your child’s doctor for advice on pain management.
• Rest: Allow your child to rest and avoid strenuous activities for the day. If it’s naptime or bedtime, let them sleep but check on them periodically throughout the night. Gently wake them after a couple of hours to ensure they are easily aroused and responsive. Continue to monitor for any delayed symptoms, which might indicate a more serious injury.
• Hydration and Nutrition: Keep your child hydrated with clear fluids and offer small, light meals. In case of nausea, it’s best to stick to a bland diet until they feel better. Avoid heavy, greasy foods that could upset their stomach.
• Emotional Support: Provide reassurance and comfort. Head injuries can be scary for children, so it’s important to stay calm and provide plenty of cuddles and comforting words.

Severe Head Injuries

Severe head injuries are medical emergencies and require immediate attention. Symptoms to watch for include:

• Loss of Consciousness: If your child loses consciousness, even briefly, call 911 immediately. Ensure they remain still and try to avoid moving them unnecessarily to prevent potential spinal injuries. Provide support and monitor their breathing until help arrives.
• Seizures: If your child has a seizure following a head injury, this warrants urgent medical evaluation. Protect them from injury during the seizure by gently placing them on their side and cushioning their head. Do not put anything in their mouth, and call 911 as soon as possible.
• Severe Headache: A severe or worsening headache, especially if it doesn’t improve with over-the-counter pain medication, is a red flag. Persistent headaches after a head injury should be assessed by a healthcare provider promptly. This could indicate increased intracranial pressure or bleeding.
• Confusion or Behavior Changes: Changes in behavior, such as confusion, agitation, excessive drowsiness, or difficulty recognizing people or places, are significant concerns. These symptoms suggest a potential brain injury that needs immediate medical evaluation. Keep your child calm and still while you seek medical help.
• Physical Symptoms: Weakness or numbness in limbs, difficulty walking, slurred speech, or persistent vomiting are all signs of serious injury. If your child exhibits any of these symptoms, call 911 or go to the nearest emergency room. These could indicate damage to the brain or spinal cord that requires immediate intervention.
• Monitoring and Documentation: While waiting for medical help, try to keep your child as calm and comfortable as possible. Note the time of the injury, any changes in symptoms, and any other relevant details to provide to the medical team. This information can be crucial in diagnosing and treating the injury effectively.
• Long-term Care: After the immediate emergency is addressed, follow up with specialists such as neurologists or pediatricians for ongoing care and rehabilitation. Severe head injuries can have long-term effects that need comprehensive management, including physical therapy, cognitive therapy, and emotional support.
• Parental Intuition: Trust your instincts. You know your child best. If something feels off or if you’re uncertain about the severity of the injury, err on the side of caution and seek medical advice. It’s better to have a professional evaluation and be assured than to miss a potentially serious condition.

Supporting Recovery

• Physical and Brain Rest: For both minor and severe head injuries, ensuring your child gets adequate rest is paramount. Physical rest means avoiding strenuous activities, while brain rest involves limiting cognitive tasks such as reading, screen time, and schoolwork. Gradually reintroduce activities as symptoms improve, under the guidance of healthcare professionals.
• School and Activity Adjustments: Communicate with your child’s school about the head injury so they can provide appropriate accommodations. This might include reduced homework, extended deadlines, and breaks throughout the day. For athletes, a gradual return to play plan should be followed to prevent re-injury and ensure full recovery.
• Emotional and Psychological Support: Children recovering from head injuries may experience emotional and psychological challenges, including anxiety and depression. Provide a supportive and understanding environment. Professional counseling or therapy might be beneficial in helping them cope with the aftermath of the injury.
• Follow-up Care: Regular follow-up appointments with healthcare providers are crucial to monitor recovery and address any persistent or new symptoms. Early intervention can help prevent long-term complications and support optimal recovery.

Concussion and Its Implications

Concussions, as a form of mild TBI, require specific attention. Recovery from a concussion involves a period of physical and cognitive rest, followed by a gradual return to normal activities. Key points in managing concussions include:

• Rest: Both physical and cognitive rest are crucial. This means no sports, reduced screen time, and avoiding activities that require intense mental concentration. It’s vacation time for your kid.
• Gradual Return: Activities should be reintroduced gradually, starting with light activities and slowly increasing the intensity. Any return of symptoms means stepping back and giving more time for recovery.
• Medical Clearance: Always get medical clearance before allowing you kid to return to sports or any high-risk activities.

Long-term Outlook for Different Types of Head Injuries

• Lacerations and Contusions: Lacerations and contusions generally have a positive long-term outlook, especially when promptly and properly treated. Lacerations, which are cuts on the scalp, typically heal without significant complications if they are cleaned and monitored for signs of infection. Scalp contusions, or bruises, often resolve on their own, with swelling and discoloration gradually diminishing over time. However, children who experience multiple scalp injuries may develop sensitivity in the affected area. It is important to keep an eye on the healing process to ensure that there are no lasting issues or infections that could cause further complications. Proper wound care and follow-up with a healthcare provider ensure that these injuries do not leave permanent marks or lead to more serious conditions.
• Skull Fractures: The long-term outlook for skull fractures depends largely on the severity of the fracture and whether there is any associated brain injury. Most skull fractures, especially those that do not involve brain injury, heal well with time and appropriate medical care, such as rest and pain management. However, severe skull fractures that involve complications like bleeding or infection can have a more guarded prognosis. In some cases, there may be residual effects, such as chronic headaches or neurological deficits. Regular monitoring and follow-up imaging may be required to ensure proper healing and to address any emerging issues promptly. Advances in medical treatments and surgical techniques have significantly improved outcomes for severe skull fractures, but the risk of long-term complications necessitates careful management.
• Concussions: Concussions, classified as mild traumatic brain injuries (TBIs), can have a variable long-term outlook depending on the individual and the severity of the injury. Many children recover completely from a concussion within a few weeks, especially with appropriate rest and gradual return to activities. However, some children may experience persistent symptoms, such as headaches, dizziness, and cognitive difficulties, a condition known as post-concussion syndrome. Repeated concussions can increase the risk of long-term cognitive and emotional issues, including memory problems and mood disorders. Ensuring a full recovery before returning to high-risk activities and following medical advice on managing symptoms are crucial for minimizing long-term effects.
• Hematomas and Hemorrhages: The prognosis for hematomas and hemorrhages varies significantly based on the type and severity of the bleeding. Acute subdural hematomas, which involve rapid bleeding, can be life-threatening and often require emergency surgical intervention. The long-term outlook for these cases depends on the promptness of treatment and the extent of brain damage. Chronic subdural hematomas, which bleed more slowly, may have a better prognosis if diagnosed and treated early. Even after successful treatment, patients may experience lingering symptoms such as headaches, cognitive changes, or motor deficits. Continuous follow-up care and rehabilitation can help improve the long-term outcomes, but some individuals may experience permanent impairments.
• Traumatic Brain Injuries (TBIs): The long-term outlook for traumatic brain injuries, including moderate to severe TBIs, is highly individualized and depends on factors such as the location and extent of the injury, the age of the child, and the quality of medical care received. Moderate TBIs can result in lasting cognitive, physical, and emotional challenges, requiring extensive rehabilitation and support. Severe TBIs often lead to significant long-term impairments, including motor deficits, communication difficulties, and behavioral changes. Early intervention and comprehensive rehabilitation programs can enhance recovery and help children regain as much function as possible. Ongoing support from healthcare providers, therapists, and educators is essential to address the diverse needs of children recovering from TBIs and to optimize their quality of life.

Communication and Support

Support from parents, coaches, and teachers is crucial for a child recovering from a head injury. Effective communication ensures that everyone involved in the child’s life is aware of their needs and any necessary accommodations. This can include:

• School Accommodations: Inform teachers about the injury and request necessary accommodations, such as extra time for assignments or a reduced workload.
• Monitoring and Reporting: Regularly check in with the child about their symptoms and report any concerns to healthcare providers promptly.
• Emotional Support: Children may feel frustrated or anxious about their recovery. Providing reassurance and understanding can help them cope better.

Understanding and properly managing pediatric head injuries is essential to ensuring the best possible outcomes for children. While many head injuries are minor and resolve with simple care, others require immediate medical attention and careful management. By recognizing the signs and symptoms of different types of head injuries, knowing what steps to take after an injury, and implementing preventive measures, parents can help protect their children from the potential long-term effects of head trauma. Always trust your instincts and seek medical advice if you have any concerns about your child’s health.