What is it about ?
Children easily hit their heads when they fall or in accidents when playing.
A shock to the head can cause a head injury.
Head trauma, also called traumatic brain injury, is a disorder in the functioning of the brain caused by a shock to the head.
A concussion is minimal or mild head injury.
In childhood head trauma, it is most often a concussion. More serious problems, such as a fractured skull or bleeding inside the skull (intracranial hemorrhage) are rarer, and are caused by severe shocks.
How to recognize them?
Often, children hit their heads without realizing it. A marked change in behavior should alert us. For example, the child is irritable or he answers questions slowly.
In the event of a concussion, the child may remain unconscious for a few minutes. He no longer knows exactly what happened. He feels nauseous and must vomit. He is tired and wants to sleep. He may complain of headaches and have problems with balance.
With a fractured skull, bleeding is usually seen in the area of the fracture, behind the ear or around the eyes.
If the symptoms worsen, for example, the child is more and more drowsy, he loses more and more consciousness, he continues to vomit,…, this is not normal. This may be because there is bleeding inside the skull (intracranial hemorrhage).
How is the diagnosis made?
A head injury or traumatic brain injury is diagnosed when the shock to the head is followed by at least one of the following symptoms:
- loss of consciousness;
- memory loss regarding events that happened just before or just after the accident (post-traumatic amnesia);
- a change in mental state at the time of the accident;
- a neurological sign.
A blow to the head is therefore not enough to make the diagnosis of head trauma.
To make the diagnosis, your doctor will ask a few questions:
- what exactly happened and when?
- were there any witnesses?
- has the child lost consciousness (loss of consciousness)?
- does the child have a memory loss, difficulty remembering what happened just before or after the accident?
- has the child vomited?
Your doctor will perform a neurological examination, paying particular attention to the state of consciousness, reflexes, muscle strength and sensations. Using a small lamp, the doctor looks to see if the pupils on the right and left are the same, and if they react to light.
Your doctor will examine the head and possibly the rest of the body for any injuries. He will look in the ears to see if there is blood behind the eardrum.
In infants, the doctor assesses the small hollow at the top of the skull (the fontanel).
On the basis of these examinations, the doctor decides whether x-rays of the skull, a CT scan or an MRI are necessary.
What can you do ?
When something has happened to your child, try to get as much information as possible about it.
If your child is alert and active enough there will likely be no need for further testing and you can wait to see how things go. You can keep your child at home. Avoid bright light, as this disturbs the child. If he’s sleeping, wake him up regularly
- every 30 minutes, for the first 6 hours after shock;
- every hour between the 7th and the 12th hour after shock;
- every 2 hours between the 13th and the 24th hour after shock.
Contact your doctor immediately if it gets worse, for example if
- your child’s state of consciousness and reactions decrease;
- your child vomits several times;
- your child has seizures;
- your child starts to bleed from the nose or ears;
- if his headaches increase sharply.
What can your doctor do?
Based on his observations, your doctor will decide what to do next.
A mild concussion with a normal neurological examination does not require any special treatment. With enough rest, the complaints will go away within a few days. The doctor will explain to you what to watch out for and schedule a check-up within 24 hours. If necessary, an X-ray, CT scan or MRI of the head will be performed.
Some fractures do not require special treatment.
In some cases, the child will be hospitalized for observation and additional examinations. This is the case, for example, if:
- symptoms worsen;
- the shock was violent;
- if other parts of the body are affected;
- the child has had an epileptic seizure;
- the child is unconscious;
- the child is less than 2 years old, …
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