I
was less than two steps ahead of my 3-year-old daughter, Jillian, when
her foot slipped off our front stairs. Within the seconds it took to
grab her off the cement walkway, a nasty goose egg had started to form,
and blood was gushing from a scrape above her eye. The result -- a shiny
black eye, an unsightly gash, and an odd-shaped lump -- remained for
weeks, but the doctor's prognosis was good: Jillian, like most kids who
have that sort of accident, would be fine.
If
it feels like your child is constantly taking a tumble, you're probably
right. Falls are the leading cause of nonfatal injuries in kids of all
ages, and they're the number-one cause of head injuries in those under
age 9, according to the Centers for Disease Control and Prevention
(CDC). Children under 4 are the most frequent victims of head injuries,
and young athletes get mild-to-serious concussions on a regular basis.
It's not known how likely it is that a child who hits her head will have
a concussion, partly because there's no agreement among experts on the
definition of the term in children.
Most
people think of a concussion as just a bump to the head and assume
everything is going to be okay, says Carol DeMatteo, associate clinical
professor of occupational therapy at the School of Rehabilitation
Science at McMaster University, in Hamilton, Ontario. In fact, a
concussion is technically a traumatic brain injury (TBI), though this
doesn't necessarily mean that there will be permanent damage. "Even if
it's mild, be concerned and watch your child closely," advises DeMatteo.
Chances are, your child will one day have a knock on the noggin, so we
asked experts to tell us what you should know.
How Head Injuries Happen
Young
kids are the most likely to hurt their head -- and for good reason:
They have lots of falls in the tub, and they're less sure on their feet
as they're starting to walk. They're testing their limits too. Tricia
Honea, of Issaquah, Washington, learned this not long ago. Her
5-year-old son, Atticus, was hanging on a railing at Disneyland's
California Adventure, despite her requests for him to stop. "Then he
flipped upside down and lost his grip," Honea explains. "He hit his head
on one of the decorative rocks and there was blood everywhere."
Most
kids' head injuries happen in an instant. Children will roll off a
changing table, tumble down stairs, run into each other on the
playground because they weren't watching where they were going, or fall
off their bike or an ATV (which they shouldn't be riding until they're
at least 16, says the American Academy of Pediatrics).
These
days, doctors are increasingly concerned about a condition called
second-impact syndrome. Research has shown that if a child bumps her
head again before a first injury has healed, the second injury can have a
more lasting effect. In rare cases, second-impact syndrome can be
fatal.
What to Look For
As
soon as the accident occurs, and up to a few weeks after, it's crucial
to watch for confused speech, lethargy, blurred or double vision,
difficulty with balance or walking, vomiting, headaches, and pupils that
are bigger than normal or of unequal sizes. Ask your child whether he
feels nauseous, has trouble tasting or smelling, or hears a ringing in
his ears.
With
babies who aren't yet walking or talking, danger signs include bulges
at the fontanelles (the soft spots on the front and back of the skull),
vomiting, lethargy, difficulty feeding, and high-pitched crying. Head
injuries can even leave a dent in the skull. If you notice any of these
symptoms, call your pediatrician. Of course, head straight to the
emergency room should your child lose consciousness, advises Avinash
Mohan, M.D., co-chief of pediatric neurosurgery at Maria Fareri
Children's Hospital at Westchester Medical Center, in Valhalla, New
York.
That's
what Atticus Honea's parents did. Once at the local hospital, they
struggled to keep the 5-year-old awake. If they had let him fall asleep,
doctors would not have been able to tell whether he was sleeping or
whether he'd lost consciousness. In the end, the doctors stapled a flap
of skin on Atticus's head and concluded that he had not suffered a
concussion because he wasn't losing consciousness; he was just tired.
Fortunately, the gash on his head was not a sign of anything serious.
There are a lot of blood vessels in the face and scalp, which is why
head wounds often bleed so heavily, explains Dr. Mohan.
What Happens After the Dianosis
Getting a Diagnosis
Signs
of a concussion are the first thing doctors look for when a child
suffers a bump on the head, says Anatoly Belilovsky, M.D., a
pediatrician in Brooklyn, New York. "It's the most common type of head
injury we see in kids."
Even
the most mild form can lead to fatigue and repeated headaches that last
for days beyond the injury's occurrence. More serious ones will often
cause a child to have sleeping trouble and behavior issues and can
affect his ability to concentrate on schoolwork. So after asking whether
the injury left the child dazed or knocked out, a physician will
perform a basic neurological exam to check vision, hearing, reflexes,
and balance.
If
the history or exam gives the doctor reason to suspect a more serious
injury, she may order a CT scan to check for a far less common type of
TBI called a subdural hematoma, when blood builds up between the surface
of the brain and its outer covering, called the dura. (A rare subset of
TBI is an epidural hematoma, in which blood pools between the skull and
the dura. This is what actress Natasha Richardson died from in 2009
after she hit her head while skiing. Richardson initially felt fine, so
by the time a scan could be performed to reveal her hematoma, it was too
late to save her life.) If the CT scan shows any internal bleeding in
the head, doctors may operate to reduce the pressure. Although hematomas
can be deadly, they are easy for a trained neurosurgeon to treat if
caught -- which is why you should get your child checked out right away.
Life After an Accident
Children
who have suffered a concussion should initially avoid any activity that
works their brain -- even computer and video games, says DeMatteo. So
they may need to stay home from school. They should also steer clear of
tumbling, sports, even amusement-park rides. After a few days, they
should return for a follow-up visit to see whether side effects persist.
(In recent research conducted by DeMatteo, more than 70 percent of the
children studied were still experiencing symptoms six months
post-injury.) Your pediatrician may ask teachers and coaches to weigh in
too. "We really want to know whether your child seems to be back to the
way he was before the injury," she explains. "That's the marker we need
in order to give a clean bill of health and let kids resume their
regular activities."
The
number of sports-related concussions is growing. A new study in
Pediatrics shows that E.R. visits more than doubled for children ages 8
to 13 over ten years -- 3,800 kids in 1997 to 7,800 in 2007. To
highlight the seriousness of concussions, the CDC launched Heads Up, a
major public-awareness campaign, with information specifically for
coaches. Its aim is to help them spot the signs of a concussion and know
how to respond when one is suspected, including removing the child from
play. (Even the world of pro football is recognizing the dangers -- in
December 2009 the National Football League announced a new policy
requiring that players not be allowed to play on the same day after
showing signs of a concussion.)
