Greetings, dear readers! It often happens that children accidentally fall and hit themselves and get a concussion. But parents do not always notice that the baby has suffered a serious internal injury, while its consequences may be far from rosy. How to recognize a concussion in a child, its main signs and symptoms, first aid methods and, of course, the consequences of the disease.

Symptoms of concussion in children

Children are restless creatures, so most injuries occur between the ages of one and 12 years.

Concussions are divided into three categories based on the danger to the body:

• Concussion of brain structures. This is the mildest form of injury a child can suffer.
• Brain contusion. It is considered a moderate injury, in which a fracture of the skull bones is possible.
• Bruise with hematoma. The most severe injury in which a hematoma is formed and the cranial vault is damaged.

Depending on the severity of the injury and the age of the child, symptoms may manifest differently. For example, in infants, concussions are rare and the signs are almost subtle. In school-aged children, symptoms may not appear immediately, so the baby should be monitored for several hours. In the first days, parents should pay attention to the following features:

• Pale skin.
• After a bruise, the skin looks paler than usual, then redness occurs. The symptom appears in 70-80% of cases, but it may not exist.
• Astigmatism. The movements of the pupils are asynchronous. One of the manifestations is nystagmus (fluctuations of the pupils, reaching several hundred per minute).
• Nausea and vomiting . They can be single or multiple, but you cannot ignore this symptom.
• Headache. If children of the first year of life cannot report their sensations, then in adolescents and preschoolers you can find out whether there is a headache indicating a bruise.
• Loss of consciousness . Fainting can be either short or long lasting. Increased or slow heart rate.
• To observe this symptom, just put your hand on the baby’s wrist. Hesitant breathing.

• Nosebleeds. They can be a sign not only of a concussion, but also of more serious injuries.
• Enlargement or reduction of pupils. Along with the lack of response to stimuli, this symptom indicates a concussion.

Along with these, other symptoms may also appear. They can be less or more pronounced, short or protracted:

• lethargy, drowsiness, lack of interest in favorite activities;
• aching headaches;
• sensation of tinnitus;
• dizziness;
• sleep disorder

During a concussion, the integrity of the cranial bones may be damaged, but it is impossible to establish this fact at home. The parents’ task is to quickly deliver the child to a medical institution, where instrumental diagnostics will be carried out.

Remember: body temperature does not increase during a concussion. If fever and chills appear along with headaches, you are dealing with a viral infection.

What to do if you have a concussion?

The action plan of the person next to the injured child should be aimed at alleviating the patient’s condition until the ambulance arrives:

• As soon as you call a doctor, carefully examine the surface of your scalp. If there are damages, treat them with an alcohol-free antiseptic (Chlorhexidine, hydrogen peroxide).
• If there is bleeding, apply a cotton swab to the damaged area and apply a bandage.
• In the first degree of concussion, when there is a slight headache, dizziness, weakness, but the baby is conscious, you can take him to the hospital yourself, giving the body a horizontal position. Do not take your child on public transport under any circumstances: shaking will only worsen the injury. At the clinic, get examined by a traumatologist and neurosurgeon.

• In the second degree, accompanied by vomiting and short-term loss of consciousness, place the baby in a horizontal position and call an ambulance.
• In the third degree, which is accompanied by loss of consciousness, place the child on his right side. Your right hand should be under your head, and your legs should be bent at the knees. This way you can protect your baby from vomiting and convulsions and wait for the doctors to arrive.

In the third degree of concussion, never place the child on his back and make sure that the head is higher than the body.

Treatment of concussion

Before deciding whether a child requires hospital treatment, doctors prescribe diagnostics, which include:

• neurosonography;
• X-ray of the skull;
• echo-encephalography;
• CT m MRI;
• electroencephalography;
• lumbar puncture (performed according to indications if meningitis or hemorrhage is suspected).

During the diagnosis, the baby may be hospitalized. If no serious violations are found, the time of stay in the hospital can be reduced to 4 days.

Treatment in a hospital has several advantages:

• it is easier to provide the child with bed rest;
• there is constant medical monitoring if the baby suddenly becomes ill;
• TV and computer viewing time is limited, which is difficult to achieve at home.

The following is prescribed as a course of therapy:

• diuretics (Furosemide, Diacarb);
• to replenish the level of potassium salts (Asparkam);
• sedatives (valerian tincture);
• antihistamines (Suprastin, Diazolin);
• for headaches (Sedalgin, Baralgin);
• for nausea (Cerucal).

At home after discharge, it is recommended to maintain a regimen of calm and limited physical activity for some time. Bed rest is indicated for 2 weeks. If necessary, nootropic drugs and vitamin complexes are prescribed. If all rules are followed, recovery occurs within 3 weeks, and the baby can return to school or kindergarten.

Consequences of a concussion

A concussion is dangerous due to its complications. If the injury is left untreated, the consequences can be serious:

• increased sensitivity to temperature changes in the external environment;
• the appearance of phobias;
• sudden changes in mood, which are associated with headaches;
• convulsions;
• decreased immunity;
• problems with concentration and memory.

Complications may not appear immediately. Sometimes they make themselves felt after a few weeks, and sometimes after a few years.

If concussions often occur in a child, adults should reconsider the child’s lifestyle and attitude towards his safety. Injuries may be the result of insufficient supervision of the baby, which will invariably affect his health in the future.

After a bruise, parents should carefully monitor the condition and the slightest changes in the child’s behavior. If headaches, dizziness, or nausea continue for more than four weeks, you should consult a doctor, even if you have completed a course of treatment.

Do not ignore the slightest disturbances and changes in the child’s condition! The quality of his future life may depend on this.

If the article was useful to you, dear readers, leave comments on social media. networks. The information provided is for informational purposes only. See you soon, friends!

This is one of the most common diagnoses in pediatric traumatology. But the symptoms can be very vague. However, it is important to track them so that the child receives the correct treatment and there are no consequences.

Take care of your head!

A concussion is the mildest form of traumatic brain injury; No irreversible changes in the brain occur. The next most severe injury is brain contusion. We will consider these two forms of TBI, since it is their parents who are able to “blink.”

The structure of the skull in babies compensates for shocks from falls, which are inevitable during the period while the child learns to walk. It may seem that nature has completely prevented childhood injuries from minor concussions. But this margin of safety gives rise to failures, all the more dangerous since the symptoms in children are not so clear.

Newborns make up 2% of concussion victims, infants 25%, toddlers 8%, preschoolers 20%, and school-age children 45%.

Babies most often fall from changing tables, from strollers, or from the arms of older children. Starting from the age of 1 year, when children learn to walk, the cause of TBI is a fall from their own height. In children under 3 years of age, their head often “outweighs” it, after all, it is large, and they do not know how to put their hands up when falling, and as a result they hit their head.

A little later, the “fall map” expands to include stairs, trees, slides, and so on.

In addition, up to 5 years of age, a concussion sometimes occurs from shaking a child during rough handling or even too active rocking...

Well, with the elders everything is clear without explanation.

Keep in mind that the fall may not always be trackable. If a nanny or relatives were looking after the child, they may be “embarrassed” to tell the parents that the baby fell, or in the most honest way they will not pay attention to it. Older children themselves hide troubles so as not to be scolded. All this further complicates the difficult task of recognizing a concussion if it does happen.

Main signs of concussion in children

Here, for comparison, is a list of symptoms in adults.

• Loss of consciousness from a few seconds to 10-15 minutes.
• Nausea and vomiting.
• Dizziness, headache.
• Amnesia (loss of memory) of events immediately before the injury, the injury itself, and immediately after the injury.
• Twitching of the eyeballs, loss of coordination of movements.
• In the case of a brain contusion, there is a loss of sensitivity on the side of the body opposite to the site of the injury.

And here is a picture of a concussion in a child.

In children under 1 year

• Loss of consciousness most often does not occur.
• Single or repeated vomiting, nausea, regurgitation during feeding.
• Pale skin.
• Unreasonable anxiety and crying.
• Increased drowsiness or poor sleep, lack of appetite.

All this, you see, is difficult to reconcile with a concussion.

In preschool children

• Loss of consciousness, nausea and vomiting occur more often after injury.
• Headaches, dizziness.
• Increased or slow heart rate.
• Blood pressure jumps.
• The skin turns pale.
• You feel weak and sweating increases.
• Disorientations in time and space are observed
• Inability to concentrate.
• Sometimes children experience post-traumatic blindness. It occurs immediately after injury, but may occur later, persists for several minutes or hours, and then disappears.
• There is also this peculiarity: immediately after the fall, the child feels normal, but after a few hours and even days, symptoms appear and begin to rapidly increase: in infants, the fontanelle bulges, in older children, clouding of consciousness is possible. In such a case, even with minimal complaints, the baby may suffer severe brain damage, including hemorrhages.

Complications of concussion in children

If you suspect a TBI, if minimal symptoms are present, it is better to show the baby to the doctor, and after a significant fall - even without any symptoms. When doctors offer hospitalization, do not refuse. This is necessary to prevent complications of injury - cerebral edema, hematomas, meningitis, epilepsy. If the child can be treated at home, you must strictly follow medical instructions, first of all, rest. If the condition worsens (prolonged nausea and vomiting, persistent headaches, general weakness and weakness in the limbs, convulsive twitching, frequent regurgitation in infants), you should immediately contact a neurologist for re-examination or hospitalization.

For a month or two after a concussion, a child may experience motion sickness in transport. This will gradually pass.

Severity of concussion

The severity of the injury is determined by the intensity and duration of general cerebral symptoms, headache, for example.

With mild to moderate concussion, a few hours after the injury or on the second day, the general condition improves: vomiting stops, children become active. Of course, the duration of bed rest depends on the severity of the injury. In a mild case, you will have to lie down for a week, in a moderate case - 2-3 weeks, in a severe case - 3 weeks or longer.

Signs of a severe concussion, of course, are unlikely to go unnoticed, but it is not always possible to correlate them with a child’s recent fall, which may look quite ordinary.

Symptoms of a severe concussion

• In severe cases, vomiting and nausea appear for 1-2 days.
• Infants experience tremors and short-term convulsions.
• Older children complain for a long time of headaches, delirium and psychomotor agitation are possible.
• Against the background of these general cerebral symptoms, focal disorders are revealed: slight convergent strabismus, asymmetry of muscle tone and reflexes.
• From the 3rd or 5th day the condition gradually improves, but fatigue, excitability, irritability, and poor concentration will remain for a long time.

Attention: signs of brain contusion in children!

It occurs much less frequently than a concussion. A brain contusion reveals itself as a combination of signs of a different order: general cerebral symptoms (headache, dizziness, nausea) are accompanied by symptoms of disorders of the stem-basal parts of the brain (respiratory disorder, circulatory disorder). Focal, local symptoms also intensify.

Moreover, all this happens chaotically and unpredictably. In general, the picture is like this.

• In the acute period, against the background of impaired consciousness, severe pallor or redness of the skin, sweating, repeated vomiting, a rare pulse, a drop in blood pressure, sometimes respiratory arrhythmia, local or general convulsions occur.
• Due to the resorption of hematomas, the temperature rises 1-2 days after the injury, and symptoms of toxicosis may appear.
• The weaker the general cerebral symptoms become, the more clearly focal neurological disorders are identified: seizures, speech disorders.

Even with a brain injury, all its dangerous signs in children may be blurred, but it is necessary to understand what is happening and consult a doctor.

Warning: Risk!

Proper treatment will help cope with a brain injury without irreversible consequences for the child. But it will take him much longer to recover than after a concussion. School performance decreases, and the depressed or overexcited state increases. This is a dangerous moment: in childhood, a temporary state of affairs is easily mistaken for permanent, self-esteem drops sharply, depression can become chronic for psychological reasons. Try to explain to your child that this will all pass. You will first have to teach your child to monitor his condition and not to overwork. And then help him return to a normal rhythm of life. Identify this vision and work together to realize it.

Excessive activity and mobility, lack of fear and sense of self-preservation often lead to injury and become the reason why a concussion can occur in children, regardless of age. Sometimes, even the most vigilant and attentive parents do not have time to keep track of the baby who is trying to understand the world around him. Often a concussion occurs in a schoolchild who has no idea about the consequences and complications of craniocerebral disorders. In this case, it will not be possible to get by with a simple bruise, lump or hematoma, and treatment will require mandatory hospitalization.

Severity of concussion

But, it is not so much the external manifestation of skin damage that is dangerous as a closed craniocerebral injury or concussion in children with subsequent disruption of the central nervous system and organ function at the internal cellular level. Even a severe head injury requires immediate examination by a doctor to rule out intracranial changes.

A child who has received a mild concussion of the first degree experiences weakness, slight dizziness, and possible vomiting. Consciousness is present. After 20-30 minutes, children return to normal activities and games.

II degree or moderate concussion in children. At this stage, there are minor damage to the structure of the skull, hematomas and soft tissue bruises. The victim may lose consciousness in the first minutes, be disoriented in space, and will feel nausea and bouts of repeated vomiting for several more hours.

Severe or III degree. Accompanied by injuries, fractures, severe bruises, hemorrhages, prolonged and frequent loss of consciousness. Hospitalization, rest, round-the-clock medical supervision and intensive treatment for more than 2 weeks are required.

Over 1,230 young patients in Russia are diagnosed annually in neurosurgical departments with serious head injuries. If we rely on statistical data, the braincase and skull are most often affected in children under one year and 4-6 years old - more than 21%; among schoolchildren, these data exceed 45% of the total number of all cases. In infants and newborns, rates reach 2%, and in toddlers - 8%.

Signs of a concussion in a baby

Careless, inept parents are the cause of traumatic brain injuries in newborns. A child falling from a changing table, a bed, or from the hands of mom and dad is recorded quite often. Mild and insignificant symptoms of a concussion in children under one year of age make it very difficult to identify damage:

1. frequent regurgitation;
2. lack of appetite;
3. enlargement of the fontanel;
4. pale complexion;
5. restless sleep;
6. nervousness and crying.

But, thanks to the still undeveloped brain and skeletal system, such injuries rarely lead to serious consequences. Rapidly passing symptoms and treatment are not provided. The prognosis for a quick recovery is justified in 90% of cases.

Concussion in a 2-3 year old child

The ability to express one’s feelings and the presence of speech skills contributes to the rapid identification of traumatic brain injuries. Experienced and attentive parents may observe uncharacteristic behavior and signs of a concussion in a child under 3 years of age.

A noticeable change in the color of the baby’s facial skin should alert you: a pale or whitish tint. Sudden loss of orientation in space, staggering gait and loss of consciousness. Pain in the navel and abdomen, gag reflex. Children complain of compressive pain in the temple area and migraines, sleep poorly and cannot concentrate on objects, lose activity and interest in outdoor games.

How to determine a concussion in a child from 3 to 6 years old

Places with large concentrations of children, such as preschool institutions, playgrounds, and parks, become dangerous if there is insufficient attention to the child. Injuries in children under 6 years of age are growing by 2% or more every year. The reasons for a concussion include poor upbringing and aggression in the child, symptoms of increased excitability and uncontrolled behavior.

The baby fell or was pushed, hit on the head with a heavy toy or stone, a bump formed or a hematoma or bruise appeared - immediately contact the nearest medical center for diagnosis and examination.

What do doctors pay attention to in order to determine a concussion in young children, what are the main symptoms: excessive sweating, severe pain and dizziness, a feeling of pressure, repeated vomiting, and possible post-traumatic blindness. Very often, a child cannot reproduce the situation when an injury occurred or a fall occurred.

Concussion in a schoolchild

Dysfunctional families, social and material inequality, which occurs and is reflected primarily in children in educational institutions, provoke fights as a way to prove their superiority over others or to assert themselves through force. Unfortunately, signs of serious injuries, concussions and bruises of the brain are noted specifically in school-age children.

During this period, there are frequent cases of dangerous injuries and neurological manifestations, such as twitching of the eyeballs, nystagmus, the Babinski reflex, in which the big toe extends after physical impact on the foot, convulsions, loss of coordination of movements, and consciousness may be absent for more than 15-20 minutes. The child feels sick with profuse vomiting, partial memory loss occurs, and there is a lack of concentration and concentration.

First aid for a concussion

There is no need to start treatment on your own for a concussion in children, but every parent, educator, teacher and adult who happens to be nearby should know what to do in such a situation at home or in an organization. The most important thing is to contact emergency medical workers or take the child to the hospital.

Before providing qualified assistance, it is necessary to apply ice or a cold, damp towel to the damaged area. The victim needs rest, but not sleep, so put the baby down and try to calm him down. Wounds can be treated painlessly with Chlorhexidine disinfectant and rinsed with running water.

Diagnosis of concussion in children

A more accurate examination will be carried out within the clinic and at an appointment with a traumatologist, neurologist, ophthalmologist and pediatrician. But in order to begin full treatment of concussion in children, depending on the severity and age of the patient, a preliminary diagnosis is prescribed.

Neurosonography (NSG). A non-invasive method of visual examination of parts of the brain in infants using two-dimensional ultrasound scanning performed through the fontanel. Indications for the procedure: birth injuries, central nervous system disorders, congenital pathologies.

Electroencephalography (EEG). Ordered by a pediatric neurologist to obtain a graphical recording of the electrical activity of brain cells taken from small electrodes attached to the surface of the child's head. At an early age, it is recommended to record physiological and pathological processes during the baby’s sleep. EEG allows you to determine the severity of traumatic brain injury and birth injury, signs of concussion, damage to the central nervous system and tumor.

Ultrasound echoencephalography. Makes it possible to obtain three-dimensional images of intracranial injuries, hematomas, abscesses, tumors and cerebral edema.

X-ray of the skull. Shows the condition, structure and thickness of bones, cranial sutures and fontanelles. Widely used in pediatric traumatology, neurology and neurosurgery.

MRI of the brain in a child under one year old. A neuroimaging diagnostic method that allows us to identify concussions and damage to the nervous system in children, symptoms of developmental anomalies and pathologies, traumatic brain injuries and hemorrhages.

X-ray CT scan for children is performed under anesthesia and involves scanning morphological changes in the organs and tissues of the central nervous and skeletal system. Safe procedure even for newborns.

Treatment of concussion

After an initial examination by a traumatologist and neurologist, surgical treatment and suturing of damaged soft tissues and head wounds, the symptoms of a concussion that are pronounced and proven during diagnosis require urgent treatment. Recovery from a traumatic brain injury takes place with the prescription of drug treatment with vitamins, nootropic, diuretic, sedatives, antihistamines and painkillers, and drugs containing potassium.

"Diakarb." In case of severe hypertension and epileptic activity against the background of TBI, it is used for children from 4 months. We treat 1-2 times a day from 125 to 250 mg.

Diuretic drug "Hypothiazide" recommended for gentle removal of excess fluid while retaining calcium necessary for the child’s body. Prescribed from 2 months of a child’s life at the rate of 1 mg per kilogram of the baby’s body weight.

Sedative "Reminyl" after the first year of life, it enhances and facilitates the functioning of processes in the spinal cord and brain, increases and stimulates muscle tone, and promotes the conduction of nerve impulses in the central nervous system. For children under 2 years old, the recommended dose is up to 1 mg orally, up to 5 years old - 5 mg, over 6 years old - 6.5 mg, from 8-9 years old - 7.5 mg.

"Asparkam." Restores the potassium and magnesium content in the body necessary for the conduction of nerve impulses, regulates metabolic processes, and, depending on the dosage, narrows and dilates the coronary arteries. The amount of active substance per day is from 2 tablets.

"Fenkarol". An antiallergic drug that has a positive effect on the permeability of blood vessels in the brain is prescribed to children of any age. Reception per day - 2-3 times. From 3 years of age the dosage is 5 mg, up to 6-7 years - 10 mg, until 12 years of age the amount of the drug increases to 15 mg. Teenagers are recommended to use 25 mg.

After one year, the baby can take the antiemetic drug Dramamine. It has a calming and analgesic effect, eliminates vestibular disorders. Prescribed in a daily dosage of 12.5 mg. Reception should not exceed 3 times a day.

The length of hospitalization and the victim’s stay under the supervision of medical personnel and doctors depends on the severity of the injuries received. Approximate treatment for a mild concussion will take about a week. Improvement in condition reduces hospital stay to 3-4 days. Average severity requires up to 2 weeks within a medical facility. Complex traumatic brain injuries with numerous bruises and fractures are treated until recovery takes about a month or more.

Consequences of a concussion

As a result of injuries and bruises, fractures and tumors, it is quite difficult to avoid complications. After suffering damage to the skull or brain, severe disorders of the central nervous and skeletal system, weather dependence, hydrocephalus and epilepsy, convulsions and tics, and obsessions are possible.

Even after a mild concussion, headaches, developing phobias and unjustified fears, deterioration of brain activity and mental activity, and surges in blood pressure are common. Children experience mood swings and increased nervousness, hysterics and sleep disturbances, and feelings of anxiety and restlessness.

Complications after brain and skull trauma may appear many years later in the form of vegetative-vascular dystonia, post-traumatic vestibulopathy, and mental disorders. At older ages, the functioning of the heart, vascular system and blood circulation are disrupted. Personality changes and signs of dementia are diagnosed. Damage to areas of the brain responsible for motor activity causes a shuffling or flopping gait and uncoordinated or unnatural muscle activity.

A concussion is a common reason for visiting a traumatologist or neurologist. This type of injury accounts for about 90% of all head injury cases. According to statistics, every year more than 30 thousand young patients are treated with this diagnosis. Most often, mild TBI is diagnosed in the age group of five to fifteen years.

Mechanism and causes of injury

The brain is a vital organ and very sensitive to various damages. Therefore, it is reliably protected by the bones of the skull. In addition, the brain substance is surrounded by cerebrospinal fluid, which, among other things, acts as a shock absorber.

During a concussion, a strong mechanical impact on the head area, vibration, shaking can lead to displacement of the anatomical structures of the brain and their injury to the walls of the skull. In this case, the meningeal membranes and bones of the brain part of the skull often do not have any damage.

The circumstances that cause traumatic brain injury vary among different age groups.

• Concussion in a child under one year of age. Occurs in cases of insufficient adult control. Injury occurs when falling from a table, high bed, or carelessly descending stairs.
• Skull injuries in preschool age. Occurs when falling from a swing, riding a bicycle without a helmet, or while playing with other children. In adolescents, the most common factors leading to concussions are climbing trees or garages, aggressive behavior, and playing dangerous sports.

In addition, the mechanism of injury itself is important. If a child trips and falls on his face or hits his forehead on a hard-carpeted floor, it rarely results in any serious injury. The most dangerous are falls from a height of more than two meters or injuries sustained while moving at a speed of more than 30 km/h. Falls on a hard surface (ceramic tile floor or concrete) can also cause concussion.

Concussion in a child: characteristic symptoms

The most clear criterion and the first sign of a concussion is loss of consciousness during a blow to the skull or a fall from a height. The unconscious state can last for seconds or 10-15 minutes. However, in infants, disturbances of consciousness do not occur so often, even despite severe head damage. Older children sometimes do not realize the moment of loss of consciousness, especially if no adult was nearby at the time of the injury.

The fact of injury can be determined by examining the child. In most cases, it is possible to identify a mark from a blow, abrasion or bruising on the scalp or face.
At the time of TBI, autonomic disorders are often observed: severe pallor, marbling of the face, increased sweating. A rapid or, conversely, slow heartbeat and changes in blood pressure are objectively determined.

It is extremely important for parents to know how to identify a concussion in a child in order to seek medical help in time. Mild TBI has five typical signs that can appear both in the first hours after injury and in the long-term period (within a day or two).

1. Nausea and/or vomiting. Very often they occur half an hour or several hours after hitting the head. Children under three years of age sometimes do not want to eat, and infants do not latch on to the breast.
2. Severe and persistent headache. In preschoolers, this can be expressed by causeless anxiety and crying.
3. Loss of some events from memory. Amnesia occurs for events before the injury or at the time of the TBI. Some patients confuse the time and date, and may be less able to navigate their surroundings.
4. Lethargy, slow reactions, drowsiness. The child reacts differently to external stimuli, refuses to play, and gets tired quickly. If he has a concussion, he may fall asleep at an unusual time.
5. Increased sensitivity. Trembling, squinting, crying in response to sound and light stimuli.

Sometimes young children experience an increase in temperature to 37.5 °C and frequent regurgitation. Concussions are also characterized by dizziness and tinnitus.

The above signs of a concussion in a child should force parents to call an ambulance. The doctor will check and evaluate the symptoms, and the child's concussion will be treated appropriately. This will avoid life-threatening complications and consequences in the future.

Diagnostics

Any head injury should be the basis for consultation with a neurologist, traumatologist or neurosurgeon. Already during the initial examination, a specialist will be able to recognize neurological signs of a concussion and, if necessary, prescribe additional research methods.

If a concussion is present, neurological tests reveal the following signs:

• involuntary horizontal eye twitching;
• decreased muscle tone;
• increased tendon reflexes;
• coordination problems.

The main goal of instrumental diagnostics is to exclude or identify more severe damage to the brain substance.

• Neurosonography. Performed on children under two years of age: using ultrasound through the large fontanelle, the doctor evaluates the structures of the brain, the presence or absence of pathological signals. Also, this method can identify signs of increased intracranial pressure during a concussion.
• Echoencephalography. It is a less informative diagnostic method. It is used to determine the displacement of the midline formations of the brain, which indirectly confirms the presence of a hematoma. Electroencephalography is used to determine the severity of head injury.
• Radiography. Recommended in all cases to avoid damage to the cranial bones and cervical vertebrae.
• Computed and magnetic resonance imaging. They are the most accurate research methods. They are justified if more severe damage to the brain substance is suspected and in clinically unclear situations.

Thus, the presence of a head injury in a child and objective signs of a concussion require a mandatory examination by a doctor. Also, to exclude complications of TBI, additional instrumental diagnostics are necessary.

Therapy

Immediately after an injury, the child should be kept at rest and seek medical help as quickly as possible. If the baby is unconscious, he should be turned on his side. It is not recommended to self-administer any painkillers.

After examination by specialists and diagnostic measures, the issue of hospitalization in a neurological or neurosurgical department is decided. Treatment of a concussion in a preschool child is usually carried out inpatiently. This is necessary in order to monitor the condition of the little patient around the clock and prevent possible complications. In addition, being in the department guarantees psycho-emotional and physical peace, which is very important in the first days after an injury.

For therapeutic purposes the following are prescribed:

• analgesics;
• potassium salts;
• diuretics (“Diacarb”, “Furosemide”);
• medications that have a sedative effect;
• drugs that improve metabolic processes (“Actovegin”, “Solcoseryl”);
• medications that affect microcirculation;
• antihistamines.

Typically, the duration of hospital treatment does not exceed seven to ten days. After discharge from the hospital, nootropics (Encephabol) and multivitamin complexes are prescribed.

At home, it is imperative to limit the child’s physical activity, exclude sports, as well as games with jumping, running and falling on the floor. It is also recommended to reduce TV and computer viewing as much as possible. An outpatient treatment regimen is recommended for two weeks. Physical activity is contraindicated for at least a month after discharge from the hospital.

What to do if your baby gets a TBI and stays home

The best option, of course, is hospitalization in a neurosurgical or trauma department. However, quite often situations arise when a child is at home after an injury. This happens when parents do not know how a concussion manifests itself or refuse hospitalization.

In addition, not all cases of TBI symptoms can be identified immediately after the injury. In some situations, dynamic monitoring of the child is required to exclude or confirm the diagnosis. Monitoring the baby’s well-being is necessary for at least 12-24 hours.

In such cases, a number of indicators of the child’s condition should be checked.

• The child's reaction to external stimuli. With a traumatic brain injury, the reaction is slow and sluggish.
• If the child falls asleep immediately after the injury. He should be awakened (even at night) every two hours to assess his consciousness.
• How it reacts to light. In the absence of a TBI, the baby actively opens his eyes, the pupils are the same size and narrow when exposed to bright light. If one pupil is larger, this may indicate the presence of intracranial hemorrhage.
• Having a headache. Evidence in favor of a concussion.
• Nausea or vomiting. Symptoms may occur several hours after the injury occurs. Characteristic of concussion or more severe TBI.
• Feeling of "crawling" or numbness. The baby may complain of such unpleasant sensations in one or more limbs. This symptom can also be an indirect sign of TBI.

A characteristic sign of concussion in young children is an increase in the severity of symptoms. If in the first hours after hitting the head the child’s condition remains satisfactory, then it may subsequently worsen, which is an ominous sign and requires an immediate call to the doctor.

What could be the consequences?

The prognosis for mild TBI is favorable. Sometimes trauma causes a mild asthenic state, attention deficit disorder, and vegetative-vascular disorders. Headache after an injury can bother a child for six months. In such cases, observation by a pediatric neurologist is indicated with the prescription of appropriate treatment.

Very rarely, epileptic syndrome develops after TBI. Such consequences of a concussion in a child often occur when the severity of the injury is underestimated, as well as the lack of adequate therapy and non-compliance with bed rest in the first three to four days after the injury.

Prevention of concussion in children involves constant monitoring by adults. Older children need to be explained the rules of behavior on the road, during play and sports training. If a child receives a head injury, they must inform their parents.

Children's increased activity, curiosity and restlessness, combined with imperfect coordination and a decreased sense of danger, explain the frequency of child injuries. Moreover, young children have not yet acquired the skill of supporting their heads with their hands, so the consequence of blows and falls in children is often a concussion.

SHM is the most common type (90%) of traumatic brain injury (TBI) in children. 120 thousand children in Russia are hospitalized annually with a concussion in a hospital.

Among all TBIs, concussion is a mild form, but this injury can lead to complications.

Causes

Children often fall and may suffer head injuries.

The frequency of TBI and the reasons for their occurrence are specific to each child’s age. Thus, newborns account for 2% of all cases of childhood TBI, infants – 25%, toddlers – 8%, preschool children – 20%, schoolchildren – 45%.

It is clear that infants and infants receive TBI due to the oversight or carelessness of their parents, falling from the changing table, from the stroller, and even from the hands of their parents. After a year of starting to walk, a baby may be injured when falling from his own height, and a little later when falling from a slide, ladder, swing, from a window, from a tree, etc.

Moreover, the fact of injury is not always known to parents if the child remained under the supervision of relatives, nannies, older children, or employees of preschool institutions. Older children themselves may, for whatever reason, hide the fact of a fall.

It should also be remembered that brain injury can occur without a direct blow to the head. We are talking about the so-called “shaken baby” syndrome.

SHM can occur during sudden braking or acceleration of the body when running, when jumping from a height and landing on the feet, and even during intense rocking of the baby.

Signs of a concussion

The symptoms of FMS in children differ from those in adults (loss of consciousness, nausea, dizziness, headache, vomiting, memory loss, etc.). The children's brain has distinctive features. For this reason, children rarely present with the classic signs of FMS seen in adults.

The younger the child, the fewer obvious symptoms of a concussion. In children, loss of consciousness occurs only in rare cases.

Characteristics of SGM for young children will be:

• anxiety;
• causeless crying;
• regurgitation (or repeated vomiting);
• loss of appetite;
• pale skin;
• bulging fontanel in infants;
• sleep disturbance (drowsiness or poor sleep).

For school-age children, the clinical symptoms of SHM are as follows:

• loss of consciousness is more common;
• in some cases, amnesia (loss of memory for the circumstances of the injury) is possible;
• nausea;
• vomiting (may be repeated);
• headache (to varying degrees);
• slow or rapid heart rate;
• instability of blood pressure;
• pronounced pallor;
• sweating;
• disturbed sleep (insomnia or drowsiness);
• irritability or apathy;
• tearfulness and whims.

Sometimes after an injury or a little later, children experience post-traumatic blindness, lasting from several minutes to several hours, which then disappears on its own. More often, this symptom appears after a blow to the occipital region of the head, where the visual center is located.

One of the features of the symptoms of BMS in a child is that they may not occur immediately, but after some time (from several hours to several days). In this case, symptoms can increase very quickly.

When a child is injured, it is difficult to determine whether there has been brain damage. Even imaginary well-being for a long time does not exclude the presence of an internal hematoma, manifested by a progressive deterioration of the condition in the future.

Considering these features of the clinical manifestations of TBI in children, it is necessary to consult a doctor at the slightest suspicion of injury, even with mild symptoms, without complicating the situation.

The danger with SHM is not the pain from bruising the soft tissues of the head, but the possible deep-seated damage to the nervous system. An internal hematoma (bleeding) that occurs in the brain tissue poses a greater danger than in an adult.

In such cases, children are examined by a pediatric traumatologist (or neurosurgeon) and a pediatric neurologist.

If necessary, doctors prescribe additional examination methods:

• neurosonography (ultrasound of the brain) – for young children (up to 2 years);
• echoencephalography (after 2 years);
• CT scan of the brain;
• lumbar puncture;
• electroencephalography.

To identify occult skull fractures, a skull x-ray is prescribed.

Here's what experts say about concussions in children and first aid for injuries:

Head injury in a child: what to do? Advice for parents - Union of Pediatricians of Russia.

Summary for parents

If a child has a head injury, you should not try to make a diagnosis on your own or rule out a concussion. Moreover, you should not hope that a child who has been injured will “take it easy and everything will pass.” It is better to consult with specialists without delay. With timely diagnosis and treatment, concussion has a favorable outcome.

Which doctor should I contact?

If the child has a head injury or bruise, he should be shown to a neurologist, especially if his condition has changed and complaints have appeared. If this is not possible, you need to contact the pediatrician observing the child. Additionally, consultation with a traumatologist and neurosurgeon is often required.

Children are unable to sit still - they climb into hard-to-reach places, climb onto heights, and are therefore susceptible to injury. Even the most attentive parents may not notice how the baby hits his head. Traumatic brain injury is a condition that requires immediate hospitalization, because a concussion in a child - not every adult can identify the symptoms and signs. If the pathology is not noticed in time, the baby will have serious health problems later.

What is a concussion

Reversible damage to the brain caused by trauma is called a concussion. Doctors believe that this condition is based on a functional disruption of communication between nerve cells. In terms of frequency of occurrence, concussion ranks first among all head injuries. In the structure of childhood injuries, this condition accounts for 65% of all cases. According to statistics, closed craniocerebral injuries are more often observed under the age of 5 years and after 14.

How to determine a concussion in a child

After a head injury, it is important to provide your child with timely medical care. Symptoms of concussion in children manifest themselves differently, depending on the severity of the disease: mild, moderate, severe. Nature has made sure that the child’s brain is protected from damage, therefore, when in contact with heavy objects, the bones of the skull are cushioned, since they are mobile and strong.

Thanks to this, most injuries do not have negative consequences, especially in one-year-old children, whose body weight does not create strong inertia. However, with a significant impact, a child of any age can suffer a traumatic brain injury (TBI). The smaller the baby, the more difficult it is to identify his disease, because children react differently to irritating factors. Parents should be attentive and have information: if a child has a concussion, what are the symptoms?

Symptoms

Regardless of age, body temperature does not change during TBI. Symptoms of a concussion in a newborn child are minor: sleep disturbance, excessive regurgitation that lasts no more than 3 days. In older children, after a blow, the following conditions may immediately appear:

• pallor of the skin will be sharply replaced by facial redness (erythema);
• repeated or single vomiting;
• temporary desynchronization of pupil movement (astigmatism);
• there is no consciousness;
• fast or slow heart rate;
• nose bleed;
• shortness of breath;
• lack of pupillary response to stimuli.

Headache

With timely and proper treatment of a concussion, all the symptoms that arise quickly pass, but the headache can remain for a long time. The problem with young children is that they cannot tell what is hurting them, so even if there are no obvious symptoms, you should see a doctor. Teenagers may remain silent about the injury, fearing parental anger, but if their headache does not go away within 1-2 days, and is also accompanied by dizziness, this fact should alert them.

Signs

Any pediatrician knows how a concussion in a child manifests itself - often they are not detected immediately after the blow. Sometimes you can get a TBI for no reason, when your child suddenly starts or slows down. In medicine, this term is called “shaken baby syndrome.” The causes of concussions are fights, falls from bicycles and other vehicles, and jumps from heights. Excessive activity often results in head injury. In infants, illness often occurs due to parental oversight. Let's look at the most important signs of a concussion in a child.

Pupils during a concussion in a child

Direct confirmation of a concussion is the size of the pupils. They can be of different shapes, expanded or narrowed. The pupils react normally to light, and the affected child may not even feel any symptoms, but the doctor will notice an abnormal reaction. It’s worse if they are different sizes - this indicates a severe brain injury. Dilated or constricted pupils are associated with intracranial pressure, which affects the nerve centers that regulate contraction of the eyeball.

If a concussion in a small child causes symptoms of nausea and vomiting, then you need to apply ice to the site of the injury and call an ambulance or take yourself to the hospital. The baby may vomit the contents of the stomach through the mouth once or repeatedly with some breaks. At the same time, tears and saliva are released, and breathing quickens. The reason is impaired blood circulation in the vestibular apparatus and the vomiting center, which experiences irritation upon impact.

Signs in a baby

A newborn baby cannot complain about his health, therefore, the sooner a concussion is diagnosed, the sooner hemorrhage can be avoided. Signs of a concussion in an infant are primary and secondary. With a slight bruise, the child experiences motor activity, becomes agitated and screams. Secondary signs, when the baby refuses to eat, becomes lethargic and inactive, indicate severe injury. A doctor will make a diagnosis of a concussion based on even one of the above factors:

• vomiting that occurred more than 2 times;
• short-term or long-term loss of consciousness;
• anxiety, poor sleep.

Danger signs that may indicate a serious traumatic brain injury in an infant:

• a sharp decrease in the newborn’s reflexes;
• oculomotor disorders;
• bulging or swelling of the fontanel area;
• constant sleep;
• refusal to eat.

The first signs of a concussion in a child

When the brain is damaged, a child of any age immediately loses orientation in space and his ability to concentrate his gaze is turned off. At such moments, the eyes move involuntarily. The patient becomes lethargic and wants to sleep constantly, regardless of the time of day. With TBI, children typically experience headache, dizziness, nausea, and vomiting. Frequent signs of a head injury are increased sweating, weakness, increased blood pressure, and rapid pulse.

Skin changes

Parents should be wary of the pallor of the skin and lack of elasticity. This is one of the most important symptoms that appears immediately. First, the epidermis turns pale on the face, then on the limbs. The skin may take on a greenish or blue tint and appear transparent. Capillaries are clearly visible on the legs and arms. Pallor is often accompanied by increased sweating - this is a particularly alarming signal, indicating that the baby’s condition is deteriorating.

How to diagnose a concussion in a child

It is necessary to immediately identify the presence of bumps, hematomas, fractures, and detect signs of cerebral edema in order to avoid serious consequences. This requires different diagnostic methods. The procedure for a standard examination of a sick child, which is used in the hospital:

• consultation with a traumatologist and neurologist;
• the doctor determines intracranial pressure with an ophthalmoscope;
• X-rays of the brain and computed tomography are prescribed;
• after examination and history taking, the specialist conducts echo-encephalography, neurosonography, electroencephalography or MRI.

Depending on the severity of the brain damage, after the diagnosis is made, the issue of hospitalization of the baby is decided. If no serious injuries are detected, then the duration of hospital stay is 4 days. In case of severe injury, the minimum stay of the child in the hospital is one week. The consequences of a concussion can only be treated with medication. The child is prescribed:

• diuretics: Diacarb, Furosemide;
• potassium-containing medications: Asparkam, Panangin;
• sedatives: Phenazepam, valerian tincture;
• antihistamines: Diazolin, Suprastin;
• painkillers: Baralgin, Sedalgin.

After leaving the hospital, the baby should receive additional treatment at home. This is taking nootropic drugs and vitamins prescribed by a doctor. A prerequisite is bed rest for 14 days after discharge from the hospital. The child should not overexert himself. You will have to change your usual lifestyle during rehabilitation - reduce the amount of time you watch TV and limit the amount of time you spend on the Internet. If symptoms return, you need to see your doctor again. Headaches, drowsiness and malaise should not be felt after the course of treatment.

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It is important to know what the symptoms of a concussion are in children, because children are in constant motion, playing all kinds of outdoor games. It also happens that entertainment becomes unsafe and threatens to cause some kind of injury. Physical activity goes hand in hand with this injury and therefore every parent must know how to recognize them in a timely manner.

Causes of concussion

The reason for the high percentage of concussions among children is the fact that a child's skull weighs more than an adult's skull. That's why children fall headfirst more often. The reason for this is the weight ratio between the head and torso. Another cause of concussion in children can be the inattention of young parents.

The percentage of concussions in children under one year of age is 2%. Infants fall more often and statistics show that they account for 20-25%. Common causes are falling from a crib, stroller, or even parental arms, in particular.

If the baby has “grown out of diapers,” then this is not a reason to loosen control. Preschool and school age are the most dangerous for children. It is dangerous, first of all, because parents are the last to know about poor health, and the symptoms of a concussion in children are not immediately noticeable. Sometimes children hide the fact of falling or hitting their head.

There is a definition for concussion in children - shaken baby syndrome. Unsuccessful acceleration or braking is enough to injure the brain. For newborns, severe motion sickness is sufficient.

3 degrees of concussion

First degree

Injury to the brain structure or a mild form, which is characterized by confusion without loss of consciousness. Brief vomiting is possible.

Second degree

With a moderate form of damage, fractures and bruises of the skull may occur. They are accompanied by a prolonged disturbance of consciousness lasting up to several hours, inhibition, agitation, and disorientation.

Third degree

Brain contusions with hematoma formation and skull fracture. The third degree is characterized by loss of consciousness. Loss of consciousness can last from several minutes to half an hour to 6 hours. Additionally, there is increased drowsiness, alternating with agitation, stupor and disorientation.

All the symptoms of a concussion in children

In newborn babies, symptoms appear immediately. The same cannot be said about preschoolers and schoolchildren. Their symptoms may only become apparent 3-4 days after the head hit.

The first signs of a concussion

Concussion in children has different symptoms and if not treated promptly, it can lead to serious complications.

Symptoms are similar to many other diseases:

• pale skin,
• constant crying
• restless sleep,
• vomit,
• after feeding.

Late concussion symptoms

The symptoms of concussion in children are slightly delayed. Signs of brain injury may not appear immediately after the injury. Symptoms appear later and develop at breakneck speed in terms of deteriorating the child’s well-being.

If a child gets up after a fall and runs to continue playing, this does not mean that the threat has passed.

For some time after a fall sufficient to cause a bruise, it is worth observing his condition. Regarding behavior, there are a couple of signs of a concussion::

• poor appetite
• lethargy,
• mood swings,
• whims,
• touchiness,
• tearfulness.

When to sound the alarm

At any age, when the brain is damaged, orientation in space and the ability to concentrate are lost. At such moments the eyes move involuntarily. The patient wants to sleep all the time, no matter what time of day.

When a child has a concussion, symptoms can vary. Children mostly experience:

• headache,
• nausea,
• dizziness and vomiting.

Increased heart rate, high blood pressure and increased sweating are also signs of a head injury.

A disorder that requires an immediate call to help is loss of vision. Blindness can occur either immediately or after some time.

Vision will return over time. The duration of post-traumatic blindness varies from 10 minutes to 3-4 hours.

How to help your child while waiting for a doctor

The first action will be to call an ambulance. The specialist will give an accurate assessment of the patient’s health status.

As first aid In case of a concussion, care should be taken to:

1. the child was in a stable position,
2. Apply a cloth soaked in cold water to the injury site,
3. don't leave the baby's side
4. It is not recommended to sleep for at least an hour after receiving a bruise,
5. If the child has lost consciousness or is vomiting, then you need to put him on his side.

Diagnosis of concussion

Many parents whose children were hospitalized with a similar diagnosis complain that doctors are sometimes negligent.

To prevent such treatment of a sick child parents should know the procedure for standard examination in the clinic:

• Upon admission to the hospital, the patient is interviewed by 2 specialists - a neurologist and a traumatologist. The child is asked what he is complaining about. Parents are asked how the child was injured;
• After completing the survey, the specialist examines the patient. Using an ophthalmoscope, the doctor determines the pressure inside the skull. Along with this procedure, computed tomography and radiography of the brain are prescribed;
• At the end of the general examination and history taking, the specialist doctor conducts the following studies: neurosonography, echo-encephalography, MRI or electroencephalography.

Used as a diagnostic method to identify pathology in children under two years of age. It is used to determine the presence or absence of swelling, hemorrhages, bruises and hematomas in the brain. The procedure is painless and has no contraindications.

Ultrasound examination is carried out in any children's clinic. Electroencephalography will allow specialists to determine the source of pathology based on readings of the bioelectrical activity of nerve cells in the brain.

The presence of a hematoma or other formation in the brain is determined using echo-encephalography. MRI is a long-term method of studying the child’s health status relative to the length of the procedure. This makes it more difficult if the patient is a child. In this case, the little patient is given anesthesia.

Proper treatment of concussion in children is prescribed only by a specialist. An exception is made when there is bleeding.

In this matter, parents will have to take the initiative into their own hands, without waiting for the doctor to arrive. The wound is treated, after which a sterile bandage is applied.

Depending on the severity of the injury, the question of whether the child should be hospitalized will be decided. The duration of hospitalization is 7 days.

This period is reduced to 4 days if a computed tomography scan was performed, the results of which did not reveal serious damage.

Timely detection of symptoms of concussion in children will significantly reduce the negative impact of injury on the child’s body.

Treatment in a hospital setting

A week in hospital conditions will benefit the child. The consequences of a concussion are treated exclusively with medication.

The child is prescribed diuretics:

• Furasemite,
• Diacarb.

These drugs flush potassium from the body. Drugs that replenish potassium levels - Panangin or Asparkarm. Treatment with these drugs will remove the symptoms of concussion in children, in particular its swelling.

To control motor activity, a sedative group of drugs is prescribed:

• Phenozepam,
• Infusion of valerian root.

Antihistamines, an alternative to sedatives:

• Suprastin,
• Diazolin.

If signs of a concussion the child manifests itself in the form of headaches and nausea:

• painkillers - Sedalgin or Baralgin.
• for nausea - Cerucal.

Treatment at home

Having received appropriate treatment, the child is removed from inpatient observation. Residual concussion - treatment at home involves taking vitamin complexes and nootropic drugs prescribed upon discharge from the hospital.

After a concussion, you should not overexert yourself for a long time. You will have to change your usual lifestyle - reduce the amount of time you spend walking and watching TV.

Bed rest remains mandatory for 14 days, even after discharge from the hospital. If symptoms recur, you should see a doctor. Weakness, drowsiness and headaches should not appear after treatment in the hospital.

Consequences of concussion in children

The consequences that arise as a result of improper treatment are highlighted. They are characterized by the same symptoms as those that occur in the case of a concussion.

If your child is worried about insomnia, poor appetite, headaches, or nausea, you should immediately consult a doctor.

The main consequences include:

• weather dependence,
• impaired concentration,
• constant headaches,
• epilepsy,
• brain tumors.

If you notice unusual symptoms after your baby falls, or changes in his behavior, do not let it get away with it. Symptoms of a concussion that are not detected in time can lead to extremely negative consequences. From long-term treatment to incomplete recovery of the child.

Concussion is one of the most common diagnoses in pediatric traumatology. Overall, traumatic brain injury (TBI) ranks first among all childhood injuries requiring hospitalization. Approximately 120 thousand children with concussion are admitted to Russian hospitals every year.

According to the severity, traumatic brain injury is divided into mild (concussion), moderate (mild to moderate brain contusion, with possible fractures of the cranial vault) and severe (severe brain contusions, intracranial hematomas with compression of the brain, fractures of the base of the skull). Fortunately, up to 90% of childhood TBIs are concussions, which is what this article will discuss.

The high level of injuries in children is explained by the child’s increased motor activity, restlessness and curiosity, which is combined with imperfect motor skills and coordination of movements, as well as a reduced sense of danger and fear of heights. In addition, in young children, the head has a relatively large weight, and the skill of belaying with hands has not yet been developed, so small children, as a rule, fall upside down and do not use their arms.

The causes of childhood TBI are very specific to each age group. Newborns in the total number of victims make up 2%, infants - 25%, toddlers - 8%, preschool - 20% and school-age children 45%.

Injuries in infants are primarily the result of the inattention and carelessness of their parents. Children under 1 year of age most often (more than 90%!) receive head injuries after falling from changing tables, beds, from parents' arms, from strollers, etc. You should never leave your baby alone in a place where he could fall. If you need to move away from your child at a distance greater than an outstretched hand, do not be lazy, put him in a crib, in a stroller with sides, in a playpen! One or two seconds is enough for the baby to roll to the edge of the changing table and fall.

Beginning from 1 year babies begin to walk. The main cause of TBI is a fall from one’s own height, and a little later - falls from stairs, trees, roofs, windows, slides, etc. The episode of TBI itself cannot always be identified. It should be borne in mind that if the child remained under the supervision of relatives, neighbors or a nanny, then they can hide from the parents the fact that the baby fell.

Older children For various reasons, they themselves often hide the trauma. In addition, children may experience brain damage without direct head trauma. These injuries usually occur when a child's body is subjected to sudden acceleration or deceleration (shaken baby syndrome). Shaken baby syndrome is most commonly observed up to 4-5 years of age and can occur with rough handling, jumping from heights, and in young children even with excessively intense motion sickness.

Signs of a concussion

With a concussion, there are no gross, irreversible changes in the brain, and such an injury, being the most common, has the best prognosis and very rarely leads to complications.

It should be remembered that the brain of a child (and especially an infant) is significantly different from the brain of an adult. The course of a concussion in adults differs significantly from the course of this injury in a child.

In adulthood, a concussion is manifested by the following main symptoms: an episode of loss of consciousness from a few seconds to 10-15 minutes; nausea and vomiting; headache; amnesia (loss of memory) of events associated with the trauma (before the trauma, the trauma itself and after the trauma). In addition, some specific neurological symptoms are detected, such as nystagmus (twitching of the eyeballs), impaired coordination of movements and some others. The picture of a concussion in a child is completely different.

In children up to 1 year A concussion, as a rule, is asymptomatic. Loss of consciousness often does not occur, single or repeated vomiting, nausea, regurgitation during feeding, pale skin, causeless restlessness and crying, increased drowsiness, lack of appetite, and poor sleep are noted.

In children preschool age More often it is possible to establish the fact of loss of consciousness, nausea and vomiting after injury. They experience headaches, increased or slow heart rate, instability of blood pressure, pale skin, and sweating. In this case, moodiness, tearfulness, and sleep disturbance are often noted.

Sometimes children experience a symptom such as post-traumatic blindness. It develops immediately after the injury or a little later, persists for several minutes or hours, and then disappears on its own. The reason for this phenomenon is not completely clear.

The characteristics of a child’s body lead to the fact that a long-term state of compensation can be replaced by a rapid deterioration of the condition. That is, immediately after the fall the child feels satisfactory, but after a while symptoms appear and begin to rapidly increase.

First aid for TBI

What should parents do if their child has suffered a traumatic brain injury? There is only one answer - the child should definitely and urgently be shown to a doctor. It is best to immediately call an ambulance, which will definitely take the child to a hospital with pediatric neurosurgeons or neurologists. And this measure is not unnecessary. With minimal symptoms and complaints, the baby may have severe brain damage. The long-term visible well-being of the child, the absence of symptoms, especially with hemorrhages in the brain, often after a few hours and even days is replaced by a progressive deterioration of the condition, which begins with a change in the child’s behavior, his increased excitability, there may be nausea, vomiting, nystagmus, and in infants the fontanelle bulges , then drowsiness appears, depression of consciousness is observed.

Diagnosis of concussion

In the hospital, the child is examined by a pediatric neurologist, neurosurgeon or traumatologist. He carefully ascertains complaints, collects anamnesis (history of the disease), and conducts a general and neurological examination. Additional diagnostic methods are prescribed. The main ones are skull radiography, neurosonography (in young children), echo-encephalography (Echo-EG). If necessary, computed tomography of the brain (CT), magnetic resonance imaging (MRI), electroencephalography (EEG), lumbar puncture.

Radiography skull is performed in most patients. The purpose of this study is to identify skull fractures. The presence of any damage to the bones of the skull automatically transfers the injury to the category of moderate or severe (depending on the condition of the child). Sometimes in young children with a favorable clinical picture, linear fractures of the skull bones are revealed on radiographs. It is impossible to judge the state of the brain substance from radiographs.

Neurosonography(NSG) is an ultrasound examination of the brain. Neurosonograms clearly show the substance of the brain and the ventricular system. You can identify signs of cerebral edema, areas of contusion, hemorrhages, and intracranial hematomas. The procedure is simple, painless, quickly performed, and has no contraindications. It can be done multiple times. The only limitation of neurosonography is the presence of so-called “natural ultrasound windows” - a large fontanelle or thin temporal bones. The method is very effective in children aged up to 2 years. Later, ultrasound becomes difficult to pass through the thick bones of the skull, which dramatically degrades image quality. Equipment for performing neurosonography is available in most children's hospitals.

Echo-encephalography(Echo-EG) is also an ultrasound research method that allows you to identify displacement of the structures of the midline of the brain, which may indicate the presence of additional space-occupying formations of the brain (hematomas, tumors), and provide indirect information about the state of the brain substance and the ventricular system. This method is simple and fast, but its reliability is low. Previously, it was widely used in neurotraumatology, but with the availability of modern diagnostic tools, such as neurosonography, computed tomography and magnetic resonance imaging, it can be completely abandoned.

The ideal method for diagnosing brain damage and diseases is CT scan(CT). This is an x-ray research method in which high-definition images of the skull bones and brain matter can be obtained. CT can diagnose almost any damage to the bones of the vault and base of the skull, hematomas, bruises, hemorrhages, foreign bodies in the cranial cavity, etc. The accuracy of this study is very high. Its main disadvantage is that the CT machine is expensive, and not every hospital has it.

Magnetic resonance imaging(MRI) is the most accurate, but complex and expensive method of examining the central nervous system. It is rarely used to diagnose acute traumatic brain injury because it does not allow the bones of the skull to be seen, is less accurate for recognizing acute hemorrhages, takes longer than computed tomography, and often requires anesthesia when examining small children - the child must lie absolutely still for 10 -20 minutes, but small children cannot do this; In addition, very few clinics can boast of having magnetic resonance imaging scanners.

Electroencephalography(EEG) allows you to study the bioelectrical activity of the brain. It is used for special indications to assess the severity of traumatic brain injury and identify foci of epileptic activity. The focus of epiactivity is an area of ​​the cerebral cortex with pathologically altered activity of neurons (nerve cells), which can lead to epileptic seizures.

Lumbar puncture- this is the collection of cerebrospinal fluid (the fluid that washes the brain and spinal cord) from the spinal canal at the lumbar level. Changes in the cerebrospinal fluid may indicate injury or hemorrhage (the presence of blood) or an inflammatory process, meningitis. Lumbar puncture is performed extremely rarely and only for special indications.

Concussion treatment tactics

After the baby has fallen, before the doctor examines him, helping the child is to create a calm environment. You need to put the baby to bed and provide him with peace. If there is bleeding from the wound, treat it and bandage it if possible.

In addition to diagnostic procedures, the hospital’s emergency room treats injuries to the soft tissues of the head (bruises, abrasions, wounds). Children, especially young children, with a confirmed traumatic brain injury, including a concussion, are subject to mandatory hospitalization.

Hospitalization has several purposes.

Firstly, for several days the child is under the supervision of doctors in a hospital setting for early detection and prevention of complications of injury - cerebral edema, the appearance of intracranial hematomas, epileptic (convulsive) attacks. The likelihood of these complications is low, but their consequences are extremely severe and can lead to a catastrophically rapid deterioration of the child’s condition. Therefore, for a concussion, the standard hospitalization period is a week. With good technical equipment of the hospital (computed tomography, neurosonography), which makes it possible to exclude more severe brain damage, the length of stay in the hospital can be reduced to 3-4 days.

Secondly, during hospitalization the patient is provided with the creation of psycho-emotional peace. This is achieved by limiting the child’s motor and social activity. Of course, it is difficult to achieve complete bed rest for children, but still, hospital conditions do not allow running around, noisy games, watching TV for a long time, or sitting at the computer. After discharge, the home regimen is maintained for another 1.5-2 weeks; sports activities are limited for several weeks.

Drug therapy for concussion has several goals. First of all, the child is prescribed diuretics (most often DIACARB, less often - FUROSEMIDE) in mandatory combination with potassium drugs (ASPARKAM, PANANGIN). This is done to prevent swelling of the brain. Calming therapy is carried out (PHENOSEPAM, VALERIAN ROOT INDUSTRY) and antihistamines are prescribed (SUPRASTIN, DIAZOLIN, DIMEDROL). For headaches, analgesics (BARALGIN, SEDALGIN) are prescribed, and for severe nausea - CERUKAL. At a later date, nootropic drugs that improve metabolic processes in the brain and vitamins may be prescribed.

Monitoring of the children's condition is carried out by the attending and duty doctors, as well as by guard nurses. In case of any deterioration, the child is re-examined and additional diagnostic tests (neurosonography, computed tomography, EEG) are prescribed.

When suggesting going to the hospital, the doctor first of all takes care not to miss a more severe injury than a concussion, and this is only possible with qualified supervision of the child.

If the baby’s condition is satisfactory, after a few days the parents can take him home with a signature. However, at home it is also necessary to observe a therapeutic and protective regime, limit watching TV, playing on the computer, walking, visiting friends, and continue drug therapy. If there is any suspicion of a deterioration in the child’s condition (the appearance of nausea and vomiting, headaches, unmotivated drowsiness, convulsive attacks, the appearance of weakness in the limbs, frequent regurgitation in babies), you should immediately consult a doctor again for further examination and possible hospitalization.

As a rule, after 2-3 weeks the child’s condition completely returns to normal. A concussion usually resolves without consequences or complications. The child can again attend nursery and kindergarten and play sports.

In conclusion, it is once again necessary to emphasize the importance of promptly visiting a specialized children's hospital, which will eliminate more severe forms of traumatic brain injury.