A concussion is an injury to the brain. It is caused by a fall or by a blow on the head from a blunt object. In many ways, a concussion is like a bruise of the brain. There is swelling in the brain, and sometimes blood escapes into the brain tissue. Since a concussion is an injury to the brain matter itself, it may occur even if the skull is not fractured. Concussions range from mild to serious.
Most children suffer one or more blows to the head at some time during childhood. Typical reactions to head injuries are immediate crying, headache, paleness, vomiting once or twice, a lump or cut at the site of injury, and sleepiness for one or two hours. These are not the signs of a concussion; they are usual reactions to a blow on the head.
Signs and symptoms
Any of the following are signs of a possible concussion: unconsciousness at the instant of the injury; no memory of the accident or of events that occurred before the accident; confusion (child doesn’t recognize parents or know his or her own name); persistent vomiting; inability to walk; eyes not parallel; pupils of different sizes (note: some children have unequal pupils normally); pupils that do not become smaller when a bright light is shined into the eyes; blood coming from the ear canal; bloody fluid which does not clot coming from the nose; headache that continues to become more severe; stiff neck (the chin cannot be touched to the chest with the mouth closed); increasing drowsiness; slow pulse (less than 50 to 60 beats per minute); and abnormal breathing.
There are two rare forms of concussion in which symptoms do not develop until hours after the injury (called epidural bleeding) or until days or weeks afterward (called subdural bleeding).
Home care
If the child shows any of the signs of a concussion, see your doctor.
If there are no signs of a concussion, or if you are waiting to see the doctor, have the child rest in bed. Bed rest is the most essential treatment for a head injury that does not penetrate the skull. Keep the child lying quietly, with the head on a pillow. Check the child frequently. The child may sleep but must be wakened every hour so that you can check on the child’s condition until he or she feels well. Keep the child in bed until at least one day after the child seems fully recovered. Give only aspirin or paracetamol for headache.
Precautions
• Do not attempt home treatment if there are any signs of concussion.
• Do not treat a head injury at home if the scalp is depressed (pushed in) at the site of injury or if a gentle tapping of the skull produces the dull sound of a broken melon. (These symptoms rarely, if ever, occur without other signs of concussion.)
• Do not give pain killers, sedatives, or any medication stronger than aspirin or paracetamol to a child with a head injury.
Medical treatment
Your doctor may or may not order X rays of the skull. Your child may be hospitalized for observation. A CAT scan may be useful. A CAT (computerized axial tomography) scan gives three-dimensional X rays of the brain. Echoencephalogram, electroencephalogram, and spinal tap tests are sometimes helpful. If the concussion is serious, your doctor may consult a neurosurgeon (a specialist in the brain and nervous system).
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