Concussion can affect children not only on the school sports field, but in car and bike accidents, and even in what we like to think of as the safety of our homes. One in three children admitted to the Red Cross Children's Hospital has been in a fall – often off beds and playground equipment, even out of the arms of caregivers. A number involve concussion.
What is concussion?
Concussion is bruising of the brain against the skull that can cause long-term changes affecting thinking and the emotions. And children are at greater risk than adults, says Dr Kevin McEwen, head of the trauma unit at St Augustine's Hospital in Durban. “Their skulls are still soft and malleable, providing less protection, and their heads make up a greater proportion of their body mass, making them more susceptible to injury.”
The trouble is, it's not possible to fix injured brains the way we fix broken bones. And X-rays may not detect concussion – a CT scan may be needed to determine if there is bleeding or swelling of the brain.
Spot concussion symptoms
Many parents don't realise that a child does not need to be knocked out to have a concussion – in fact, only about 8% of cases involve loss of consciousness. The child doesn't even need to have a blow directly to the head – a blow to the face, neck or body that causes a sudden jarring of the head can be enough.
What you need to be aware of is the symptoms of concussion. These include nausea and vomiting, convulsions, headache, dizziness, vision problems (light sensitivity, blurriness, seeing double or seeing stars), ringing in the ears, stomach pain and sleepiness.
The child may also have poor coordination or balance, appearing clumsy or limping, and have slurred speech, be slow to answer questions, struggle to concentrate, and express strange or inappropriate emotions, from irritability to laughing or crying – or even odd silence. “Crying is appropriate after a fall or accident,” says Dr McEwen. “Worry if a child is quiet.”
If a child is unconscious, make sure his air passages are open (use a finger to sweep his mouth clear), says registered nurse Jenny Bekker, former skills resource manager of the SA Red Cross Society. Loosen tight clothing, and if he battles to breath, give mouth-to-mouth resuscitation.
Suspect concussion if he displays the symptoms listed above, or if he has even partial loss of consciousness, is pale and clammy, breathes shallowly or has a weak pulse, says Dr McEwen.
Treat for shock: comfort him and keep him lying still, preferably in the recovery position – on his left side, knees bent – to prevent choking. If he could have a neck or back injury, don't move him or a helmet, if he is wearing one – call an ambulance and wait for paramedics to arrive.
How your child will be treated
Concussion can impair blood flow and glucose delivery to the brain, which needs energy to function properly and heal itself. This means the most important treatment for concussion is rest, says Dr McEwen.
After being monitored in hospital and released home, the child should not exercise, go to school or even read, play video games or work on a computer – or symptoms can last longer and worsen. Symptoms may last anything from a few days to many months, and if the child has had previous concussions, or experiences stress, they may take longer to heal.
When can your child resume activities?
Only when the last symptoms have gone and the child is given the all-clear by a doctor should he resume normal activities. Depending on the severity of the concussion, he could start by returning to school part time to see how he manages.
Inform teachers and caregivers that your child has suffered concussion, and share the telephone number of your doctor and the nearest emergency department. If your child experiences a sudden recurrence of symptoms, or has a seizure, excessive irritability, visual or balance problems, they need to get help immediately.
If he plays rugby, also share the number of the ER Emergency Contact Centre Concussion Hotline/BokSmart Spineline – a dedicated emergency helpline operating countrywide for potential serious concussion, head, neck and spine injuries sustained during a rugby match or practice: 0800 678 678.
For going back to sport such as rugby, BokSmart advises the 'step-wise' approach:
- Complete rest.
- Light exercise such as walking for 10 minutes.
- A sport-specific activity, such as running for 20 minutes, without contact.
- On field practice such a ball drills, still without contact.
- On field practice with body contact, if approved by a doctor.
- Playing again.
Each step should take at least one day, and if any concussion symptom recurs, such as a headache or nausea, the child should stop, wait another day or two, and go back to the previous step.
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