Concussion in children - a mild degree of TBI, accompanied by minor functional disorders of a transient nature without disturbing the integrity of the bones of the skull. Concussion in children occurs with short-term impairment of consciousness, vomiting, pallor of the skin, which is later replaced by headache, dizziness, lethargy, tinnitus, pain in the eyeballs. If a concussion is suspected, the children are consulted by a traumatologist and a neurologist, NSG, Echo EEG, EEG, skull X-ray, CT scan (MRI) of the brain, lumbar puncture. Medical tactics for concussion in children include hospitalization, rest, local hypothermia, dehydration, sedative, nootropic therapy.
Concussion in children is a type of closed craniocerebral injury with reversible changes in the central nervous system, manifested cerebral and unstable focal neurological symptoms. Concussion of the brain is one of the easiest and most common types of damage in pediatric traumatology, which is diagnosed annually in 120,000 Russian children. Among all TBIs, concussion in children accounts for 90% of cases. According to statistics, the greatest number of cases of concussion in children occurs in the age groups up to 5 years and older than 15 years.
The peculiarity of the course and outcome of concussion in children is due to the fact that the influence of mechanical energy falls on the growing and developing brain. On the one hand, the plasticity of the child’s brain causes a high degree of compensation, on the other hand, the disruption of brain functions, even in childhood, does not always go without a trace. It is known that in the long-term period (after 6 months - 3 years after brain concussion) in 30% of children develop the so-called post-communal syndrome, characterized by dizziness, headaches, memory and attention disorders, apathy, anxiety, emotional lability, problems with a dream.
Causes of brain concussion in children
Circumstances leading to concussion in children are specific for different age groups. Head injuries in children of the first year of life are the result of oversight of adults. Usually babies get a brain concussion due to falling from the changing table, from the cot, stroller, from the hands of parents, etc. After a year when the baby starts walking on its own, the main cause of a child's concussion is falling from the height of their own growth. Injuries to preschoolers are associated with a fall from slides, swings, stairs, windows, blows to the head, etc. Schoolchildren and adolescents usually get a brain concussion due to their own carelessness and negligence - when falling from roofs, trees, occupations traumatic sports, in fights, etc.
Increased physical activity and curiosity of children contribute to the high prevalence of TBI in childhood, and at the same time, a reduced sense of danger, imperfection of motility and coordination. Given the relatively large weight of the head in children and the underdevelopment of insurance with the hands, the majority of falls in childhood end up with a head injury. It should be noted that concussion of the brain in children is not always possible to identify immediately: adults who look after a small child (nannies, neighbors, relatives), as well as older children can consciously conceal the fact of injury from their parents.
In addition, concussion in children can occur without mechanical trauma to the skull. This phenomenon, which develops when the body is exposed to a sharp acceleration or inhibition, in pediatric surgery and pediatrics has been called the “shaken child” syndrome. This phenomenon is most characteristic of young children and may occur due to excessively intense motion sickness of infants, rough handling of a child by an adult, jumping from height to feet, etc.
Pathological changes in brain concussion in children are detected only at the molecular-cellular level. A number of theories have been put forward to explain the disorders arising from this.
According to the vibratory molecular concept, the mechanism of damage to brain cells is associated with molecular changes caused by vibration at the time of the injury. From the place of application of force, on the principle of counterstrike, the vibration spreads through all the brain tissue to the opposite side.
Vasomotor theory as a major mechanism of concussion of the brain considers the disorder of the activity of vasomotor centers, leading to impaired cerebral circulation (vascular spasm - cerebral ischemia - prolonged congestive hyperemia).
According to the hydrodynamic theory, the impact at the time of injury causes the movement of the cerebrospinal fluid, which dramatically moves from the lateral ventricles of the brain to III and IV, causing them to stretch, bruise and irritate nearby centers.
Classification of brain concussion in children
Concussion in children refers to a closed head injury (along with contusion and compression of the brain), being its most mild form.
However, the clinical course of concussion in children can also have mild (I), moderate (II) and severe (III) severity. When I degree episodes of loss of consciousness are absent, and the symptoms persist no more than 15 minutes. With grade II, there is also no loss of consciousness, but symptoms are noted for more than 15 minutes. Concussion of the third degree in children is characterized by loss of consciousness during any time.
Definition of the disease. Causes of disease
Brain concussion (SGM) is the main clinical form of traumatic brain injury (TBI), in particular, diffuse damage to the brain parenchyma. She ranks first among all childhood injuries requiring inpatient treatment.
According to epidemiological studies, TBI in children and adolescents in many countries reaches 200 cases per 100 thousand people. Moreover, TBI is more common in males (up to 70% of all cases).
There are two age groups with a high risk of getting a brain injury:
- children under 5 years old
- patients from 15 to 25 years.
In children from the first year of life begins high motor activity, there is a desire to learn everything, try, get to different places. This takes place against the background of imperfections of motor skills and coordination of movements, reduced sense of danger and overestimation of physical abilities, which leads to the appearance of injury.
The main causes of concussion in childhood are:
- injuries in the process of birth,
- the fall of babies and children up to three years from beds, changing tables, from the hands of parents, strollers, etc.,
- lack of coordination as a result of the disproportionate physical development of the body in children under three years old (heavy head weight) and falling headfirst with a sharp acceleration or inhibition (at this age children have not yet learned to insure themselves with their hands during a fall),
- blows during the fall of children 4-7 years old from a height (children's slides, swings, window sills or trees),
- violation of traffic rules and car accidents with an unfixed child in a special car child seat,
- violation of safety regulations and the absence / malfunction of sports equipment during outdoor games and sports competitions.
What is a concussion
Reversible disruption of the brain due to injury is called concussion. Doctors believe that the basis of this condition is a functional disruption of communication between nerve cells. The frequency of occurrence of concussion of all injuries of the head ranks first. In the structure of child injuries, 65% of all cases are allocated to this condition. According to statistics, closed head injuries are more often observed before the age of 5 years and after 14.
How to determine child concussion
After a head injury, it is important to provide the child with timely medical care. Symptoms of brain concussion in children manifest themselves in different ways, depending on the severity of the disease: mild, moderate, severe. Nature has taken care that the children's brain is protected from damage, so when in contact with heavy objects, the bones of the skull are absorbed, as they are mobile and strong.
Due 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 blow, a child of any age can earn a head injury (TBI). The smaller the baby, the more difficult it is to identify his disease, because children react to irritating factors differently. Parents should be attentive and have information: if a child has a concussion, what are the symptoms?
Regardless of age, body temperature during TBI does not change. Symptoms of concussion in a newborn baby are mild: sleep disturbance, copious regurgitation that lasts no more than 3 days. In older children, after the impact, the following conditions can immediately appear:
- pallor of skin will be sharply replaced by redness of the face (erythema),
- repeated or single vomiting,
- temporal out of sync pupil movement (astigmatism),
- there is no consciousness
- rapid or slow pulse,
- nose bleed,
- confused breathing
- lack of reaction of pupils to stimuli.
With the timely and correct treatment of concussion, all the symptoms that arise in this case, pass quickly, but the headache can remain for a long time. The problem with young children is that they cannot say that they have pain, so even in the absence of obvious symptoms, you should consult a doctor. Adolescents may be silent about the injury, fearing parental anger, but if they do not have a headache within 1-2 days, and even accompanied by dizziness - this fact should be alerted.
How a child's concussion manifests itself in a child, any pediatrician knows - they often do not appear immediately after a stroke. Sometimes TBI can be earned without a reason, when the baby starts or slows down abruptly. In medicine, this term is called "shaken child syndrome." The causes of concussion are fights, falls from bicycles and other vehicles, jumps from a height. Excessive activity often ends with a head injury. Infants often have the disease due to an oversight of their parents. Consider the most important signs of concussion in a child.
Pupils with concussion in a child
Direct confirmation of concussion of the brain - the size of the pupils. They can be, as a different form, or extended or narrowed. Pupils react to the light normally, and the affected child may not even feel any symptoms, but the doctor will notice the wrong reaction. Worse, if they are of different size - this indicates a serious brain injury. Extended or constricted pupils are associated with intracranial pressure, which has an effect on the nerve centers that regulate the contraction of the eyeball.
If a small child has a concussion - symptoms of nausea and vomiting, then ice should be applied to the injury site and you should call an ambulance or take it to the hospital yourself. Baby can once spew through the mouth the contents of the stomach or again with some interruptions. At the same time, tears, saliva stand out, breathing becomes faster. The cause is impaired blood circulation in the vestibular apparatus and the emetic center, which upon impact experiences irritation.
Signs in infants
A newborn baby cannot complain about health, therefore, the sooner a concussion is diagnosed, the faster hemorrhage will be avoided. Signs of concussion in infants are primary and secondary. With a slight injury to the child, motor activity occurs, he is excited and screaming. Secondary symptoms, when the baby refuses to eat, becomes sluggish and inactive, indicate a serious injury. The doctor will diagnose “brain concussion” on the basis of even one of the above factors:
- vomiting that happened more than 2 times
- short-term or prolonged loss of consciousness,
- anxiety, poor sleep.
Dangerous signs that may indicate a serious head injury in infants:
- a sharp decrease in the reflexes of the newborn,
- oculomotor disorders
- bulging or swelling of the fontanel area,
- constant sleep
- refusal to eat
First signs of concussion in a child
When the brain is damaged, a child of any age immediately loses orientation in space, his ability to concentrate his gaze is turned off. At such moments, the eyes move involuntarily. The patient becomes lethargic, wants to sleep constantly, regardless of the time of day. With TBI, children tend to experience headache, dizziness, nausea, and vomiting. Frequent signs of head injury - increased sweating, weakness, increased pressure, rapid pulse.
Changes in the skin
Parents should be alerted by the paleness of the skin, the lack of elasticity. This is one of the most important symptoms that manifests immediately. First, the epidermis turns pale on the face, then on the extremities. The skin may acquire a greenish or blue tint, appear transparent. The capillaries are clearly visible on the legs and arms. Often, pallor is accompanied by increased perspiration - this is a particularly alarming signal, indicating that the baby’s condition is worsening.
How to diagnose child concussion
It is necessary to immediately identify the presence of cones, hematomas, fractures, to detect signs of brain edema in order to avoid serious consequences. For this we need different diagnostic methods. The procedure for a standard examination of a sick child who is used in a hospital:
- Consultation of a traumatologist and a neurologist,
- the doctor determines intracranial pressure with an ophthalmoscope,
- brain x-ray and computed tomography,
- After examining and taking anamnesis, the specialist performs echo-encephalography, neurosonography, electroencephalography or MRI.
Depending on the severity of brain damage after a diagnosis, the issue of hospitalization of the baby is resolved. If you have not revealed serious injuries, the duration of stay in the hospital is 4 days. In case of severe injury, the minimum stay of the child in the hospital is one week. The effects of concussion are treated only with medication. The child is prescribed:
- diuretic drugs: diacarb, furosemide,
- Potassium-containing drugs: Asparkam, Panangin,
- sedatives: Phenazepam, valerian tincture,
- antihistamine medications: diazolin, suprastin,
- painkillers: Baralgin, Sedalgin.
After leaving the hospital, the baby should receive additional treatment at home. This is the reception of 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 overwork. We'll have to change the usual way of life during rehabilitation - to reduce the duration of watching TV and limit the time spent on the Internet.If the symptoms return, you need to go to the doctor again. Headaches, drowsiness and malaise should not be felt after a course of treatment.
Protect your child from falling, hitting the head, an accident, sometimes a fight with a peer can not any mother. Shaking the head sharply, a punch leads to a slight change in the brain's location in the skull, colliding with the bone tissue and returning to the site. It is associated with concussion.
As a result of a small movement, the nerve cells can rupture or stretch, their nutrition is disturbed, the vessels are damaged, hematomas are formed. At the same time there is a change in chemical balance, swelling occurs.
Concussion in children is the most common type of head injury. Sometimes it leads to serious consequences and even death, but in 80% of cases it goes without a trace.
In the post-traumatic period, there are three periods:
- Immediately after the injury, an acute period begins, its duration is about 10 days. It was during this period that the appearance of the primary symptoms and the occurrence of a disturbance in the brain function are characteristic.
- At the intermediate stage, which lasts up to six months, treatment and observation are carried out. All functions during this time are usually restored.
- In the long-term period, for up to two years after the injury, the child recovers completely. In severe cases, the symptoms of complex diseases.
According to statistics, a quarter of all cases of concussion are diagnosed in infants. The main cause of contusion is a fall from a high-lying surface - a changing table, sofa, stroller. This is mainly due to the inattention of parents, as well as active crawling and learning to walk. The head of infants is still disproportionately large, they do not know how to group, therefore it is she who suffers most when falling.
Children from 1 to 3 years often become victims of exploratory behavior and at the same time physical unwillingness to comprehend new heights. They have already lost grasping reflexes, which are characteristic of infants, and fine motor skills have only just begun to develop. The main cause of injuries is falling from chairs, swings, stairs, children's slides.
In children of four to seven years, traumatic brain injury is associated with activity and movement, climbing trees, riding skates, skate, bicycles, roller skates. A child of this age still feels danger danger, does not correlate his actions with risk. Psychology also has an effect - if you go to the end, if you go, then you will be the fastest. About 20% of cases of concussion occur at this age.
Schoolchildren are injured for a variety of reasons. This is a fall, fights, sports, accidents, careless swimming. About 45% of injuries occur in schoolchildren.
Children of any age may experience shaking syndrome. It occurs due to sudden movement when jumping, sudden braking. This effect occurs with strong twitching of the baby.
A separate cause can be identified abuse of children of any age.
Degrees of severity
Depending on the variety and severity of symptoms, a child's concussion in a child can have three degrees of severity:
- Weakness, rare vomiting, a slight sensation of discomfort in the head are signs of mild concussion.
- Small damage to tissues, skull, the appearance of hematomas, short-term loss of consciousness, vomiting indicate a moderate (II) degree. Vomiting is repeated repeatedly. The child is disoriented, does not understand what is happening to him, where he is, loses control. His skin turns pale. There is confusion.
- Severe damage is accompanied by hemorrhages, severe injuries, loss of consciousness for a long time. The child may lose consciousness periodically, seizures. Forgets what happened to him, suffers from pain in the head. He has no reflexes, his pulse becomes rare, his breathing becomes shallow. Symptoms of rigidity of the cervico-occipital muscles are noted.
Concussion can occur in different ways. The main feature of the symptoms is a gradual increase. Immediately after injury, children often cry, experience severe pain from a blow. However, after this, the symptoms may decrease in order to flare up with a new force and become more diverse.
To determine the concussion of a small child at home, pay attention to such signs as a change in the size of the pupils, color, appearance of vomiting, hematomas, complaints of pain in the head, disturbance of gait.
Any head injury is accompanied by pain. It is easy, passes quickly. In other cases, it is very intense, it “breaks” the head or, conversely, squeezes, does not allow to think about anything, interferes with sleep, concentrates attention.
Localized on the back of the head and temples. It tends to increase. Often it is accompanied by tinnitus, a feeling of circling of the head.
One of the first signs that indicate a concussion is a change in skin. Its color changes - it becomes pale, transparent, first on the face, a little later on the limbs. Sometimes the skin becomes bluish.
On the extremities through the skin the smallest vessels appear brightly. Severe injury is characterized by increased sweating.
In the place where the blow fell, bumps appear almost immediately. Small lesions indicate edema.
Hematomas that rapidly increase in size lead to serious consequences.
One of the main signs of concussion in children is the change in the size and shape of the pupils. They expand, and this indicates an increase in intracranial pressure.
Constriction speaks about the deterioration of the child. Sometimes the left and right pupils become of different sizes.
Even if the parents did not find changes in the pupils during visual examination, in some cases the kid complains about the appearance of fog, darkening before his eyes. He notices flies, sparks, circles, squints. Sometimes after a contusion, temporary blindness appears. It can last for several hours.
To identify the symptoms of visual impairment, you can hold your hand at a distance of about 50 cm from the face of the child and ask if he sees well. With increasing pressure at this moment the picture for the baby loses its clarity.
Disturbance of blood circulation in the vestibular apparatus leads to vomiting. It can be constant or periodic. Often accompanied by rapid breathing, increased salivation, tears, nausea.
A child loses interest in everything. He is not amused by new toys, books, games. He becomes passive, prefers to lie.
After some time, if the little patient is not helped, he may develop secondary symptoms. These include loss of appetite, photophobia, painful sensitivity to sounds, sleep disturbances. Children often have nightmares at night. He becomes moody, apathetic. The mood often changes.
The secondary signs include the complete loss of memories of the bottom when the traumatic event occurred.
Symptoms in infants
In a newborn and a baby up to a year the concussion is accompanied by frequent and abundant regurgitation. The spring on the head swells, pulsation is visible through the skin, sleep becomes restless. Twitching of the limbs may be observed.
The baby is naughty, cries a lot, gets tired quickly, loses appetite. Infants usually do not lose consciousness.
Primary diagnosis can be carried out at home. To do this, analyze the change in the state of the child, examine the skin, check the pupils, measure the pulse. If he can already speak, ask him about the state of health, pain.
If you even identify several symptoms of concussion in a child, you must urgently call an ambulance or call the emergency room.
The following studies are performed at the hospital:
- Check the fundus.
- X-ray. Performed to exclude fractures of the skull bones.
- Echoencephalography. Allows you to determine the offset, which indirectly indicates the formation of hematomas or edema.
- CT scan. With this method you can see any changes.
- Ultrasound or neurosonography. The study helps to verify the state of the brain, detect signs of hematoma, hemorrhage. Children under one year undergo ultrasound through a large spring - neurosonography.
- MRI This method allows you to get a detailed picture of the brain, to detect hemorrhages, the consequences of injuries.
In severe cases, when signs of concussion remain for a long time, spinal puncture and electroencephalography are performed.
If mom or dad witnessed the injury of the baby, hitting his head on any objects, the surface, first of all you need to call an ambulance. Before she arrives, it is necessary to lay the baby on a firm horizontal surface, but do not allow him to fall asleep. The doctor will not be able to quickly clarify the symptoms and severity of the condition in a sleeping child. It is better to constantly talk to him, to attract attention.
If the child has lost consciousness, he is placed on the flank, bending the opposite limbs. This is done to ensure proper breathing, and in order to avoid choking when vomiting. In the presence of injuries, scratches them washed and treated with antiseptic. On the bumps impose ice or a towel dipped in cold water.
It is necessary to constantly monitor the well-being of the child. It is impossible to “facilitate” his condition with video games, computer, TV. It is better to provide houses with twilight, peace and quiet.
If the baby’s breathing is uneven, the pulse is slowed down and heart massage is performed.
If a child has a concussion, he should not be given painkillers, other medicines or traditional medicine.
After all the necessary diagnostic activities in the hospital with a slight shaking of older children are allowed to go home. For one to two weeks, he was recommended complete rest. If drugs are prescribed, they must be taken in accordance with medical prescriptions. You should avoid listening to loud music, playing sports, watching TV.
Treat moderate and severe concussion in the hospital. Hospitalization is also necessary for babies, children of younger age. The main goal of treating concussion in the hospital is to monitor the condition of the child, to detect and exclude complications. Usually after three days the children are allowed to go home. For severe injuries, longer hospitalization is indicated.
The removal of symptoms and the elimination of severe consequences is carried out by complex therapy. In order to remove the swelling and reduce the amount of fluid in the body, diuretics are prescribed. Diacarb is used for children from 4 months, Hypothiazide - from 2 months.
Together with these drugs, Asparks and Papangin are used - they restore the level of potassium, which decreases when taking diuretics.
Children will be sedated with sedatives, for example, valerian tincture, Reminil. With increased drowsiness prescribed drugs with ginseng, echinacea.
Calm will nauseate nausea. Stop vomiting dramina. Reduce the pain in the head of Sedalgin or Baralgin.
To stimulate cerebral circulation and improve brain nutrition, use nootropic agents, for example, Pirates.
Antihistamines prescribed to the child as needed.
Symptoms of brain concussion in children
In infants, recognition of concussion is difficult due to the nonspecificity of the symptoms. Consciousness, as a rule, is not lost, however, babies have abundant regurgitation during feeding, vomiting, causeless crying and anxiety, disturbed sleep and appetite.
In older children, immediately after the injury there is a short-term impairment of consciousness (stunning, spoor), pallor of the skin, cold sweat. Characterized by the emergence of vomiting, which in children under 3 years of age is usually repeated. After clearing the mind, the main complaints of the child include indications of headache and dizziness, drowsiness and weakness, ringing and tinnitus, pressure and pain in the eyeballs. After concussion of the brain in children, there may be a loss of memory in the events preceding or following the injury (retrograde and anterograde amnesia).
With concussion of the brain in children, there may be an exacerbation of sensitivity to light and sounds, arterial hypotension, pulse lability, an increase in body temperature. After hitting the back of the head, post-traumatic blindness may occur. When examining a child, oculomotor disorders can be noticed: nystagmus, gaze paresis, diverging squint, anisocoria, etc.
With concussion in children, subjective symptoms and objective signs can occur in various combinations. The younger the child is, the more difficult it is to identify the symptoms of a concussion.
Treatment of brain concussion in children
Children with a concussion need to be hospitalized in the pediatric traumatology department to carry out the necessary amount of diagnosis and dynamic observation. In the presence of damage to the soft tissues of the head (wounds, abrasions, bruises), their primary surgical treatment is performed. A child with a concussion of the brain is given bed rest, psycho-emotional rest, local hypothermia (attachment of a bladder with ice to the head), inhalation of moistened oxygen, and hyperbaric oxygenation.
Drug treatment of brain concussion in children is aimed at preventing brain swelling, restoring the balance between the processes of inhibition and arousal, improving metabolic and bioenergetic processes in the brain. For this purpose, diuretics (acetazolamide, furosemide), sedatives (valerian, phenobarbital), nootropic drugs and vitamins (glycine, B vitamins, ascorbic acid, hopantenic acid and glutamic acid, etc.) are used. For severe headaches, analgesics are prescribed, for nausea, antiemetic drugs.
In the case of elimination of severe brain damage and regression of symptoms, the child can be discharged for outpatient follow-up care within another 1.5–2 weeks already within 7–10 days. A visit to a children's institution is allowed after a follow-up examination of a neurologist with the release of the child from physical activity for 1-2 months.
Prognosis and prevention of brain concussion in children
Concussion in children usually does not entail significant complications. The most frequent consequences of concussion of the brain are post-commotion syndrome, asthenic syndrome, vegetative-vascular dystonia, with moderate and severe closed TBI, post-traumatic epilepsy can develop. Timely access to a doctor and a full course of drug therapy can eliminate the long-term effects of concussion in children.
Prevention of brain concussion in young children requires constant and vigilant parental control over the child. Older children need to explain the importance of compliance with the rules of the road, caution in games, head protection with a helmet when practicing traumatic sports. In case of any recorded head injury, it is necessary to show the child to a specialist, who will decide on the advisability of further examination and treatment.
A concussion without a trace or leaves behind a train of complications that manifest themselves even after several years:
- Postcommotional syndrome. Later, there are severe headaches, sleep disorders. The child becomes restless, nervous. Conventional pain medications do not help.
- Vegetative-vascular dystonia. It will appear a few years after the concussion. Characterized by pain in the head, irregular pressure, fatigue, sweating, sleep disorders.
- Inflammations of the brain and its membranes. In the case of infection develops encephalitis, meningitis.
- Difficulties in learning. The child may begin to lag behind his peers in the development of intelligence. The concentration of attention decreases, memory, analytical skills suffer.
- Psycho-emotional instability. Constant change of mood, irritability, nervousness, sometimes manifestations of aggression.
Pathogenesis of brain concussion in children
The mechanism of SGM in children is due to shock acceleration and inertial trauma.
The acceleration imparted to the brain at the time of TBI serves as the main component of the pathogenesis of its concussion both in the case of indirect (inertial injury) and in the direct (shock) effect of mechanical energy on the head.
According to modern concepts, in any closed craniocerebral injury, all parts of the brain are involved in its pathogenesis, which leads to a breakdown in the connections between neurons.
It is believed that the basis of the clinical manifestation of SMG is asynapsia - a temporary breakdown of connections of brain cells (mainly functional). Studies by a number of authors have confirmed that the morphological substrate of the SMG is a violation of the synaptic apparatus. In more severe cases, violations of the ultrastructure of axial cylinders of neurons - axons join them.
The basis of the formation of clinical syndromes SGM are violations in the mid-stem structures of the brain and the reticular formation, as well as disorders of the cortico-subcortical relationship. Involvement in the pathological process of stem formations leads to the suffering of both specific and non-specific brain systems, manifested in the form of various autonomic and neuropsychiatric disorders.
Classification and developmental stages of concussion in children
By severity of SMG is:
- easy - preservation of symptoms less than 20 minutes,
- moderate - from 20 minutes to 6 hours,
- heavy - from 6 to 48 hours,
- extremely difficult - more than 48 hours.
A number of authors note that in children of an early period of life and preschool age, loss of consciousness may be absent.
Children's Coma Scale (for children under four years old) allows to assess the degree of depression of consciousness:
- Eye opening:
- arbitrary - 4 points
- as a reaction to the voice - 3 points,
- as a reaction to pain - 2 points,
- no - 1 point.
- Speech response:
- a child smiles, orientates himself in space, reacts to sound, follows movements, is responsive - 5 points,
- child can be reassured, inadequate responsiveness - 4 points,
- while crying, the baby calms down for a while, groans - 3 points,
- cries and does not calm down, anxiety does not pass - 2 points,
- does not respond to an attempt to reassure - 1 point.
- Motor Reaction:
- performs movements on the team - 6 points,
- pushes back in response to painful irritation - 5 points,
- rejects limbs for pain irritation - 4 points,
- pathological flexion as a response to painful irritation (decortication) - 3 points,
- pathological extension as a response to pain irritation (decerebration) - 2 points,
- movement completely absent - 1 point.
In victims with mild TBI, after the injury, the consciousness is clear (15 points), or there is a depression of consciousness to the degree of moderate stunning (13-14 points). Concussions can manifest short-term depression of consciousness (from 1-2 seconds to several minutes), and more often at the time of stunning (spoor).
In the clinical course of TBI, it is customary to distinguish three periods:
- acute - the first 2-10 weeks after injury,
- intermediate - from 10 weeks to 6 months,
- remote - from 6 months to 2 years or more.
The course and manifestations of TBI in all its periods largely depend on the background on which the injury occurred.
Complications of brain concussion in children
Despite the fact that shaking in children does not lead to structural changes in the brain, the consequences can be very severe. So, in the absence of timely diagnosis and treatment, complications such as cerebral edema, intracranial hematoma, epileptic seizures may develop.
The most frequent effects of CMS in children are:
- violation of the formation of reading skills (dyslexia), writing (dysgraphia) or counting (dyscalculia),
- school disadaptation, cognitive and speech impairments, emotional and behavioral difficulties,
- problems with learning, mastering the school curriculum (knowledge is fragmentary),
- inattention during classes, memory impairment,
- untidiness in clothing and personal hygiene, rapid "cooling" to the work begun,
- difficulties in using the information received, drawing conclusions and conclusions,
- in the remote period, head injury - difficulty of social adaptation due to emotional outbursts or aggression,
- migraine, nervousness, insomnia, causeless fear and anxiety, development of neurosis.
Concussion is usually a reversible clinical form of TBI. Therefore, in 80-97% of cases, the SCM ends with the recovery of the child with full restoration of all body functions, but subject to compliance with the regime in the acute period and the absence of circumstances aggravating the injury.
In some children, after the acute period of tremor, manifestations of the post-communal syndrome are observed:
- impaired cognitive functions (loss of concentration, impaired memory) and mental lability (depression, irritability, anxiety),
- deviations in physical well-being (dizziness, headaches, sleep disturbances, fatigue, irritability from sound and light sources).
In the dynamics after 3-12 months after suffering TBI, these symptoms disappear or significantly decrease.
Prevention of concussion involves:
- use of sports equipment and a protective helmet during sports (wrestling, boxing, hockey, skating, cycling or roller skating),
- fastening seat belts of special child seats in cars,
- compliance with the rules of the road,
- home improvement furniture safe to use
- maintaining cleanliness in the rooms (immediately wipe the liquid spilled on the floor),
- the observance of safety measures in the lessons of physical culture and labor training, as well as the rules of sanitary requirements for the installation, equipping and maintenance of residential premises in children's educational and pedagogical institutions.
Signs of concussion in infants
Careless and inept parents are the cause of head injuries in newborns. The fall of the child from the changing table, the bed and from the hands of mom and dad are fixed quite often. The weak and slight symptoms of brain concussion in children under one year complicate the detection of damage:
- frequent regurgitation
- lack of appetite,
- increased fontanel,
- pale complexion
- restless sleep
- nervousness and crying.
But, due to not yet developed brain and bone system, such injuries rarely lead to serious consequences. Quickly passing symptoms and treatment do not provide. The prognosis for rapid recovery in 90% of cases is justified.
How to determine the concussion in a child from 3 to 6 years
Places of large concentrations of children, such as preschool institutions, playgrounds, parks become dangerous with insufficient attention for the child. Injuries every year for children under 6 years old grows by 2% or more. The reasons for concussion followed are poor upbringing and aggression in a child, symptoms of increased excitability and uncontrolled behavior.
The kid fell or was pushed, hit with a heavy toy or a stone on the head, a lump appeared or a hematoma appeared, a bruise - immediately contact the nearest medical assistance center for diagnosis and examination.
What doctors pay attention to determine concussion in young children, which at the same time distinguish the main symptoms: excessive sweating, severe pain and dizziness, feeling of pressure, repeated vomiting, post-traumatic blindness. Very often, a child cannot reproduce the situation when an injury was sustained or a fall occurred.
First aid for shaking
When treating children’s brain concussion, treatment is not necessary, but what to do in such a situation at home or in an organization should be known to each of the parents, educators, teachers, and adults who are nearby. The most important thing is to contact the emergency medical staff or take the child to the hospital.
Before providing qualified assistance, it is necessary to attach ice or a cold wetted towel to the place of damage. The victim needs rest, but not sleep, so put the baby and try to calm him down. Wounds can be treated painlessly with Chlorhexidine disinfectant, rinsed with running water.