Head Injuries/Traumatic Brain Injuries |
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Kids fall. When I was working as the advice nurse at Noe Valley Pediatrics, not a week went by when I didn't get the ‘call’. The mom or dad would be in tears as they recounted in horror that their baby fell. With young babies, this can happen if you leave them on an unprotected surface for even a moment. More often than not, the caregiver was close by, watching it happen, but couldn't move fast enough. That thud is an awful sound. Of course it isn't only babies who fall. Children and adults have accidents and sports injuries all the time. If your baby falls or you are the first responder at any kind of accident, take a deep breath. You need to remain calm. You can give yourself some great self care, like a big glass of wine, later. Medical personnel will want to know:
Of course, if there is a loss of consciousness, or any possible neck injury, don’t move them, CALL 911! A moment of stunned silence is common. If the fall is soon followed by crying it is unlikely that there was any loss of consciousness. Do a quick head to toe assessment. Is there any obvious bleeding, bruising, sprains or fractures? Put immediate pressure on any bleeding wounds. Check the mouth and make sure there are no loose teeth. I suggest that you have an established relationship with a pediatric dentist. In the case of a mouth injury this will be very useful. If your child will cooperate, get a cold pack on any bruises. If you are out of the house, a cold can from a vending machine is a good option. If you are near a freezer, a bag of frozen peas makes a nice ice pack. For toddlers and preschoolers, playing doctor before anything happens can be very useful. “Uh oh, we have a boo boo, quick, let’s put the cold pack on there to help make it feel better.” Kids might cooperate better with one of the cute pediatric friendly cold packs. There are many options available. I also recommend Arnica. I imagine that some of you are asking, “what on earth is that?” Arnica is a homeopathic treatment. It comes as a topical ointment or little oral pellets. Many parents swear that it significantly decreases bruises. Roll your eyes if you must, but I have seen it work. It is worth having some around. I would keep it handy in your diaper bag or backpack. Kids often like to have ‘cream’ applied to a little ‘owie’. Arnica is perfect for that. Head wounds can create a huge amount of blood if there is even a tiny little break in the skin. If the skin remains intact, all that blood can collect into an enormous goose egg. These can look alarming. They also can turn all sorts of lovely colors, but they do resolve. A big goose egg should be checked out to make sure there is no fracture. Mild bruises and bumps by themselves are not a concern if the child is acting fine otherwise. As long as you can get it to stop, simple bleeding doesn’t worry me. Hold pressure for at least 10 minutes. At that point if it is still oozing, you might need to go in to get the wound sutured or glued. Bleeding that is taking place underneath the skull is a different story. Any accumulation of fluid or swelling can cause potential pressure on the brain. If this is happening, your child's behavior will probably not be normal. I remind you that most of the time kids are fine after a mild fall, but we always need to be on the lookout to make sure there isn’t a concussion. A concussion is a type of traumatic brain injury that stems from an impact that causes the head and the brain to move quickly back and forth. The brain may bounce or twist in the skull from this sudden movement. This in turn can cause stretching and damage to the brain cells as well as chemical changes in the brain. If your child is acting fine after a fall, that is very reassuring. If you are worried, it is appropriate to call the doctor's office to let them know what happened. Most of the time they will tell you to keep a close eye on them at home and don’t need to come in. Keeping someone awake after a head injury is not necessary: It is just essential to do frequent assessments so that you can see if there is a status change. Experts agree that once your child has calmed down it is fine to let them take their normal nap. An overtired baby will be cranky and may be near impossible to assess. If they are nodding off, it is likely because they are tired, and not from the head injury. Do not let them take a nap that is longer than the typical nap time. Nights are a bit different. Depending on how far and hard they fell, I would also check on your child every couple of hours. You can set your clock to make sure you get up to do this. You are establishing consciousness; you often don't need to wake them completely up. With an infant you can do that by offering them a dream feed. They don't need to be fully roused. With an older child, let them know you will be checking on them during the night. You can offer them a sip of water or have them mumble “I love you”. Keep in mind that if your child is in a deep sleep stage, a gentle whisper might not be enough to wake them up. For older kids, if they know ahead of time that you will be coming in, they are easier to wake up. If your child is in a deep phase of sleep you might need to be a little more aggressive making them stir. I know it seems like sacrilege to wake a sleeping child, but after a head injury it is important. If there is a TBI ( traumatic brain injury) you are going to have clues that something is not right. Physical symptoms would include
I actually give the kids "one free vomit". Often they have cried hard enough that they might spit up a little. Let's not worry about that first emesis. If they vomit a second time, it’s time to call your doctor. Murphy's Law comes into play here. With children, Vomiting could simply be a sign that they are coming down with a tummy bug. Nonetheless, if they whacked their heads and are now vomiting, they need to be checked out. Traumatic Brain Injury symptoms are not only physical. We need to keep an eye out for social or emotional changes as well. If the head injury patient is having any of the following issues, bring that up with your medical team.
There is no downside to getting your child evaluated if you are even the least bit concerned. Most pediatric emergency rooms will do a thorough assessment. They may order a Cat scan if there is:
Doctors will use their clinical judgement and make a case by case decision. A basic neurological exam might include the following
Of course these little tests are age dependent. Newer protocols for concussion care are not as restrictive as they used to be.
Screen time has a big impact. Patients who abstained from it for the first 48 hours had a quicker recovery Your child can return to non strenuous activities as soon as they start to feel better.
After a solid knock to the head you are not out of the woods right away. Pay attention to any dizziness or headaches. This is especially important within the first couple of weeks. Get immediate attention for any vomiting or confusion. Discuss return to sports with your medical team. The large majority (70-80%) of people with Traumatic Brain Injuries recover within 3 months. Every child’s recovery period is unique. There have been some new findings that females across all the age spans recover more slowly from a TBI than males. Studies are being done to look more closely into that. I was discussing this post with my chiropractor Sandra Roddy Adams ( https://www.yelp.com/biz/ "Once the scaries are ruled out, it's a good idea to have your baby/child checked by a Chiropractor for spinal misalignments. Chiropractors are trained to deliver gentle, specific adjustments to the spine, and provide cranial-sacral care if needed. While people of all ages can benefit from chiropractic care, there are tremendous benefits of pediatric chiropractic as the skull is malleable until around 18 months. The cranium and spine house your nervous system, and even the smallest misalignment can impair its function. These misalignments don’t always cause pain; therefore the absence of pain is not a good indicator of optimal function. Correcting misalignments can not only help speed up your child’s recovery from an injury, it will also help your child feel better and function better." Prevention Accidents happen on the watch of even the most vigilant care giver. Sometimes a parent falls when holding the baby and they both get injured. Beware of trying to manage a baby along with armloads of groceries. I have seen “selfie” accidents. No photo op is worth it if your baby's head gets whacked in the process. Never leave your baby on a surface that they can fall from; they will! Watch out for wet squirmy babies right out of the tub. Using a towel or terry cloth robe can help give you traction. Skin to skin is especially slippery. Make sure your kids wear helmets when using bikes, scooters or skates. Model good behavior! Make sure your house is child-proofed with appropriate safety gates. Make sure that stairs are free from clutter. If your child is sitting in a shopping cart, make sure to keep a hand on it. I had a little patient reach over to grab a box of cereal and she toppled the entire cart over! Choose playgrounds that have a safer ground to fall onto. Sand beats concrete anytime! Sometimes it feels more traumatic for the parent than the patient! Stay safe! |
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