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Concussions in Children- A Headache of a Problem

In the old sitcoms, a head injury would cause amnesia and then a second head injury would instantly reverse the effects of the first injury. Unfortunately, in real life, the second head injury multiplies the impact of the first. The knowledge that repeated injuries can lead to significant and irreversible damage, has led to guidelines for delayed return to activity and sport.

A concussion is defined as a jolting of the brain. It can result from a hit to the head from heading a ball in soccer, knocking the head against the boards in hockey, or a hard fall to the ground. There are generally no findings on imaging, so CT scans or MRIs are not recommended when symptoms point to a concussion.

Symptoms of concussion include headache, loss of balance, dizziness, blurred vision, mood changes, sensitivity to light and noise and fatigue. There is increasing awareness of concussion so that it is difficult to know whether the incidence has actually increased.

Children who have suffered a head injury require to be watched carefully in the first 48 hours to look for symptoms of more worrisome head injury.  The following symptoms require immediate medical care:

  • Your child has a headache that gets worse, or they develop a severe headache.
  • Your child has arm or leg weakness, loss of feeling, or new problems with coordination.
  • Your child will not eat or stop crying.
  • Your child has blood or clear fluid coming out of his or her ears or nose.
  • Your child is an infant and has a bulging soft spot on his or her head.

The most important treatment for concussion is physical and mental rest. Return to play should be delayed in order to prevent a second injury.  Screen time can delay healing and prolong symptoms.  This is, perhaps, the most challenging restriction for most kids today.  The gradual return to activity should be guided by your primary care provider or a physiotherapist with expertise in concussion management.

Sport and play are such an important part of development, it is crucial not to restrict play for fear of injury.  A cautious return after injury will ensure lifelong health and activity- a long term gain for short term caution!

Dr. Bhooma Bhayana is a family physician in London and the mother of two young men and grandmother of one lovely princess! She continues to find wonder and enjoyment in family practice despite more than 30 years on the job!


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