MY CHILD HAS A HEAD INJURY

1. What does this mean and how will my child be affected?

It is common for children to get head injuries. Very rarely these may be severe. Usually they are mild and do not require hospital admission. However, children with concussion do require admission, assessment and follow up.

What do we mean by ‘concussion’. Concussion is a situation where your child has a degree of force applied to the head that results in some form of bruising to the brain. This bruising may not be detectable on scanning but can clinically affect the child. In essence the child may have had a period of loss of consciousness, although this is not always required for the diagnosis of concussion. Headache will be common. Other changes include vomiting, nausea, drowsiness, listlessness and clumsiness. When your child has a head injury involving any or all of these symptoms it is important that they are assessed by a doctor and will often, if not always, require a period of observation for several hours, if not overnight in hospital. It is important during this time that close observation is made of the child to make sure that is no evidence of swelling within the brain which is very uncommon after concussion but the actual level of symptoms may not necessarily indicate the severity of the problem.

Longer Term Problems -- Post Concussion Syndrome

Most children are discharged and about two-thirds will have no problems after a simple episode of concussion. However, one-third of children do get further problems. These include persistent headaches, clumsiness, changes in appetite, changes in thinking, changes in behaviour and personality and general physical symptoms: headaches, as mentioned previously, double or blurred vision, occasionally seizures, intolerance to loud noise. Children essentially require a considerable period of rest to recover from these symptoms. Most children will recover within 2-3 weeks but some will take several months. During this time their performance may be severely affected. School-age children will often need to be kept home from school for several days with quiet activity. On return to school it is often best they go for reduced days to start with as they can often be in a situation where their learning and concentrating will not be as good as it was previously and this may take several weeks for recovery. Most children who are admitted with concussion, where there is evidence of ongoing problems, need an occupational therapy assessment. Liaison with the school is also important as often it is a reduction in work that is required rather than intensification if there appears to be problems. It is important also that a child avoids situations where further head injury can occur as the effects of another concussion are not only additive but additional problems occur. For example, children who have had a significant concussion should not play contact sports such as rugby for the rest of the season. Another concussion could permanently affect outcome. They should not ride a bike if there is any chance of further head injury and certainly should be wearing a helmet when they can ride. If your child has had a concussion and the headache becomes more severe and is unrelieved by Paracetamol they definitely must be re-reviewed in hospital.

If your child has features of post concussion syndrome they need proper assessment and management.

Seek help from your GP, Paediatrician, Paediatric Surgeon.

The Head Injury Society of New Zealand can provide useful support and information.