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How dangerous is a child's head concussion? Concussion in children. Clinical manifestations of mixed type angiopathy

According to epidemiological studies, every year in many countries the number of new cases of traumatic brain injury (TBI) among children and adolescents reaches 180-200 per 100 thousand people. The most common is mild TBI (including concussion and contusion). mild degree), which accounts for approximately 80% of all cases. Moderate and severe TBI account for about 15% of cases, the remaining 5% are extremely severe TBI, often ending fatal. TBI is the leading cause of disability and mortality among children and adolescents.

Two main age groups at increased risk of TBI: under 5 years old, 15-25 years old. At the same time, the absolute maximum cases of TBI occur in the second age group and are often associated with alcohol consumption and road traffic accidents. Among victims with TBI, about 70% are male patients.

The classification of TBI is based on the nature and extent of brain damage. Closed TBI includes injuries in which there are no violations of the integrity of the scalp or there are soft tissue wounds without damage to the aponeurosis; open TBI includes fractures of the bones of the cranial vault, accompanied by damage to the aponeurosis, fractures of the base of the skull, bleeding or liquorrhea (from the nose or ear).

Brain damage due to TBI is divided into primary (focal and diffuse) and secondary. Primary injuries include those that occur when exposed to mechanical energy (bruises, crushes of brain tissue, diffuse axonal damage, primary intracranial hematomas, brain stem contusions, etc.). Secondary damage occurs as a result of the adverse effects on the brain of a number of additional intra- and extracranial factors, which provoke a chain of complex reactive processes that aggravate the severity of the primary damage.

Basic clinical forms TBI can be represented by focal and diffuse lesions.

Focal damage:

brain contusion;
compression of the brain - intracranial hematoma (epidural, subdural);
intracerebral hemorrhage;
subarachnoid hemorrhage.

Diffuse damage:

brain concussion;
diffuse axonal damage;
diffuse vascular damage(including hypoxic-ischemic).
clinical course of TBI is usually distinguished following periods:
acute: first 2-10 weeks after injury;
intermediate: from 10 weeks to 6 months;
long-term: from 6 months to 2 or more years.

When assessing the severity of TBI and predicting its course, the following indicators are taken into account:

duration of loss of consciousness in acute period injuries;
Glasgow Coma Scale (GCS) score;
duration of post-traumatic amnesia;
vital status assessment important functions, focal symptoms in the area of primary lesion and dislocation - according to the scale of the Research Institute of Neurosurgery named after N. N. Burdenko A. N. Konovalov, L. B. Likhterman, A. A. Potapov et al., 1998).

Depending on the severity of TBI, the following duration of loss of consciousness may be noted in the acute period of injury (R. Appleton, T. Baldwin, 1998):

mild - duration of loss of consciousness less than 20 minutes;
moderate - from 20 minutes to 6 hours;
severe - from 6 to 48 hours;
extremely severe - more than 48 hours.

Meanwhile, in children, especially younger age groups, loss of consciousness during TBI is not always observed and may even be absent in severe trauma.

To assess the condition of patients with closed TBI, GCS is widely used (B. Jennett, G. Teasdale, 1981), which allows one to judge not only the severity, but also make a prognosis for TBI. Overall rating according to the GCS is calculated by adding the scores for each of three groups of reactions: eye opening, vocalization (or speech activity), motor activity. To increase the sensitivity and prognostic significance of the traditional scale in pediatric practice, age-specific modifications of the GCS have been proposed for children under 1 year of age and for children from 1 to 5 years of age; for children 6-15 years old, the same version of the scale is used as for adult patients (A. S. Iova et al., 1999). The overall GCS score can vary from 15 to 3 points. The severity of TBI according to the GCS is determined as follows (B. Jennett, G. Teasdale, 1981; K. M. Yorkston, 1997):

easy: initial score 13-15 points;
moderate: (1) initial score - 9-12 points or (2) initial score - 13-15 points, but after 3 days the score does not reach 15 points;
severe: initial score - 3-8 points.

Since its development in 1974, the GCS has been widely used to determine the severity of TBI. It has been proven that as the total GCS score decreases, the likelihood of adverse outcomes increases. When analyzing the prognostic significance of the age factor, it was found that it significantly affects both mortality and disability in TBI. Despite some inconsistencies in the literature, outcomes are found to be better in children than in adults.

Originality clinical course and outcomes of TBI in children is due to the fact that mechanical energy affects the brain, the growth and development of which is not yet complete. Due to the high plasticity of the developing brain, children are more likely to have a favorable outcome than adults, including after severe clinical variants of TBI. Meanwhile, even mild TBI in childhood does not always go away without leaving a trace. Thus, it is shown that in long term after a concussion (in the range from 6 months to 3 years) in at least 30% of patients childhood a complex of disorders is formed, referred to as post-concussion syndrome.

The main manifestations of post-concussion syndrome:

cerebrasthenic symptoms - fatigue, emotional lability, anxiety, irritability, difficulty falling asleep;
headaches, dizziness, periodically accompanied by nausea;
moderately severe disturbances in coordination of movements when examining the neurological status;
cognitive impairment (attention, memory), accompanied by difficulties associated with learning at school.

There is no doubt that moderate and severe TBIs lead to more serious consequences. It is necessary to keep in mind that the consequences of TBI may not appear immediately, but may be delayed. If TBI affects the normal course of brain development, then as a result it affects the formation of the child’s personality, his cognitive and emotional development, school learning, and the formation of social skills. The severity of psychoneurological disorders in the long-term period of TBI is largely determined by the initial severity of the injury.

Clinical manifestations of the consequences of TBI

Previously, it was believed that restoration of impaired functions after a TBI in children and adolescents occurs more fully than in adults. It was also believed that the younger the age at which the TBI occurred, the greater the likelihood of complete regression of neurological disorders. However, the results of targeted studies have not been as encouraging (J. R. Christensen, 1996). Survival after severe TBI among pediatric patients is indeed higher than among adults, but there is a possibility of delayed clinical symptoms. Indeed, it gradually became obvious that in the long-term period of moderate and severe TBI, many children retained residual neurological disorders.

Moderate TBI is usually accompanied by transient neurological disorders, only in some cases they turn out to be persistent (J. R. Christensen, 1996). The outcomes of severe TBI, according to the literature, vary quite widely.

J. D. Brink. (1980) and co-authors studied the consequences of severe and extremely severe TBI in 345 children and adolescents under the age of 18 years. The duration of coma in the acute period of TBI was more than 24 hours with a median of 5-6 weeks. In the long-term period of TBI, 73% of patients moved independently and completely took care of themselves, 10% had restrictions in movement and remained partially dependent on care, 9% recovered consciousness, but remained completely dependent on others. The work of J. F. Kraus et al (1987) showed that with a GCS score of 3-4 points in the acute period of TBI, 100% of children develop at least moderate disability, with scores in the range of 5-8 points - in 65% of those examined.

Movement disorders

Paresis or plegia of the limbs in the long-term period of TBI in children is quite rare. Often, when muscle strength is preserved, examination reveals a decrease in the speed of movement (D. Chaplin et al., 1993). Impaired motor coordination, on the contrary, is observed in many children who have suffered a TBI (J. R. Christensen, 1996).

Although the restoration of motor functions in the long-term period of closed TBI in children is in many cases satisfactory, during a neurological examination even minor motor impairments are considered pathological. Residual movement disorders affect not only the general motor activity and success in physical education and sports, but also on the attitude of peers towards the child. At negative attitude from peers, a child who has suffered a TBI develops social adaptation disorders.

Cognitive impairment

The severity of cognitive impairment in the long-term period of TBI is also determined by the initial degree of its severity. A number of violations of higher mental functions is determined by the specific localization of lesions, in particular the predominant lesion in brain contusions of the frontal and temporal lobes. Cognitive impairment in patients with TBI often affects the following areas: mental activity, such as memory, attention, speed of processing incoming information, as well as provided by the prefrontal regions cerebral hemispheres brain executive functions (planning, organizing, decision making). However, in many cases, residual disorders are formed due to diffuse involvement of the cortex and damage to the axial structures of the brain, which modulate the functional activity of the cortex. It is the combined damage to local zones of the cerebral cortex, axial and subcortical formations that leads to the development of disorders of memory, attention, regulation of the level of mental activity, emotions and motivation.

Speech disorders

Immediately after closed TBI, children often experience speech and motor impairments, which largely regress over time. Dysarthria (bulbar or pseudobulbar) is quite common; in some cases, motor aphasia is observed, as well as respiratory control disorders, accompanied by transient stuttering, whispered or monotonous speech. Among the features of speech in the long-term period of TBI, its slow pace, difficulties in selecting words, poverty of the active vocabulary with additions may be noted. own speech facial expressions and gestures, in some cases - difficulties associated with understanding long and complex statements.

Difficulties in school

Traumatic damage to certain cortical centers can lead to specific difficulties associated with the formation of reading (dyslexia), writing (dysgraphia) or counting skills (dyscalculia), but such cases are not so common. For most children, the school skills acquired before TBI are retained or acquired again. Nevertheless, in many cases, the formation of school maladjustment is possible, caused by cognitive and speech disorders arising from TBI, as well as emotional and behavioral difficulties. Many children and adolescents in the long-term period of TBI experience the following difficulties associated with learning at school:

The acquired knowledge is heterogeneous and fragmentary.
During lessons at school, the child has difficulty getting involved in completing assignments and copes poorly with them.
There are disturbances of attention during classes, difficulties associated with memorization are noted.
The child is sloppy, does not finish what he starts, and is not organized.
The child cannot effectively use the help of others in order to complete a task or work.
The child experiences difficulties when we're talking about about the application of information and skills, as well as in formulating conclusions and generalizations.

Emotional and behavioral disorders in children and adolescents in the late period of TBI are difficult to distinguish, since they are closely related to each other. Traumatic cerebrovascular disease is characterized by a predominance in clinical picture severe fatigue and irritability, sometimes reaching affective explosiveness; Against this background, hysterical, neurasthenic, hypochondriacal or depressive symptoms. Often noted motor disinhibition, impulsiveness, inability to adhere to instructions and cope with certain tasks, refusal to complete them. When a child or teenager finds himself in difficult life circumstances, residual effects after traumatic injuries brain serve as a predisposing factor to the occurrence of psychogenic or neurotic disorders, are a favorable basis for the pathological formation of personality. Emotional and behavioral disturbances in the long-term period of TBI make social adaptation difficult.

Behavioral disorders in the long-term period of TBI:

outbursts of irritation, episodes of aggressive behavior;
impulsiveness; motor disinhibition may be observed;
emotional lability, mood swings;
loss of motivation, interest in achieving good results when performing certain tasks and affairs;
isolation, indecisiveness, unsociability;
dependence on others: the child cannot stand up for himself;
inability to fully evaluate the results of one’s actions and correct one’s behavior;
insufficient self-control and incorrect self-esteem, which entails difficulties when communicating with others.

Post-traumatic epilepsy is one of the most serious consequences TBI suffered in childhood and adolescence. Post-traumatic epilepsy develops after open TBI - 50% of cases. Among them, in 2/3 of patients the onset of epilepsy is observed within the first year after TBI, in 90% - within 5 years after injury (including the first year of life), in another 7% of patients epilepsy develops 10-15 years after TBI. The maximum risk of developing post-traumatic epilepsy was observed in patients with focal neurological symptoms and massive damage to the central nervous system as a result of severe TBI.

In 70-80% of cases the first epileptic seizures accompanied by generalized convulsions (G. M. Fenichel, 1997).

After closed TBI, post-traumatic epilepsy is less common (G. M. Fenichel, 1997). Within 5 years, epilepsy develops in 11.5% of patients after severe TBI (brain contusion, intracranial hemorrhage) and in 1.6% after TBI medium degree gravity.

According to the results of a survey (N.N. Zavadenko, A.I. Kemalov, 2003) of 283 children and adolescents aged 6 to 14 years, in the long-term period of closed TBI (moderate and severe), the development of epilepsy was noted in 18 people. Among them: in 16 children, the occurrence of seizures (of the secondary generalized type) was noted in a period of 4 to 12 months after suffering a closed head injury; in two cases at the same time, closed TBI provoked the debut of idiopathic (hereditarily determined) forms of epilepsy - childhood absence epilepsy (in a 7-year-old boy) and idiopathic epilepsy with isolated generalized convulsive seizures (in a 10-year-old boy).

Thus, post-traumatic epilepsy refers to symptomatic forms of epilepsy. It is characterized by the same features as the group of symptomatic epilepsies as a whole (A. S. Petrukhin, K. Yu. Mukhin, 2000), namely:

wide age range of onset of the disease;
presence of changes in neurological status;
frequent decline in cognitive function;
identification of regional patterns on EEG;
structural changes in the brain during neuroimaging;
frequent resistance to antiepileptic therapy, which necessitates the use of valproic acid derivatives in the treatment of many patients.

Treatment of psychoneurological disorders in the long-term period of TBI in children and adolescents

Therapeutic and rehabilitation measures in the long-term period of TBI in children and adolescents should be intensively carried out both in the first 12 months after TBI, when it is reasonable to expect the most significant results from their use, and in the future, taking into account the ongoing processes of morphofunctional maturation of the central nervous system and the high plasticity of the developing brain. These activities should be comprehensive and include methods of psychological-pedagogical, speech therapy correction, psychotherapy, physical therapy, and drug treatment. To overcome cognitive and speech disorders, nootropic drugs are used. Indicated for post-traumatic epilepsy long-term use anticonvulsants. In order to prevent headaches, depending on the leading mechanisms of their pathogenesis, courses of vascular, dehydration drugs or anticonvulsants are recommended. At affective disorders and behavioral disorders, antidepressants and antipsychotics are prescribed, but anticonvulsants, especially valproates (drugs of valproic acid and sodium valproate), also have high therapeutic efficacy for these conditions. In particular, valproates reduce aggressiveness and irritability, have a normothimic effect, and smooth out the severity of affective fluctuations.

The positive effect of nootropic drugs in the long-term period of TBI in children and adolescents is manifested in improvement general well-being, regression of headaches, cerebrasthenic manifestations. In the neurological status, there is a decrease in severity motor disorders, especially in the coordination area, during a psychological examination - improvement in memory, attention, and other higher mental functions. The duration of nootropic treatment courses in patients of this group should be at least 3-4 weeks. These drugs are prescribed in the first half of the day, which is associated with their psychostimulating effect. In the first days of use, a gradual increase in dose is recommended. In the presence of liquorodynamic disorders, nootropic therapy is supplemented with the prescription of dehydration agents. In patients with post-traumatic epilepsy, before using nootropics, it is necessary to achieve complete control of seizures for 4-6 months (at least) while taking anticonvulsants continuously.

In the treatment of post-traumatic epilepsy, valproates (Convulex, Depakine, Convulsofin) are among the basic antiepileptic drugs. Their long-term purpose in stable therapeutic doses is aimed at preventing neuronal damage associated with repeated epileptic seizures. The development of neuronal damage will be indicated by: repeated epileptic seizures, decreased cognitive functions, behavioral disorders in the patient, the presence of abnormalities on the electroencephalogram and structural changes with neuroimaging. Therefore, an important direction in the treatment of psychoneurological disorders in the long-term period of TBI is neuroprotection, which implies anti-epileptic therapy in combination with functional and metabolic protection of the brain. The neuroprotective properties of valproate are confirmed the following features actions:

wide spectrum of antiepileptic activity (compared to other anticonvulsants);
maintaining effectiveness during therapy with maintenance doses (often relatively low);
the use of valproate does not lead to an increase in attacks;
the use of valproate does not provoke new clinical manifestations of attacks;
absence of specific cognitive impairments during therapy;
no side effects in emotional sphere;
normalization electrical activity brain;
improving the quality of life of patients.

Approximate daily doses for valproate therapy are 15-45 mg/kg. Special forms, convenient for use in the treatment of children and adolescents, developed for the drug Convulex (). Yes, children younger age Drops for oral administration (containing 10 mg of sodium valproate per drop) or syrup (containing 50 mg of sodium valproate per ml) are prescribed.

Reducing the number of drug doses to 1-2 times a day can be achieved by using extended-release tablets containing 300 and 500 mg of sodium valproate.

Timely contacting a neurologist and carrying out rational drug therapy make it possible to achieve a significant improvement in the condition of children and adolescents in the long-term period of TBI. However, one drug therapy to overcome the consequences of TBI may not be enough. All children who have suffered a TBI need to be examined by a psychologist to identify possible violations higher mental functions. Often these violations are not severe, but even in these cases they can have an impact Negative influence on the success of school and the child’s behavior. Therefore, assistance to children who have suffered a TBI should always be comprehensive.

Literature

Zavadenko N. N., Kemalov A. I. Peptidergic nootropic drugs in the treatment of the consequences of closed craniocerebral injury in children // Bulletin of Practical Neurology. - 2003. - No. 7. - P. 44 - 50.
Iova A. S., Garmashov Yu. A., Shchugareva L. M., Pautnitskaya T. S. Features of neuromonitoring in comatose states in children (Glasgow coma scale - St. Petersburg and its age characteristics). Radiation diagnostics at the turn of the century. - St. Petersburg, 1999. - pp. 45-48.
Konovalov A. N., Likhterman L. B., Potapov A. A. et al. Clinical guidelines for traumatic brain injury. - M., 1998. - T. 1. - 549 p.
Petrukhin A. S., Mukhin K. Yu. Epileptology of childhood. - M., 2003. - 624 p.
Appleton R., Baldwin T. Management of brain-injured children. New York, Oxford University Press. 1998: 257.
Brink J. D., Imbus C., Woo-Sam J. Physical recovery after severe closed head trauma in children and adolescents // J. Pediatrics. 1980; 97: 721-727.
Chaplin D., Deitz J., Jaffe K. M. Motor performance in children after traumatic brain injury. Archives of Physical Medicine and Rehabilitation. 1993; 74:161 - 164.
Christensen J.R. Pediatric Traumatic Brain Injury. In: Developmental Disabilities in Infancy and Childhood. 2nd ed. Eds. A. J. Capute, P. J. Accardo, Baltimore. 1996: 245 - 260.
Fenichel G.M. Clinical Pediatric Neurology. A signs and symptoms approach. 3rd ed. Philadelphia, B. Saunders Company. 1997: 407.
Jennett B., Teasdale G. Management of head injuries. Philadelphia, F. A. Davis Co. 1981: 258 - 263.
Kraus J. F., Fide D., Conroy C. Pediatric brain injuries: the nature, clinical course and early outcomes in a defined United States" population. Pediatrics. 1987; 79: 501 - 507.

N. N. Zavadenko, doctor medical sciences, Professor
A. I. Kemalov, L. S. Guzilova
V. E. Popov, Candidate of Medical Sciences
M. I. Livshits, Candidate of Medical Sciences
E. V. Andreeva, Candidate of Medical Sciences

RGMU, Moscow
Morozovskaya children's clinical Hospital, Moscow

As we all know, a child’s body is very mobile.

Rarely do children develop without receiving blows and bruises and abrasions.

Among all types of injuries, concussion ranks first. This is due to the high activity of children.

Children's heads are heavier, so they are more susceptible to injury.

Causes of concussion in children

The causes of head injuries may vary depending on the age of the person.

Infants are more often injured due to parental neglect, fall from the changing table, for example.

In infancy, the child still has imperfect coordination of movements and therefore tries, as soon as possible, to crawl somewhere and explore something.

But, since sufficient strength has not yet been developed in the hands, the baby falls and hits his head.

Children aged 4 to 5 years go to kindergarten, where they are under the supervision of a nanny, who, due to her inattention, can also cause injury and hide the incident from their parents.

Younger children are especially restless school age. They still have no fear of falling from heights. This is how it turns out that concussions occur during impacts or unsuccessful landings.

Surely many parents have heard about shaken baby syndrome. The explanation is very simple: damage occurs during a sharp start or during braking.

Symptoms and signs of injury in children

Often, the concussion injury itself does not carry any gross or irreversible changes and, since it occurs quite often, then specialists have already learned to cope with this disease.

From the point of view of human physiology and anatomy, we can say that the brain of an infant, a child and an adult is different. This is due, first of all, to age-related changes in the cerebral cortex and in the development of the brain itself.

Therefore, the signs of a concussion in a child are different from the signs of injury in adults.

If we are talking about an adult, then we can say that loss of consciousness lasts up to 15 minutes, while gag reflexes and headache.

Sometimes the concussion can be so strong that amnesia occurs and coordination of movements is impaired. But In children with such trauma, a completely different clinical picture is observed.

Children under 1 year of age cannot talk about their feeling unwell, and the symptoms of a concussion in a baby at this age are hardly noticeable.

But experienced pediatricians easily make a diagnosis based on medical history. Signs of a concussion in an infant are: frequent vomiting, regurgitation at every feeding, the skin becomes pale, the child constantly wants to sleep, eats poorly.

Guys preschool age more talkative and therefore the fact of shaking can be installed easily.

Noted loss of consciousness, pulse may either increase or decrease, blood pressure is unstable, skin becomes pale and increased sweating. Sleep often becomes restless.

Another symptom that is characteristic of a concussion in children is post-traumatic blindness.

It can occur either immediately after injury or after some time.

Observations have shown that blindness lasts from a few minutes to several hours, but in any case disappears. The reason for this symptom is not completely clear.

It is characteristic that many children do not notice the appearance of any symptoms c, which can cause some complications in treatment.

Even if more than an hour has passed since the injury and the child feels well, then after 5 minutes the pain can already be very severe.

conclusions

To prevent anything like the above from happening, you just need to devote enough time to the child.

But if it so happens that an injury does occur, then you need to contact specialists as quickly as possible in order not only to exclude complications, but also to prescribe the correct course of treatment.

Video: Concussion

The video talks about an injury such as a concussion. Diagnostics and healing procedures upon receipt of this injury.

Bruises, contusions, scratches and bumps - it is difficult to find a person whose childhood passed without such injuries. But if such marks were once a kind of symbol of dexterity and strength, then at the sight of a growing bump on the baby’s forehead, two thoughts flash through the mother’s head: what are the symptoms of a concussion in a child and does her baby have them? You can answer the second question together with the doctor after a thorough examination of the little patient, but we will try to talk about the signs of a concussion and its treatment.

Concussion in children: causes

The cause of concussion in children is traumatic brain injury. The high incidence of injuries of this kind in children is associated with their increased motor activity, imperfect motor skills and coordination of movements, as well as an almost complete absence of a sense of danger or fear of heights.

Another factor that can cause a concussion during a fall is the fairly heavy weight of the baby’s head. This is why most babies often hit their heads when they roll off a changing table, slip out of a stroller, or fall when trying to walk or crawl.

Injuries in children under 1 year of age are the result of inattention or excessive carelessness of their parents. Don't leave your baby alone in a place where he might fall.

A child can move around the house or street independently from the age of 11-12 months; for this reason, it is at the age of one that the number of concussions in children sharply increases. Children fall from heights due to their inability to maintain balance, or from stairs or slides due to the negligence of their relatives.

At an older age, the cause of injury is children's pampering, outdoor games, and competitions in courage (“I will climb the tallest tree,” “I can do a somersault”). Also, do not forget about the so-called shaken baby syndrome, in which the baby may show signs of a concussion after jumping from heights, being roughly shaken by adults, or during excessively active rocking.

Symptoms of a concussion in a child

A concussion is the optimal consequence of a closed traumatic brain injury (CTBI), which has a positive prognosis and almost never causes complications. But don't forget that Negative consequences concussions in children will be minimized only if treatment is started in a timely manner.

Due to the anatomical and physiological characteristics of the skeletal and nervous systems, the symptoms of a concussion in a child differ significantly from the signs of this pathology in an adult.

Adults often describe the following symptom complex:

An episode of loss of consciousness lasting up to 5-10 minutes;
Constant nausea, sometimes vomiting;
Inability to remember the events that immediately preceded the injury and the circumstances of the injury itself;
Short-term appearance of nystagmus and loss of coordination of movements.

The severity of the symptoms of a concussion in a child depends on his age. In the first year of life, signs of pathology appear weakly:

There is no loss of consciousness;
Nausea and vomiting are observed;
The baby's skin is pale;
The baby is sleepy or, conversely, too restless;
Episodes of regurgitation during feeding become more frequent;
The baby refuses to eat;
Sleep patterns are disrupted.

Concussion in preschool children is accompanied by more severe symptoms:

Often the child himself indicates the fact of loss of consciousness;
Nausea and vomiting are present, the baby complains of a severe headache;
His heartbeat is fast or slow, his blood pressure is unstable, and his skin is pale and clammy;
The psycho-emotional state is disturbed, the child becomes whiny and capricious;
The usual rhythm of sleep is disrupted.

In some cases, post-traumatic blindness occurs after the injury, a disorder the cause of which is still unknown. It lasts no more than a day and disappears on its own.

You also need to remember that signs of a concussion in children do not always appear immediately after the injury; sometimes they increase over several hours. This is due to high compensatory capabilities child's body. However, after the first symptom appears, the disease progresses very quickly, so monitor the injured child closely.

Treatment of concussion in children

Emergency care for a concussion in children consists of bed rest and treatment of superficial wounds (if any). Regardless of whether a child with a head injury has any complaints, he or she must be immediately examined by a medical professional. Especially strictly this rule must be observed for children under three years of age.

As soon as a small patient is diagnosed with a concussion, he is hospitalized in a hospital. This will provide the child with psycho-emotional peace, and doctors will be able to monitor the patient around the clock and prevent the development of complications in time. Optimal time hospitalization – 3-4 days.

Drug treatment of concussion in children involves the use of the following groups of drugs:

Diuretics in combination with potassium preparations (for example, Diacarb and Panangin) are prescribed to prevent the development of cerebral edema;
Sedative drops or tablets are necessary to relieve signs of emotional agitation;
Antihistamines and antiemetics should only be taken if allergic reaction or vomiting;
Nootropics and B vitamins are prescribed for faster recovery normal functions brain;
Painkillers are taken if you have a headache.

In case of deterioration of health, it is carried out additional examination child and therapy correction. If the doctor observes regression of symptoms, the little patient is discharged. However, to avoid delayed complications and undesirable consequences of concussion, it is necessary to limit physical activity, reduce the load on the brain (reduce watching TV and working with the computer) and get as much rest as possible. If the above rules are followed, the baby’s condition will completely stabilize after 3 weeks.

Concussion is one of the most common injuries in adults and children. Due to a fall or blow, minor damage to the skull or soft tissues of the brain occurs, resulting in impaired function of the nerve tissues. But this process usually does not lead to irreversible consequences. It is difficult to say how the disease progresses in stages. Many doctors are confident that cell dysfunction occurs when a concussion occurs. nervous system. Possible tissue displacement, disruption of connections between brain centers, malnutrition nerve cells. A concussion can cause minor complications that may be difficult to detect with MRI. Sometimes, with a concussion, a person loses consciousness, but this may not always be noticeable. Loss of consciousness can last from a few seconds to several minutes.

Causes

A child can get a brain injury anywhere: on the street, at home, in childcare facilities or in transport.

Due to the carelessness of their parents, babies can fall from the changing table, bed, or stroller.
Older children learn to move, so falls are common for them.
Preschoolers and younger schoolchildren love to climb trees, stairs and slides on playgrounds. Therefore, traumatic brain injuries are also possible.
A baby's brain can be damaged by severe motion sickness.

Symptoms

Determine whether a concussion is present infants not difficult: possible regurgitation after eating, pale skin covering, nausea and vomiting, as well as capricious and restless behavior of the child with severe bouts of crying.
In older children, severe headaches and dizziness occur, and the pulse changes.
The child cannot concentrate his gaze and gets lost in space.
Immediately after a fall or blow, a child may lose consciousness. But loss of consciousness is more often observed in children older than one year. How to recognize another one of the symptoms of concussion in children is post-traumatic blindness. It can last from several minutes to several hours, after which it disappears without consequences.
Some signs of brain injury do not appear until several hours after a fall or blow.
With a concussion, children may experience a sharp deterioration in their health, nausea and vomiting, and a rise in temperature.
Parents need to know that concussion symptoms do not always appear immediately after the injury. Therefore, it is necessary to take the child to a doctor for examination as soon as possible.

Diagnosis of a concussion in a child

How to understand that this is a concussion - in children this is done in this way: to make a diagnosis, it is necessary to examine the child by a doctor, as well as to take a medical history. A traumatologist and neurologist will examine the baby. An accurate diagnosis will be made after using one of the examination methods. There are several ways to assess the likelihood of brain damage, but usually the doctor will choose one of the methods. For these purposes, computed tomography or MRI is used, and in children under 1.5 years old, ultrasound is performed. CT scan allows you to quickly and easily assess the state of the brain after a fall or blow. MRI can also help detect concussions, but the examination process is longer. And the disadvantages of MRI as a method for studying the child’s brain include administering anesthesia to the baby. For babies whose fontanel has not completely healed, an ultrasound is performed.

This will help you learn more about concussions in children and provide first aid.

Complications

Usually a concussion goes away without consequences. At timely diagnosis and treatment, the child will recover quickly. Complications usually arise in cases of improper or untimely treatment.

A mild concussion may later manifest itself in the form of headaches.
A more severe form of concussion may cause severe complications, which can cause epilepsy.
Headaches can occur due to changing weather conditions.
Insomnia, irritability, abrupt change mood - all these consequences sometimes appear due to a concussion in a child.
A “replay effect” may occur. This means that the baby will experience the same symptoms as during the injury.

If complications arise and a sharp deterioration in the child’s well-being, you should immediately consult a doctor and under no circumstances self-medicate.

Treatment

What can you do

If a child has suffered a traumatic brain injury, it is necessary to provide first aid and send the child for examination to a doctor. The earlier the diagnosis is made, the greater the chances of avoiding consequences and complications.
Before the doctors arrive, it is necessary to place the child in a comfortable position, but do not allow him to sleep.
At open wound on the head, it should be disinfected.
If the baby loses consciousness, he must be turned on his side.
If a child is suspected of having a concussion, painkillers should not be given and the child’s activity should not be limited.
If a child feels well after a fall or blow, but after a few hours his condition sharply worsens, an ambulance should be called immediately.

What does a doctor do

Mild concussions are usually treated at home. Children with traumatic brain injuries are kept in the hospital in severe cases or when complications are suspected. Monitoring by doctors is necessary to prevent epileptic attacks, the development of hematomas and cerebral edema in a timely manner. For this reason, the child may be in the hospital for a week. If, after a computed tomography or magnetic resonance imaging scan, no abnormalities or abnormalities were found, the child remains in the hospital for about 3 days. Treatment of a concussion in a child consists of limiting physical activity, prescribing diuretics and medications with an increased amount of potassium. In some cases, the baby may be prescribed sedatives, as well as anti-allergy medications. After treatment, the child needs vitamin complexes, and he also needs to undergo regular examinations to prevent pathologies.

Prevention

It is not always possible to prevent concussions in children. Babies should be closely monitored and should not be left alone in the room, on the bed or on the changing table. It becomes more difficult to keep an eye on older children. Therefore, it is necessary to explain the rules to children safe behavior not only at home, but also on the street, in kindergartens and schools. And remember, any concussion in children requires seeing a doctor - after all slight concussion can not be!

This is one of the most common diagnoses in pediatric traumatology. But the symptoms can be very vague. However, it is important to track them so that the child receives correct treatment and everything went without consequences.

Take care of your head!

A concussion is the mildest form of traumatic brain injury; No irreversible changes in the brain occur. The next most severe injury is brain contusion. We will consider these two forms of TBI, since it is their parents who are able to “blink.”

The structure of the skull in babies compensates for shocks from falls, which are inevitable during the period while the child learns to walk. It may seem that nature has completely prevented childhood injuries from minor concussions. But this margin of safety gives rise to failures, all the more dangerous since the symptoms in children are not so clear.

Newborns make up 2% of concussion victims, infants 25%, toddlers 8%, preschoolers 20%, and school-age children 45%.

Babies most often fall from changing tables, from strollers, or from the arms of older children. Starting from the age of 1 year, when children learn to walk, the cause of TBI is a fall from their own height. In children under 3 years of age, their head often “outweighs” it, after all, it is large, and they do not know how to put their hands up when falling, and as a result they hit their head.

A little later, the “fall map” expands to include stairs, trees, slides, and so on.

In addition, up to 5 years of age, a concussion sometimes occurs from shaking a child during rough handling or even too active rocking...

Well, with the elders everything is clear without explanation.

Keep in mind that the fall may not always be trackable. If a nanny or relatives were looking after the child, they may be “embarrassed” to tell the parents that the baby fell, or in the most honest way they will not pay attention to it. Older children themselves hide troubles so as not to be scolded. All this further complicates the difficult task of recognizing a concussion if it does happen.

Main signs of concussion in children

Here, for comparison, is a list of symptoms in adults.

Loss of consciousness from a few seconds to 10-15 minutes.
Nausea and vomiting.
Dizziness, headache.
Amnesia (loss of memory) of events immediately before the injury, the injury itself, and immediately after the injury.
Twitching eyeballs, impaired coordination of movements.
In the case of a brain contusion, there is a loss of sensitivity on the side of the body opposite to the site of the injury.

And here is a picture of a concussion in a child.

In children under 1 year

Loss of consciousness most often does not occur.
Single or repeated vomiting, nausea, regurgitation during feeding.
Pale skin.
Unreasonable anxiety and crying.
Increased sleepiness or bad dream, lack of appetite.

All this, you see, is difficult to reconcile with a concussion.

In preschool children

Loss of consciousness, nausea and vomiting occur more often after injury.
Headaches, dizziness.
Increased or slow heart rate.
Blood pressure jumps.
The skin turns pale.
You feel weak and sweating increases.
Disorientations in orientation in time and space are observed
Inability to concentrate.
Sometimes children experience post-traumatic blindness. It occurs immediately after the injury, but may occur later, persists for several minutes or hours, and then disappears.
There is also this peculiarity: immediately after the fall, the child feels normal, but after a few hours and even days, symptoms appear and begin to rapidly increase: in infants, the fontanelle bulges, in older children, clouding of consciousness is possible. IN such a case Even with minimal complaints, the baby can suffer severe brain damage, including hemorrhages.

Complications of concussion in children

If a TBI is suspected, if present minimal symptoms, it is better to show the baby to the doctor, and after an impressive fall - even without any symptoms. When doctors offer hospitalization, do not refuse. This is necessary to prevent complications of injury - cerebral edema, hematomas, meningitis, epilepsy. If the child can be treated at home, you must strictly follow medical instructions, first of all, rest. If the condition worsens (prolonged nausea and vomiting, persistent headaches, general weakness and weakness in the limbs, convulsive twitching, frequent regurgitation in infants) you should immediately contact a neurologist for re-examination or hospitalization.

For a month or two after a concussion, a child may experience motion sickness in transport. This will gradually pass.

Severity of concussion

The severity of the injury is determined by the intensity and duration of general cerebral symptoms, headache, for example.

For mild to moderate concussion, a few hours after the injury or on the second day general state improves: vomiting stops, children become active. Of course, the duration of bed rest depends on the severity of the injury. IN mild case You will have to lie down for a week, with moderate severity - 2-3 weeks, with severe severity - 3 weeks or longer.

Signs of a severe concussion, of course, are unlikely to go unnoticed, but it is not always possible to correlate them with a child’s recent fall, which may look quite ordinary.

Symptoms of a severe concussion

In severe cases, vomiting and nausea appear for 1-2 days.
Infants experience tremors and short-term convulsions.
Older children complain for a long time of headaches, delirium and psychomotor agitation are possible.
Against the background of these general cerebral symptoms, focal disorders are revealed: slight convergent strabismus, asymmetry muscle tone and reflexes.
From the 3rd or 5th day the condition gradually improves, but fatigue, excitability, irritability, and poor concentration will remain for a long time.

Attention: signs of brain contusion in children!

It occurs much less frequently than a concussion. Brain contusion reveals itself as a combination of symptoms different order: general cerebral symptoms (headache, dizziness, nausea) are joined by symptoms of disorders of the stem-basal parts of the brain (respiratory disorder, circulatory disorder). Focal, local symptoms also intensify.

Moreover, all this happens chaotically and unpredictably. In general, the picture is like this.

In the acute period, against the background of impaired consciousness, severe pallor or redness of the skin, sweating, repeated vomiting, rare pulse, and falling occur. blood pressure, sometimes respiratory arrhythmia, local or general convulsions.
Due to the resorption of hematomas, the temperature rises 1-2 days after the injury, and symptoms of toxicosis may appear.
The weaker the general cerebral symptoms become, the more clearly focal neurological disorders are identified: seizures, speech disorders.

Even with a brain injury, all its dangerous signs in children may be blurred, but it is necessary to understand what is happening and consult a doctor.

Warning: Risk!

Proper treatment will help cope with a brain injury without irreversible consequences for the child. But it will take him much longer to recover than after a concussion. School performance decreases, depressed or overexcited state increases. This is a dangerous moment: in childhood, a temporary state of affairs is easily mistaken for permanent, self-esteem drops sharply, depression can turn into chronic form already for psychological reasons. Try to explain to your child that this will all pass. You will first have to teach your child to monitor his condition and not overwork. And then help him return to a normal rhythm of life. Identify this vision and work together to realize it.