June 20, 2016, 15:17
I often see posts in which mothers talk about their feelings about hitting a child with the head: hit, fell.
The responses in the comments are amazing: “Yes, it’s fine, don’t worry… All children fall! Mine fell a hundred times a day and nothing, normal. ”, - gy-gyyy.
I propose to figure out how “normal” a head injury is, even, at first glance, not significant ...
Concussions in children. Symptoms and treatment
A concussion is one of the most common diagnoses in pediatric traumatology. In general, traumatic brain injury (TBI) ranks first among all childhood injuries requiring hospitalization. Approximately 120,000 children with concussion are admitted to hospitals in Russia every year.
In terms of severity, traumatic brain injury is divided into mild (brain concussion), moderate (brain contusion of mild and moderate severity, with possible fractures of the bones of the cranial vault) and severe (severe brain contusions, intracranial hematomas with brain compression, skull base fractures). Fortunately, up to 90% of childhood TBIs are due to concussions, which will be discussed in this article.
The high level of injuries in children is explained by the increased motor activity of the child, his restlessness and curiosity, which is combined with the imperfection of motor skills and coordination of movements, as well as a reduced sense of danger and fear of heights. In addition, in young children, the head has a relatively large weight, and the skill of belaying with hands is not yet developed, so small children, as a rule, fall upside down and do not substitute their hands.
The causes of childhood TBI are very specific to each age group. Newborns in the total mass of victims account for 2%, infants - 25%, toddlers - 8%, preschool - 20% and school age 45%.
Injuries in infants are primarily the result of inattention and carelessness of their parents. Children under 1 year old most often (in more than 90%!) get head injuries after falling from changing tables, beds, from the hands of their parents, from strollers, etc. Never leave a baby alone in a place where he can fall. If you need to move away from the child at a distance greater than a stretched arm, do not be lazy, put him in a crib, in a stroller with sides, in an arena! One or two seconds is enough for the baby to roll to the edge of the changing table and fall.
Beginning from 1 year babies are starting to walk. The main cause of TBI is a fall from a height of one's own height, and a little later - falls from stairs, trees, roofs, windows, slides, etc. The TBI episode itself is not always possible to identify. It should be borne in mind that if the child remained under the supervision of relatives, neighbors or nannies, then they can hide the fact of the fall of the baby from the parents.
Older children themselves, for various reasons, often conceal the trauma. It is also possible for children to have brain damage without direct head trauma. These injuries usually occur when a child's body is subjected to sudden acceleration or deceleration (shaken baby syndrome). Shaken baby syndrome is most commonly seen under the age of 4-5 years and can occur with rough handling, jumping from a height to the feet, and in young children, even with their excessively intense motion sickness.
Signs of a concussion
With a concussion, there are no gross, irreversible changes in the brain, and such an injury, being the most frequent, has the best prognosis and very rarely leads to complications.
It should be remembered that the brain of a child (and especially an infant) is significantly different from the brain of an adult. The picture of concussion in adults differs significantly from the course of this injury in a child.
In adulthood, a concussion of the brain is manifested by the following main features: an episode of loss of consciousness from a few seconds to 10-15 minutes; nausea and vomiting; headache; amnesia (loss of memory) of events associated with trauma (before the trauma, the trauma itself and after the trauma). In addition, some specific neurological symptoms are revealed, such as nystagmus (twitching of the eyeballs), impaired coordination of movements, and some others. The picture of a concussion in a child is completely different.
In children up to 1 year concussion is usually asymptomatic. Loss of consciousness does not happen more often, there is a single or repeated vomiting, nausea, regurgitation during feeding, pale skin, unreasonable anxiety and crying, increased drowsiness, lack of appetite, poor sleep.
In children preschool age more often it is possible to establish the fact of loss of consciousness, nausea and vomiting after an injury. They have headaches, increased or slowed heart rate, instability of blood pressure, pallor of the skin, sweating. At the same time, capriciousness, tearfulness, and sleep disturbance are often noted.
Sometimes children have a symptom such as post-traumatic blindness. It develops immediately after injury or a little later, persists for several minutes or hours, and then disappears on its own. The reason for this phenomenon is not completely clear.
The peculiarities of the child's organism lead to the fact that a long-term state of compensation can be replaced by a rapid deterioration in the state. That is, immediately after the fall, the child feels satisfactory, and after a while, symptoms appear and begin to increase rapidly.
First aid for TBI
What should parents do if their child has a traumatic brain injury? There is only one answer - the child should definitely and urgently be shown to the doctor. It is best to immediately call an ambulance, which will definitely take the child to a hospital with pediatric neurosurgeons or neuropathologists. And this measure is not redundant. With minimal symptoms and complaints, the baby may have severe brain damage. The long-term apparent well-being of the child, the absence of symptoms, especially with cerebral hemorrhages, often after several hours and even days is replaced by a progressive deterioration in the condition, which begins with a change in the child's behavior, his increased excitability, there may be nausea, vomiting, nystagmus, the fontanel bulges in infants , then drowsiness appears, depression of consciousness is observed.
Concussion Diagnosis
In the hospital, the child is examined by a pediatric neuropathologist, neurosurgeon or traumatologist. He carefully clarifies complaints, collects an anamnesis (history of the disease), conducts a general and neurological examination. Additional diagnostic methods are assigned. The main ones are X-ray of the skull, neurosonography (in young children), echo-encephalography (Echo-EG). If necessary, computed tomography of the brain (CT), magnetic resonance imaging (MRI), electroencephalography (EEG), lumbar puncture.
Radiography the skull is held most of the patients. The purpose of this study is to identify skull fractures. The presence of any damage to the bones of the skull automatically translates the injury into the category of moderate or severe (depending on the condition of the child). Sometimes in young children with a favorable clinical picture, linear fractures of the skull bones are detected on radiographs. It is impossible to judge the state of the substance of the brain by radiographs.
Neurosonography(NSG) is an ultrasound examination of the brain. Neurosonograms clearly show the substance of the brain, the ventricular system. You can identify signs of cerebral edema, foci of contusion, hemorrhage, intracranial hematomas. The procedure is simple, painless, quickly performed, has no contraindications. It can be done multiple times. The only limitation of neurosonography is the presence of so-called "natural ultrasound windows" - a large fontanel or thin temporal bones. The method is very effective in children aged up to 2 years. Later, it becomes difficult for the ultrasound to pass through the thick bones of the skull, which drastically degrades the image quality. Equipment for performing neurosonography is available in most children's hospitals.
Echo encephalography(Echo-EG) is also an ultrasound research method that allows you to identify the displacement of the structures of the midline of the brain, which may indicate the presence of additional volumetric formations of the brain (hematomas, tumors), provide indirect information about the state of the substance of the brain and the ventricular system. This method is simple and fast, but its reliability is low. Previously, it was widely used in neurotraumatology, but with the availability of modern diagnostic tools, such as neurosonography, computed tomography and magnetic resonance imaging, it can be completely abandoned.
The ideal method for diagnosing damage and diseases of the brain is CT scan(CT). This is an X-ray method of research in which high-definition images of the bones of the skull and the substance of the brain can be obtained. Almost any damage to the bones of the vault and base of the skull, hematomas, bruises, hemorrhages, foreign bodies of the cranial cavity, etc. are diagnosed by CT. The accuracy of this study is very high. Its main disadvantage is that the CT machine is expensive and not available in every hospital.
Magnetic resonance imaging(MRI) is the most accurate, but complex and expensive method of examining the central nervous system. It is rarely used for diagnosing acute traumatic brain injury because it does not show the bones of the skull, is less accurate for recognizing acute hemorrhages, takes longer than computed tomography, often requires anesthesia when examining young children - the child must lie absolutely still for 10 -20 minutes, and small children cannot do this; in addition, very few clinics can boast of having magnetic resonance tomographs.
Electroencephalography(EEG) allows you to study the bioelectrical activity of the brain. It is used according to special indications to assess the severity of traumatic brain injury, to identify foci of epileptic activity. The focus of epiactivity is an area of the cerebral cortex with pathologically altered activity of neurons (nerve cells), which can lead to the occurrence of epileptic seizures.
Lumbar puncture- this is the intake of cerebrospinal fluid (fluid washing the brain and spinal cord) from the spinal canal at the lumbar level. Changes in the cerebrospinal fluid may indicate an injury or hemorrhage (presence of blood) or an inflammatory process, meningitis. Lumbar puncture is extremely rare and only for special indications.
Tactics for the treatment of concussion
After the baby has fallen, before the doctor examines him, helping the child is to create a calm environment. You need to put the baby to bed, provide him with peace. If there is bleeding from the wound, if possible, treat it and bandage it.
In addition to diagnostic procedures in the emergency room of the hospital, soft tissue injuries of the head (bruises, abrasions, wounds) are treated. Children, especially young children, with a confirmed craniocerebral injury, including those with concussion, are subject to mandatory hospitalization.
Hospitalization has several purposes.
Firstly, for several days the child is under the supervision of doctors in a hospital for early detection and prevention of complications of trauma - cerebral edema, the appearance of intracranial hematomas, epileptic (convulsive) seizures. The probability of these complications is small, but their consequences are extremely severe and can lead to catastrophically rapid deterioration of the child's condition. Therefore, with a concussion, the standard hospitalization period is a week. With good technical equipment of the hospital (computed tomography, neurosonography), which makes it possible to exclude more severe brain damage, the length of stay in the hospital can be reduced to 3-4 days.
Secondly, during hospitalization, the patient is provided with the creation of psycho-emotional peace. This is achieved by limiting the motor and social activity of the child. Of course, it is difficult to achieve complete bed rest for children, but still, the conditions of the hospital do not allow running around, noisy games, watching TV for a long time, or sitting at the computer. After discharge, the home regime is maintained for another 1.5-2 weeks, sports are limited for several weeks.
Medical therapy for concussion has several goals. First of all, the child is prescribed diuretics (most often, less often -) in a mandatory combination with potassium preparations (,). This is done to prevent swelling of the substance of the brain. Soothing therapy is carried out (PHENOSEPAM, VALERIAN ROOT INfusion) and antihistamines are prescribed (,). For headaches, analgesics are prescribed (BARALGIN, SEDALGIN), with severe nausea -. At a later date, nootropic drugs can be prescribed that improve metabolic processes in the brain, vitamins.
Control over the condition of children is carried out by the attending and on-call doctor, as well as guard nurses. In case of any deterioration, the child is re-examined, additional diagnostic tests (neurosonography, computed tomography, EEG) are prescribed.
When offering to go to the hospital, the doctor first of all takes care not to miss a more severe injury than a concussion, and this is possible only with qualified observation of the child.
If the baby is in a satisfactory condition, after a few days, parents can take him home against a receipt. However, even at home, it is required to observe a medical and protective regimen, limit TV viewing, computer games, walks, visit friends, and continue drug therapy. If there is any suspicion of a deterioration in the child's condition (appearance of nausea and vomiting, headaches, unmotivated drowsiness, convulsive seizures, weakness in the limbs, frequent regurgitation in babies), you should immediately re-consult a doctor for further examination and possible hospitalization.
As a rule, after 2-3 weeks the child's condition completely returns to normal. A concussion usually resolves without sequelae or complications. The child can again attend nursery and kindergarten, play sports.
In conclusion, once again it is necessary to emphasize the importance of timely access to a specialized children's hospital, which will allow to exclude more severe forms of traumatic brain injury.
How dangerous is a concussion for mental activity, the nervous system?
A concussion is a functional injury. The basis is not the destruction of neurons, but a temporary disruption of the functioning of the brain.
Subject to the regimen and the absence of aggravating factors (the presence of concomitant diseases of the nervous system), concussion ends with recovery. Otherwise, a brain concussion received in early childhood will affect adulthood, especially clearly during the years of study: school, institute - not attentiveness, not perseverance, learning difficulties, difficult digestibility of material, memory ... Often parents perceive this as laziness and parasitism, and the fault of the once untreated concussion of the brain!
A concussion is considered a minor injury, but can there be long-term complications from a concussion? Which?
In some patients, over time, there may be a weakening of attention, memory loss, dizziness, headaches, fatigue, and sleep disturbance. And also, vision loss, hearing loss, speech inhibition. There are known cases of death from not going to the doctors with a traumatic brain injury.
However, about a year after the concussion, these signs disappear or are significantly smoothed out.
As a rule, these changes occur in patients who already suffer from certain diseases of the nervous system.
If the recommended treatment regimen is not followed, the recovery period is lengthened and asthenic syndrome, vegetovascular dystonia and other disorders may occur.
Although in some cases, long-term effects may occur. This is meteorological dependence, and even epileptic seizures.
----
Personal experience
Recently (06/11/16) we ended up in the hospital with a concussion: in the kindergarten (06/10/16), in the group, after dinner and before quiet time, mine played with a stroller and a doll ... A boy and 2 girls came up, began to select ... As a result, a boy with one of these girls pushed mine so that it fell on the carpet along with the stroller - the first bump. Immediately the second girl came up to my bed and bit her in the forehead, in the scalp - the second bump. There were no teachers nearby, both teachers (one from the first shift, had not left yet and the second from the second shift, had already arrived) were washing dishes in the kitchen and talking peacefully. The nanny was the first to run to the screams. My own could not stand up due to severe dizziness and darkening in the eyes. The nanny took mine in her arms and felt sorry ... My daughter cried a lot and could not calm down for a long time. The educators punished the perpetrators of the conflict - scolded, put in a corner.
I came to pick up mine right after a quiet hour (Friday, our last day in the kindergarten, before the holidays), the teacher and the nanny did not tell me anything. We immediately went to the cottage. All the way, my daughter behaved restlessly, whimpering and constantly scratching her head. I thought: whimpering from fatigue, scratching his head - itching (right now, I already understand that my head hurt). In the morning I woke up at 07:00 - earlier than usual (usually, if you don’t need to get up early in the morning, you can wake up at 08:00 at the earliest, and you can sleep until 10:00), and with crying began to complain of pain in your head. Mine does not suffer from headaches and I immediately assumed that she might have fallen or hit her head in the garden. I started asking her questions... My daughter showed me her bumps and told me everything. I asked her why she didn’t tell me yesterday ... My daughter replied that yesterday, how it all happened, it hurt very much, but then my head began to hurt less, it didn’t hurt as much as today ... My husband and I decided to go to Moscow, show up physicians.
We arrived at the emergency room, did an x-ray of the skull - approx. The traumatologist recommended to observe for 3 days and, after that, to show the child to the Neurologist, regardless of the child's condition. Such a recommendation of the Traumatologist did not suit me - to wait 3 days ... And as soon as we arrived home, we immediately called an ambulance, they recommended that we immediately go to the hospital, and on the ambulance my daughter and I went to the Children's City Hospital No. 9. Dad followed us in a car...
In the hospital, in the admissions department, I told the Pediatrician, among other things, about the recommendations of the Traumatologist from the Trauma Center ... The pediatrician was outraged by such a recommendation - to wait 3 days ... He said that I did the right thing, that I did not wait ... - when persecuting the head, you need to immediately, during the first 24 hours from the moment of injury, contact an ambulance, because traumatologists look, only bones and visible soft tissue damage, they cannot see and assess the brain, this requires a comprehensive examination of several specialists, M-Echo , observation ..., in a hospital !
My state at admission was determined as moderate, noted soft tissue hematomas and took blood for analysis. The doctors asked me if I told the police? I say no. They - why? I explained ... They warned me that they would give a signal to the Police - the protection of the rights of the child, because I myself did not declare ...
Made M-Echo in dynamics (3 days in a row) - approx.
Examined by Neurosurgeon and Neurologist - approx.
Examined by an ophthalmologist dilated eye veins(an indirect sign of concussion).
The next day of my stay in the hospital, the District Officer calls, says the case will be transferred to the Inspector for Juvenile Affairs, and when they call me, I must come for interrogation.
Stayed for 5 days.
During this time we received:
- - 1 ton x 3 rubles / day;
- Asparkam - 1/2 tons x 2 rubles / day;
- Diacarb - 1/2 t. x 2 rubles / day
In the hospital, my daughter and I were together - p
alata is designed for 2 children and 2 parents, 1 parent for each child.They fed well, my daughter says it was delicious, like in a kindergarten ... A 5-year-old girl was lying with us in the ward with the same diagnosis - she fell off her bicycle. Entered together and left together.- Observation of Pediatrician and Neurologist at the place of residence.
- Glycine- 1 ton x 3 rubles / day - 3 weeks
- Rest: restriction in physical activity (you can’t: run, jump, ride on carousels and slides, rides ... If we were on vacation, visit the kindergarten / any children's groups, here), as well as the complete exclusion of work on electronic media (not allowed: TV, computer, tablet, iPhone...) - 3 weeks.
- Avoid direct sun, cover your head with a hat.
- Exclude air travel - 6 months.
Immediately after I was discharged from the hospital, the Inspector for Juvenile Affairs called me and invited me for interrogation. Under interrogationFirst of all, the Inspector for Juvenile Affairs demanded an explanation from me why I did not report what had happened, why the doctors did it for me ... - I had to record the explanations ... According to the child, everything was recorded in detail, signed ... They said that an inspection would be carried out in the garden , work will be carried out among all the staff of the kindergarten, parents and children participating in the conflict, of course, given that the protocol was drawn up from the words of a four-year-old. Here the Inspector and I made a decision and signed a petition, according to which I ask not to interrogate children because of their unconscious age, so as not to affect their psycho-emotional state, but to interrogate their parents, so that the parents themselves would conduct educational conversations with their children, during avoiding a similar conflict again ... Also, since the child received timely medical care, there is no longer a threat to life and health, we signed a petition for which I ask to close the Case.
I was very pleased with such attention towards children, I feel care and responsibility for our future - children, on the part of doctors and authorities ... There was confidence that after the work done, something like this in the kindergarten (God forbid) will not happen again. 06/20/16 We were taken from the Pediatrician with a referral to a Neurologist in order to get registered - we will be observed ...
06/21/16 Registered with a Neurologist...
My daughter and I came to the Neurologist, and I told her: “We had a concussion, we just got out of the hospital ...”, I hand out our extract.
She took an extract, looks, and says: “Where did you see that you had a concussion!?”, - she hands me an extract ...
I am with rounded eyes ...: “How ... Was it something? We were in the hospital, we were kept for 5 days, the recommendation says to register with you to get up ... ”, - that is, in my experiences, I didn’t even notice the fact that in our extract there was not a word about a concussion brain.
To which she replies: “You have a soft tissue injury. And that you were in the hospital and came to me ... - this is a standard procedure for all children admitted with a complaint of a blow to the head, in order to be observed and exclude a concussion ... ”, - in general, doctors will play it safe. Yes, I do not mind, only "FOR" reinsurance!
Of course, I am very glad that we got off so lightly, but my daughter still suffered, so let the police figure it out there ... so that such incidents will not happen again either with mine or with other kids in the group.
In the direction of our Neurologist, a month after discharge from the hospital, we showed ourselves to an ophthalmologist to check the veins of the fundus - ok, we have already returned to normal. Along with this, at the same time, she had a complete examination of her vision - approx. I recommended "quarantine" on TV, tablet ... extend for another 2 months. As she explained... - despite the fact that the veins of the fundus have already fully recovered, after such an injury there may still be residual effects ... - in general, the eyes still need rest. After 2 months TV, tablet… strictly limited! Watching "Good Night" before going to bed is enough. She gave me a memo of "Communication" of the child with a TV, a computer ... by age group, so that we would go to school with good eyes. She emphasized that the main %
all children in the first grade are already wearing glasses due to uncontrolled "communication" with electronic equipment.
www. detskoezrenie.ru
www. eye-focus.com
----
See from 33 min. up to 49 min. :
Health to you and our children! After all, children are the most precious, most priceless thing we have - our future!
______________________
And I think something like this is very rare ...:
Hmm, I also once gave birth, I also had this post-natal psychosis, I was like not myself for half a year ... But I didn’t even think of throwing a child with my head on the floor ... I beat the pillow with a psycho when it covered - yes, 2 times with fists on my husband pounced ... - poor, silently endured everything. But the child's gender ...
I don't judge anyone! Emotions flow...
Loading...