7 days after the concussion child. Severe traumatic brain injury. Symptoms of concussion in children.

This is one of the most common diagnoses in pediatric traumatology. But the symptoms are very "blurred". However, it is important to keep track of them so that the child receives the correct treatment and everything goes without consequences.

Take care of your head!

Concussion is the most mild form traumatic brain injury; irreversible changes in the brain do not occur. Next in severity is a brain injury. 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 the shocks from falls that are inevitable while the child is learning to walk. It may seem that nature has completely prevented childhood injuries from small concussions. But this margin of safety gives failures, all the more dangerous because the symptoms in children are not so intelligible.

Newborns make up 2% of concussion victims, children infancy- 25%, nursery - 8%, preschool - 20% and school age 45%.

Babies most often fall from changing tables, from strollers, from the hands of older children. Starting from the age of 1, when children learn to walk, the cause of TBI is a fall from the height of their own height. In babies under 3 years old, the head often “outweighs”, because it is large, and they don’t know how to substitute their hands when they fall, and as a result they hit their heads.

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

In addition, up to 5 years of age, concussion sometimes occurs from shaking the child with rough handling or even too much motion sickness ...

Well, with the elders, everything is clear without explanation.

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

The 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.
• twitch eyeballs, impaired coordination of movements.
• In the case of a brain injury, loss of sensation on the side of the body opposite the site of the injury.

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

In children under 1 year old

• Most often there is no loss of consciousness.
• Single or repeated vomiting, nausea, regurgitation during feeding.
• Paleness of the skin.
• Unreasonable anxiety and crying.
• increased sleepiness or bad dream, lack of appetite.

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

In children preschool age

• Loss of consciousness, nausea, and vomiting are more common after injury.
• Headaches, dizziness.
• Increased or slow heart rate.
• Blood pressure jumps.
• The skin turns pale.
• There is a feeling of weakness, sweating increases.
• Orientation failures in time and space are observed
• Inability to concentrate.
• Sometimes children develop post-traumatic blindness. It occurs immediately after the injury, but may later, persists for several minutes or hours, and then disappears.
• There is also such a feature: immediately after the fall, the child feels normal, and after a few hours and even days, symptoms appear and begin to grow rapidly: the fontanel bulges in infants, clouding of consciousness is possible in older children. In such a case, even with minimal complaints, the baby may have severe brain damage, up to hemorrhages.

Complications of concussion in children

If you suspect a TBI, if there are 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, don't 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 prescriptions, above 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, the child may be motion sick in transport. This will gradually pass.

The severity of a concussion

The severity of the injury is determined by the intensity and duration of cerebral symptoms, such as headaches.

With concussion, light and medium degree a few hours after injury or on the second day general state improves: vomiting stops, children become active. Of course duration bed rest depends on the severity of the injury. In a mild case, you will have to lie down for a week, with an average degree - 2-3 weeks, with a severe one - 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 recent fall of a child, which may look quite ordinary.

Symptoms of a severe concussion

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

Attention: signs of brain injury in children!

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

And all this happens randomly and unpredictably. In general, the picture is this.

• IN acute period against the background of disturbed consciousness, there is a sharp pallor or redness of the skin, sweating, repeated vomiting, a rare pulse, a fall blood pressure, sometimes respiratory arrhythmia, local or general convulsions.
• Due to the resorption of hematomas, 1-2 days after the injury, the temperature rises, symptoms of toxicosis may appear.
• The weaker the cerebral symptoms become, the more clearly focal neurological disorders are detected: convulsions, speech disorders.

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

Attention: risk!

Proper treatment will help to cope with a brain injury without irreversible consequences for the child. But it will take much longer to recover than after a concussion. School performance decreases, depressed or overexcited state increases. This is a dangerous moment: in childhood, the temporary state of things 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 pass. We will first have to teach the child to monitor his condition, not to overwork. And then help him get back to a normal rhythm of life. Set that perspective and work together to realize it.

A concussion is one of the most common diagnoses in pediatric traumatology. In general, traumatic brain injury (TBI) ranks first among all injuries. childhood requiring hospitalization. Approximately 120,000 children with concussion are admitted to hospitals in Russia every year.

According to the degree of severity, traumatic brain injury is divided into mild (concussion), moderate(brain contusion of mild and moderate severity, with possible fractures bones of the cranial vault) and severe (severe brain contusions, intracranial hematomas with brain compression, fractures of the base of the skull). Fortunately, up to 90% of childhood TBIs are due to concussions, which will be discussed in this article.

The high level of traumatism in children is explained by the increased motor activity 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 children younger age the head has a relatively large weight, and the skill of belaying with hands has not yet been developed, therefore, small children, as a rule, fall upside down and do not substitute their hands.

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 a nanny, then they can hide the fact of the fall of the baby from the parents.

Older children by yourself various reasons often hide 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, pallor of the 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 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.

Peculiarities child's body 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 grow 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's best to immediately call " ambulance", which will definitely take the child to a hospital with pediatric neurosurgeons or neuropathologists. And this measure is not excessive. With minimal symptoms and complaints, the baby may have severe brain damage. Long-term apparent well-being of the child, the absence of symptoms, especially with cerebral hemorrhages , often after several hours and even days, it is replaced by a progressive deterioration in the condition, which begins with a change in the behavior of the child, 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. Appointed additional methods diagnostics. The main ones are X-ray of the skull, neurosonography (in young children), echo-encephalography (Echo-EG). If necessary - CT scan brain (CT), magnetic resonance imaging (MRI), electroencephalography (EEG), lumbar puncture.

Radiography the skull is held most of the patients. aim this study is the detection of 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 prosperous clinical picture radiographs revealed linear fractures of the skull bones. It is impossible to judge the state of the substance of the brain by radiographs.

Neurosonography(NSG) is ultrasound procedure 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 ultrasonic method research that allows you to identify the displacement of structures middle line brain, which may indicate the presence of additional volumetric formations brain (hematomas, tumors), give 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 in the presence of modern means diagnostics, 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, foci of bruising, hemorrhages, foreign bodies cranial cavity, etc. 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 to diagnose acute traumatic brain injury because it does not show the bones of the skull, is less accurate for recognizing acute hemorrhages, takes longer than a CT scan, 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 bioelectric activity brain. It is applied 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 epileptic seizures.

Lumbar puncture - this is the intake of cerebrospinal fluid (liquid washing the head and spinal cord) from the spinal canal at the lumbar level. Changes in CSF may indicate injury or hemorrhage (presence of blood) or 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.

Apart from diagnostic procedures in the emergency room of the hospital, soft tissue injuries of the head (bruises, abrasions, wounds) are treated. Children, especially early age, with a confirmed craniocerebral injury, including 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 injury complications - 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, 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 DIAKARB, less often FUROSEMIDE) in a mandatory combination with potassium preparations (ASPARKAM, PANANGIN). This is done to prevent swelling of the substance of the brain. Soothing therapy is carried out (PHENOZEPAM, VALERIAN ROOT INfusion) and prescribed antihistamines(Suprastin, Diazolin, Dimedrol). For headaches, analgesics are prescribed (BARALGIN, SEDALGIN), with severe nausea - CERUKAL. In more late dates may be appointed nootropic drugs 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, a second examination of the child is carried out, additional diagnostic studies(neurosonography, computed tomography, EEG).

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, at home, it is required to observe a medical and protective regimen, limit TV viewing, computer games, walks, visit friends, 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 attend nursery again and Kindergarten, do sport.

In conclusion, once again it is necessary to emphasize the importance of contacting a specialized children's hospital in a timely manner, which will make it possible to exclude more severe forms traumatic brain injury.