Childhood Injuries: Post Concussion Syndrome & Recovery & Safety Measures To Prevent Concussions

My last article ”Childhood Injuries: Concussions” was about what a concussion was, its symptoms, and the initial recovery course. It reviewed some precautions parents need to take and also the activities that needed to be restricted to facilitate the healing process. It was a general overview and guide for parents. Today I will like to take a look into the Post Concussion Recovery In Children.

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Just to reiterate, most children with a concussion will feel better within a few weeks of the concussion however some symptoms may last for a month or longer. According to Centers for Disease Control and Prevention (https://www.cdc.gov/headsup/basics/concussion_recovery.html) they advise parents to make short-term changes to their child’s daily activities. This can help facilitate the child’s ability to get back to a regular routine more quickly. It is suggested that as the child starts to feel better, the parent can remove the changes slowly. However, if they notice that the child’s symptoms worsen, they should go back to the previous level of activity until symptoms abate. The CDC stresses that each child is unique so the recovery should be tailored to his/her symptoms.

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Levels of Activity Recommended After Concussion

REST: Your child should take it easy the first few days after the injury when symptoms are more severe: 1. Early on, limit physical and thinking/remembering activities to avoid symptoms getting worse. 2. Avoid activities that put your child at risk for another injury to the head and brain. 3. Get a good night’s sleep and take naps during the day as needed.

LIGHT ACTIVITY: As your child starts to feel better, gradually return to regular (non-strenuous) activities: 1. Find relaxing activities at home. Avoid activities that put your child at risk for another injury to the head and brain. 2. Return to school gradually. If symptoms do not worsen during an activity, then this activity is OK for your child. If symptoms worsen, cut back on that activity until it is tolerated. 3. Get maximum nighttime sleep. (Avoid screen time and loud music before bed, sleep in a dark room, and keep to a fixed bedtime and wake up schedule.) 4. Reduce daytime naps or return to a regular daytime nap schedule (as appropriate for their age).

MODERATE ACTIVITY: When symptoms are mild and nearly gone, your child can return to most regular activities: 1. Help your child take breaks only if concussion symptoms worsen. 2. Return to a regular school schedule.

BACK TO REGULAR ACTIVITY: Recovery from a concussion is when your child is able to do all of their regular activities without experiencing any symptoms.

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It is also good for parents to remember to make an appointment for a doctor’s follow-up visit for a check-up. Be sure to ask the doctor about the use of over-the-counter or prescription medications that may help with any symptoms and whether or not it is safe. CDC also recommends that parent limit soft drinks or caffeinated items to ensure the child’s rest.

The CDC also said that there may be other factors that may make the recovery process slower including a history of brain injury or a previous concussion, if there are any neurological or mental disorders, if the child has learning difficulties and finally family and social stressors. Any of these things may impact and/or delay recovery.

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Females May Be More Prone To Concussions

According to an article in CBC News (http://www.cbc.ca/news/health/concussion-guide-for-doctors-provides-6-step-recovery-plan-1.1314696), “Concussion guide for doctors provides 6-step recovery plan”, females may be more prone to brain injury than males, when they play hockey and basketball. Dr. Charles Tator of the neurosurgery division at the University of Toronto suspects this is because “women’s neck muscles aren’t as developed as men’s.” He referenced a female basketball player who fell during a game and had fallen and hit her head. Doctors had told her she had a concussion and recommended that she give up basketball. They also told her to stay away from sports for a year.

It should be noted here that most neurosurgeons caution athletes who have had a concussion, to stay out of sports until he/she recovers completely. The reason for this precaution, is that, if these athletes return to sports too soon and incur another injury called “second-impact syndrome”, this can lead to swelling of the brain. Sometimes, swelling in the brain can result in major neurological effects or even death. I’m sure many of you have heard about Chronic Traumatic Encephalopathy that has impacted many football players from repetitive head trauma. I will do a future article on this area of interest.

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Post-Concussion Syndrome

Most Children and teens with a concussion will feel much better within a couple of weeks. But there are some children who may have lingering effects from a concussion even though their physical symptoms have faded. In some cases emotional symptoms may occur later on. If your child or teen still has post-concussion symptoms it is advised to see his/her doctor. In some rare cases after a concussion, the child may have a Post-Concussive Syndrome. Usually this happens after multiple concussions.

What Does Post-Concussive Syndrome Look Like In Children?

In an article from Brainline (https://www.brainline.org/author/jane-gillett/qa/what-does-post-concussive-syndrome-look-children), Dr. Jane Gillett, neurologist, described post-concussive (after brain injury) symptoms in infants, children and adolescents as being similar but each have their own unique characteristics. She said that it is hard to recognize that a brain injury has occurred in infants. The most prominent symptom is a loss of consciousness but there are other symptoms that can alert parents such as inconsolable crying despite attempts at comforting the infant. Vomiting or excessive sleepiness, refusing to eat, prolonged periods of irritability or prolonged periods of quietness or inactivity can be signs of a concussion. Dr. Gillett also said that a bulging of the anterior fontanelle (the soft spot at the top of the head) is not a good sign. If your infant has any of these signs, you should immediately rush the him/her to the doctors.

For children under the age of 6 or 7, it is sometimes hard to recognize symptoms of a brain injury which are limited short-term memory and short, brief attention spans. Unfortunately these can occur in normal toddlers. With older children and adolescents these symptoms are more recognizable. Then in the teens the symptoms may be confusion and word finding problems.

Recognizing Other Concussion Signs In Children & Adolescents

In addition to memory and attention span issues or changes, Brainline listed the following signs and symptoms:

Brief (less than 20 minutes) loss of consciousness

Confusion or being dazed or stunned, or seeing stars

Headache

Nausea

Emotional lability (cry or laugh unexpectedly)

Anxiety or depression

Sleep disturbance

Fatigue and the vertigo

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So as you can see there are many problems that can develop with concussion. The best things parents can do is be proactive with your child’s safety. Parents should make every effort to provide their children with a safe environment. Here are some recommendations from Medline Plus (https://medlineplus.gov/ency/patientinstructions/000130.htm) regarding safety for children:

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Car Safety

Use a child safety seat or booster seat that is best for their age, weight, and height. A seat that fits poorly can be dangerous. Ask your health care provider, or check with your local police station, where you can have your child's car seat checked for free.

Children often move from car seats to booster seats when they weigh 40 pounds (lb) or 18 kilograms (kg). There are car seats that are made for children who weigh more than 40 lbs or 18 kgs.

Car and booster seat laws vary by state. It is a good idea to keep your child in a booster seat until they are at least 4'9" (145 cms) tall and between 8 and 12 years old.

DO NOT drive with a child in your car when you have been drinking alcohol, used illegal drugs, or are feeling very tired.

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Wearing a Helmet

Helmets can help to prevent head injuries. It is recommended that the helmet fits properly for the following activities:

Playing contact sports, such as lacrosse, ice hockey, football

Riding a skateboard, scooter, or in-line skates

Batting or running on the bases during baseball or softball games

Riding a horse

Riding a bike

Sledding, skiing, or snowboarding

Older children should always wear a helmet when riding a snowmobile, motorcycle, scooter, or all-terrain vehicle (ATV). If possible, children should not ride on these vehicles.

Almost all major medical organizations recommend against boxing of any sort, even with a helmet.

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Keeping Your Child Safe In The Home

Install window guards on all windows that can be opened.

Use a safety gate at the top and the bottom of stairs until your child can safely go up and down. Keep stairs free of any clutter. DO NOT let your children play on stairs or jump on or from furniture.

DO NOT leave a young infant alone on a high place such as a bed or sofa. When using a high chair, make sure your child is strapped in with the safety harness.

Store all firearms and bullets in a locked cabinet.

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Outdoor Safety

Make sure playground surfaces are safe. They should be made of shock-absorbing material, such as rubber mulch.

Keep your children away from trampolines, if possible.

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Bedroom Safety

Keep the side rails on a crib up.

DO NOT let your child jump on beds.

If possible, do not buy bunk beds. If you must have a bunk bed, check online reviews before buying. Make sure the frame is strong. Also make sure there is a side rail on the upper bunk. The ladder should be strong and attach firmly to the frame.

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This concludes my Childhood Injuries: Concussion series but I would like to continue along the line of concussion in young adults and adults. Due to high contact sports and other situations including car and work accidents, I will continue my research in these areas. I hope you will continue to join me in my journey to learn more about areas that we may not be fully aware of.

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These are my previous articles. if you are interested in reading it:

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