Concussion is such an important topic as Junior sport ramps up for winter…

 

Concussion and your Child

Concussion is an important topic. One in five children will experience a concussion by the age of 10.1 The recent release of the PREDICT Australian and New Zealand Guidelines for Mild to Moderate Head Injuries in Children2 provides health practitioners and the general public with more guidance on what to do when a child or adolescent gets a concussion.

What is a concussion?

A concussion is a mild head injury that involves acceleration of the brain caused by a direct blow to the head, neck or the body. The child may lose consciousness, but 90% of the time they do not.1 If a suspected concussion is sustained whilst a child is playing sport, they should be removed from play immediately and not return to play that day.

When to take your child to the hospital

The PREDICT Guidelines recommend that you take your child to the hospital if they experience any of the following symptoms within 72 hours of injury:

  • seizure or convulsion
  • double vision, ataxia, clumsiness or walking abnormality
  • loss of consciousness or deteriorating level of consciousness
  • weakness and tingling in arms or legs
  • presumed skull fracture (palpable fracture, two black eyes, bruising behind the ear)
  • vomiting
  • severe headache
  • not acting normally, including abnormal drowsiness, increasing agitation, restlessness or combativeness (in children aged less than 2 years, not acting normally is deemed by a parent)
  • significant swelling and blood clot on the scalp (in children aged less than 2 years only)

If you are concerned about your child following a head knock, seek a medical evaluation.

Should my child have a brain scan to check for concussion?

Concussion does not show up on hospital brain scans. Doctors may order a brain scan to check for a bleed on the brain or more significant brain damage. Doctors will not order a brain scan for every child who has had a knock to the head, as every scan increases the lifetime radiation exposure, which is more significant for children. The PREDICT guidelines provide medical staff with guidelines about when a CT scan should be done.

What should we do once we’re home from hospital?

In the 24 – 48 hours following a concussion, children are encouraged to participate in symptom limited activities. This means that they can do an activity for as long as they feel ok doing it. If symptoms commence, this is a sign that they should stop that activity and change to a different activity or rest a little. They should not be resting in a dark room during the day. Screen time should be symptom limited and no more than what is recommended for the child’s age.

After the first 48 hours, children can usually commence a graded return to school at a level that does not result in significant exacerbation of post-concussive symptoms. They may initially need to attend school half days and/or every second day depending on their symptoms. As symptoms improve children can build up to attending school full time again.

It is recommended that children return to organized sport after they have returned to full time school. Return to gradually increasing, low to moderate physical activity (eg. going for walks or to the park, general play) is encouraged, provided it is at a level that does not result in exacerbation of post-concussive symptoms. A gradual increase of physical activity participation can be achieved at the same time as the child is building up their hours at school, provided the return to school program is the priority.

The PREDICT guidelines recommend that children whose post-concussive symptoms do not resolve within 4 weeks should be referred to concussion specialist clinicians for persistent post concussive symptom management.

From clinical experience, I have found that it is often useful to seek advice from a concussion specialist therapist if your child has not fully returned to school within 7-10 days following injury. A concussion trained therapist can provide personalized advice about how many hours / days your child should attend school, their appropriate levels of physical activity and strategies to help return to school and sport.

Additionally, many people who have a concussion also sustain a neck injury and may get dizziness related to their vestibular system. A concussion trained physiotherapist can provide treatment to both the neck and vestibular system, which may help improve symptoms. They can also provide an individualized treatment program to help children and adolescents return to physical activity, sports training and match play following a concussion.

 

Written by Megan Hamilton, a senior physiotherapist with multiple years of experience treating people with persistent concussion symptoms.

 

  1. Browne G et al. (2016) Concussive head injury in children and adolescents; The Royal Australian College of General practitioners, AFP VOL.45, NO.7, p 470 – 476.
  2. Babl FE, Tavender E, Dalziel S. On behalf of the Guideline Working Group for the Paediatric Research in Emergency Departments International Collaborative (PREDICT). Australian and New Zealand Guideline for Mild to Moderate Head injuries in Children – Full Guideline. 2021. PREDICT, Melbourne, Australia.

 

 

Link for the PREDICT guidelines:

https://www.predict.org.au/head-injury-guideline/