Head Trauma

Definition:
A significant blow to the head that may result in unconsciousness (See also concussion - first aid).

Causes, incidence, and risk factors:
A concussion may result from a fall in which the head strikes against an object or a moving object strikes the head. A suddenly induced turning movement such as a blow that twists the head, is more likely to produce unconsciousness. However, significant jarring in any direction can produce unconsciousness.

The length of unconsciousness may relate to the severity of the concussion. Often children (and adults) have no memory of events proceeding the injury or immediately after regaining consciousness.

Bleeding into the brain can occur with any blow to the head, whether or not unconsciousness occurs. If your child has received a blow to the head, observe closely for signs indicating possible brain damage. Things to watch for include repetitive vomiting, unequal pupils, confused mental state or varying levels of consciousness, seizure-like activity, or the inability to wake up (coma). If any of these signs are present, contact your health care provider promptly.

Symptoms:

• loss of consciousness after a blow to the head
• amnesia of events surrounding the injury

Emergency signs:

• persistent unconsciousness (coma)
• altered level of consciousness (drowsy, hard to arouse, or similar changes)
• persistent confusion
• convulsions
• repeated vomiting
• unequal pupils
• unusual eye movements
• muscle weakness on one or both sides
• gait or walking abnormalities

Treatment:
An initial "baseline" neurological evaluation by a health care worker determines treatment for an uncomplicated concussion. After the evaluation the child should be kept quiet.

If a blow to the head during athletics leads to unconsciousness, a trained person must determine readiness for continued participation and timing for return to play. In this situation, if a child or young adult has lost consciousness, that person should not resume athletics for a period of three months. Studies have shown that there is an increased rate of brain injury and occasionally death in people who have had a previous concussion with unconsciousness.

Concussion complicated by bleeding or brain damage must be treated in a hospital.

Expectations (prognosis):
Full recovery is expected from an uncomplicated concussion.

Complications:

• intracerebral hemorrhage
• brain injury

Calling your health care provider:
Call your health care provider if your child has a head injury that produced unconsciousness, or if your child has had a head injury without unconsciousness that concerns you.

Go to the emergency room, call the local emergency number (such as 911), or contact your health care provider immediately if emergency symptoms develop (see the symptoms section).

Prevention:
Attention to safety, including the use of appropriate athletic gear such as bike helmets and seatbelts, reduces the risk of head injury.