How to recognize a concussion in children? How does it manifest itself and why to be alert?

Concussion is one of the possible consequences of frequent head injuries in children. Injury rates rise in spring and summer when children are most active, especially outdoors.

You ask:
How to recognize a concussion and what to look out for?
What are the symptoms?
Read along with us to learn more.

Children run, jump, climb climbing climbing frames, trees, romp on bikes, skate. They are able to turn ordinary walking into an adrenaline sport. Nowadays, more care is taken to ensure that children use safety equipment during their chosen activities. Yet, an injury can also end in a concussion.

Injuries in childhood

The childhood age is characterized by a higher incidence of injuries. Most injuries occur in the home, on sports fields, in kindergartens, schools and on the road. Boys have twice the injury rate as girls. Children from urban areas have twice as many injuries as children from rural areas.

• Children under the age of two suffer most injuries at home. This is a paradox, since the home environment should be a haven for them. Children at this age have an exaggerated level of curiosity, which drives them to explore different places. Lack of experience can cause a higher rate of injuries. Play develops motor and mental skills and it is not advisable to restrict children. The organisation of the space in which they move is important. Supervision should of course be a priority.
• Children over two years of age are already running at full speed, full of energy and have no problem overcoming the biggest obstacles. Injuries can happen during play. The most common cause is inattention. Many injuries occur in nursery and school. Organisation of time and play is important.
• A separate group are injuries caused by traffic accidents. Depending on the mechanism, high-energy trauma can be assumed and can cause serious injuries.

The mechanism of injury is an important piece of information. It will affect the injury itself and the severity of the problem. It can be used to predict the extent of the injury. Falls while walking, from another level, from a tree, from a bicycle, while skating, traffic accidents and a variety of other mechanisms. This information is important for you and the doctor who will examine the child.

Injury rates go up especially in warm weather. Also read the article:
Most common summer-related problems

What is a concussion

For a child, every injury is a negative experience. Dust yourself off, blow your nose, clean up any abrasions and keep running. With head injuries, you need to slow down and pay close attention to see if there are signs of a concussion (commotio cerebri) or other injuries.

From history:
The Arab physician and philosopher Razi Abu-Bakr Muhammed ibn Zakariya, better known as Rhazes (850-923 AD), is said to have first coined the term concussion.
It is an abnormal state of brain function, with no apparent traumatic injury.
As early as the 16th century, the French surgeon Ambroise Paré used the term commotio cerebri (concussion).

A concussion is most often caused by a blow to the head or neck, but it can also be caused by a blow to another part of the body with the transfer of forces to the brain region by inertia.

There are disturbances in neurological function that result from functional changes. Structural damage to brain tissue may not be present.

The disorder arises suddenly and is of short duration.

They gradually subside, but may sometimes persist for longer periods. Unconsciousness is not a condition.

Does your child have a concussion?

You should know the symptoms of a concussion in order to assess whether it is a concussion. A doctor's opinion is the most certain. It is important to be careful with head injuries, especially in children. Children are often afraid to tell the truth and may conceal and simplify (downplay) their problems.

Symptoms of concussion

They can be divided into two categories. The first are symptoms that may occur immediately after the injury. The second category are symptoms whose onset is later.

The symptoms of concussion are:

• unconsciousness, but not a condition (a few seconds to 30 minutes)
• noticeable drowsiness
• weakness, fatigue
• memory impairment related to the injury, memory loss may be present before or just after the injury (retrograde or anterograde amnesia)
• disorientation, confusion
• behavioural changes, tearfulness, restlessness
• slowed reactions
• speech disorders
• movement coordination disorders
• pallor, sweating
• shallow breathing, rapid pulse
• body convulsions within 3 minutes immediately after head injury (not associated with brain damage, but also not associated with epilepsy)

Symptoms occurring later include:

• headache (cephalea).
• dizziness
• feeling sick (nausea) to vomiting (vomitus)
• sleep disturbance (insomnia)
• exaggerated sensitivity to light, noise
• disturbances in attention, memory, general slowing of thinking, impaired performance
• depressed mood, emotional disturbances, nervousness, apathy

Symptoms of concussion can persist up to one year, but this is only a small percentage (5% of all concussions). Usually headache, insomnia, mood changes resolve within 1-2 weeks. Headaches, dizziness, attention disorders may less often persist up to three months.

In pediatric patients, a longer time extension is possible.

When to be alert?

Every head injury requires attention. If you notice one of the symptoms, a medical examination is necessary. If the injury does not seem that serious, the child should be further monitored. The first hours after the injury are especially important.

Head injuries can cause injuries that are more severe than concussions, such as fractures of the skull, facial bones, bleeding into the cranial cavity and brain.

In epidural haemorrhage, there is a latent (hidden) period of 6 hours. This is the time from the head injury to the onset of difficulty. Epidural haemorrhage is bleeding between the dura and the skull bones (the brain is encased in three shells, one of which is the dura).

In general (not only in children), care should be taken when falling from a height. In an adult, falls from a height of more than 6 m are high risk. In children, falls from any height are high risk.

Traffic accidents above 64 km/h and car deformation are indicators of high risk of injury. A fall from a motorbike or scooter above 32 km/h is also an indicator.

A violent handling, shaking of a newborn or infant can result in concussion.

How to prevent injuries?

• Preventing injuries during play, sports, on the street, in traffic (selection of appropriate toys, sports activities), adapting play space to the child's age (children's rooms)
• safety equipment, helmets, pads for cycling, skating and other sports
• clearly marked playgrounds, paths for cyclists, skaters, traffic restrictions in places with a higher incidence of children
• educating children about the risks of traffic, play and sport
• 24-hour supervision of younger children is essential
• children must be restrained in vehicles and should not eat or drink while in a child seat

If you are interested in concussion, read the next article.