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Headline, Headline! Read All About It! Jack Broke His Crown!

Yesterday, we went over some of the basic what’s and how’s of concussions or traumatic brain injuries.  We did our very best not to be alarmist or scolding.  We know that most such injuries are mild, and most recoveries complete.  However…

When to see a doctor

  • The American Academy of Pediatrics recommends that you call your pediatrician for advice if your child receives anything more than the slightest of bumps on the head.  If your little one remains normal and alert, responds to you in his or her usual way and moves about and plays normally, the injury is probably mild and won’t require additional testing or monitoring. But make that call anyway.  It’s probably fine to let him or her take a nap.  But if anything worries you or if something seems off or amiss later on, seek emergency care.
Seek prompt emergency care for a child who has had a head injury and exhibits any of the following:
  • A headache that gets worse over time.
  • Vomiting.
  • Changes in physical coordination, including clumsiness or stumbling.
  • Changes in his or her behavior, including fussiness or irritability.
  • Confusion.
  • Disorientation.
  • Slurred speech; other changes in speech.
  • Changes in breathing pattern.
  • Lasting or recurrent dizziness.
  • Vision or eye disturbances, including dilated pupils (bigger than normal) or pupils of unequal size.
  • Blood or fluid discharges from the ears or nose.
  • Large head bumps or bruises on areas other than the forehead – especially in infants under 12 months of age.
Seek prompt emergency care for anyone who has had a head injury and:
  • Vomits repeatedly.
  • Has seizures.
  • Loses consciousness for more than a minute.
  • Has difficulty with mental function or physical coordination.
  • Shows symptoms that worsen over time.
For athletes:
  • Experts strongly recommend that child and adolescent athletes with concussions not return to the playing field on the same day as the injury.  Any athlete with a suspected concussive injury should not return to play until he or she has been evaluated by medical personnel trained in head trauma.  No one, child or adult, should return to play or other vigorous physical activity as long as any symptoms or signs of a concussion are apparent.
Potential complications of concussion include:
  • Epilepsy.  Research shows that people who have had a concussion double their risk of developing epilepsy with the first five years following the injury.
  • Second impact syndrome.  After a concussion, there are alterations in the levels of brain chemicals.  It typically takes a week or so for these levels to stabilize.  Experiencing a second concussion before the symptoms and signs of the first brain injury have resolved may result in very rapid, and typically fatal, brain swelling.  Because the time it takes to recover from a concussion varies, it is very important that athletes of all ages never, ever return to sports while they continue to experience any signs or symptoms of concussion.
  • Cumulative effects of multiple brain injuries: Studies have found ample evidence indicating that individuals who have sustained multiple concussive brain injuries over their lifetimes may acquire lasting, possibly even progressive, cognitive impairment.
You’ve made the appointment.  Now what?
Anyone with a head injury needs to be checked over and evaluated by a doctor within a day or two of the injury – even if emergency care was not required.  We already went over the protocol for a child with a head injury: call your doctor or pediatrician at once.   Depending on the nature and source of the injury and the signs and symptoms you describe, your doctor may want the child to get immediate medical care.  To get the most out of your medical appointment, consider the following:
  • List any and all symptoms you, or your child, have been experiencing.  Note the duration of these symptoms, too.
  • Write down any important medical information.  Include any other medical problems or issues for which you or your child are being treated.  Note any history of previous head injuries.  Write down the names and dosages or any medications, supplements, vitamins or natural remedies you or your child take.
  • Pay attention to any pre-appointment instructions or restrictions.  You must rest your brain, physically rest your brain, while you wait for the appointment.  Avoid all sports and vigorous activity and minimize mentally difficult, complex or stressful mental undertakings.  When you call in for the appointment, ask if there are any suggestions for you or your child to follow to prevent further injury and encourage complete recovery.  
  • Bring a friend or family member with you if you are the one with the injury.  You may not be able to absorb all the information provided during the exam or visit.  
  • Write down questions for the doctor.  

Some basic questions to ask the doctor include:

  • Is this a concussion?
  • Will there be tests?  If yes, what are they?
  • What kind of treatment do you recommend?
  • What is the risk of future concussions?
  • How soon can I expect the symptoms to improve?
  • What is the risk of long-term complications?
  • When can I get back to competitive sports?
  • Is it safe to go to school or work?
  • When can I exercise or work out again?
  • Is it safe for me to drive or operate power equipment?
  • Should I see a specialist?  Will my insurance cover that?
  • Have you any literature or brochures about head injury that I can take home with me?  Are there any resources online that you recommend?
Tomorrow, what to expect from the doctor, some notes about neurological and imaging tests, treatment and medications for concussions, and (of course) some tips on prevention. 
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