Head Injury and Concussion in Children

Children often bump or bang their heads, and it can be difficult to tell whether or not an injury is serious. Any knock to the head is considered a head injury. Head injuries are classified as mild, moderate or severe. Many head injuries are mild, and simply result in a small lump or bruise. Mild head injuries can be managed at home, but moderate or severe injuries to the head need to be evaluated by a doctor.

• Your child has had a head injury involving high speeds or heights greater than a meter, for example, car crashes, high-speed skateboard accidents or falling from playground equipment
• Your child loses consciousness
• Your child seems unwell and vomits more than once after hitting their head
• You have any difficulty waking your child

Concussion is a temporary injury to the brain caused by a bump, blow or jolt to the head. While concussions usually only last up to a few days or weeks, they sometimes require emergency treatment and some people can have longer-lasting problems.

• Vomiting or differences in one’s eating habits
• Headache
• Feeling like one is in a fog
• Just ‘not feeling right,’ or ‘feeling down’
• Clumsiness/balance problems or dizziness
• Sleep disturbances or drowsiness
• Being bothered by light or noise
• Confusion and difficulty concentrating or remembering
• Slowed reaction times
• Unusual behavior – your child may become irritated easily or have sudden mood swings
• Memory loss – your child may not remember what happened before or after the injury
• Changes in one’s vision – such as blurred vision, double vision or "seeing stars”

Cognitive fatigue is a common problem that can happen after a head injury. When a child has cognitive fatigue, it means the brain has to work harder to concentrate on tasks it used to be able to do easily, for example watching TV, playing computer games, or having a long conversation. Cognitive fatigue is not related to a child’s intellectual capacity or physical energy levels. It can lead to behavioral problems, mood swings and educational difficulties.

Your child may experience some or all of the following symptoms of cognitive fatigue:

• Slowness when thinking, understanding and responding to questions or commands
• Problems concentrating
• Difficulties with memory
• Difficulty thinking of the right words to say
• Being more demanding than usual; easily frustrated
• Increased fear and anxiety
• Changed sleep patterns
• Mood swings and irritability
• If your child’s cognitive performance or behavior is very different from normal, or it is getting worse, take them back to the hospital

Children experiencing cognitive fatigue should have complete rest—for both their brain and body. This means no watching TV or playing on mobile electronic devices. Allow your child to gradually return to reading and other activities that require periods of greater concentration or thinking.

Children and adolescents suffering from concussion can take up to four weeks to recover, but most concussions will get better on their own over several days. 

• Following a mild head injury, your child will need to get plenty of rest and sleep, particularly in the first 24 to 48 hours; there is no need to wake your child 
• Your child may have a headache. Give them paracetamol (not ibuprofen or aspirin) every six hours if needed to relieve pain 
• Hold an ice pack to the injury regularly for short periods in the first few days to bring down any swelling
• Make sure an adult stays with your child for at least the first 24 hours
• Return to school only when the child is feeling better
• Do not play contact sports or at-risk activities for at least 3 weeks to avoid a consecutive head injury; after a head injury, your child’s reaction times and thinking may be slower, which can put them further at risk

Only move on to the next step if your child is not showing any symptoms of concussion. 

Steps for returning to school

• Daily activities at home – Start with typical daily activities, such as reading or gentle walking
• School activities at home – Introduce homework, school reading or other educational activities at home
• Return to school part time – start with a shorter school day or have increased breaks during the day
• Return to school full time – Gradually increase school activities until the child can tolerate a full day

Children should not return to sports until they have successfully returned to school. Allow at least 24 hours for each step and at least 1 week before a return to normal game play. 

Steps for returning to sports

• Symptom-limited activity – Simple daily activities that do not provoke symptoms
• Light aerobic exercise – Gradually introduce walking, swimming or stationary cycling at a slow to medium pace
• Sport-specific exercise – Running, warm-up drills and practicing ball skills (with a soft ball)
• Non-contact training drills – Your child may start progressive training
• Full contact practice - Following medical clearance, participate in normal training activities
• Return to sport - Your child can now progress to normal game play

• Vomiting more than five times
• Bleeding or any discharge from the ear or nose
• Fits/seizures/twitching/convulsions
• Blurred or double vision
• Poor coordination or clumsiness
• Any new arm or leg weakness, or any existing weakness that worsens or does not improve
• Difficulty swallowing or coughing when eating or drinking
• Sensitivity to noise
• Slurred or unclear speech
• Unusual or confused behavior 
• Severe or persistent headaches that are not relieved by paracetamol