Severity of traumatic brain injury is divided into mild (concussion), moderate (brain contusion mild and moderate severity, with possible fractures of the skull vault bones) and heavy (brain injury severe intracranial hematoma with compression of the brain, fractures of the skull base). Fortunately, up to 90% of childhood brain injury accounted for a slight concussion, and will be discussed in this article.
The high level of injuries in children due to increased physical activity of the child, his restless and curiosity, combined with the imperfection of motor skills and coordination, as well as a reduced sense of danger and fear of heights. In addition, younger children head has a relatively large weight, and skill insurance hands are not yet developed, so small children fall, as a rule, heads down and hands are not substituted.
Causes of childhood brain injury is very specific for each age group. Infants in the total mass casualties amount to 2% of infants - 25%, nursery - 8%, pre - 20% of school age 45%.
Injury in infants is primarily the result of inattention and carelessness of their parents. Children up to 1 year more often (more than 90%! ) get a head injury after falling from changing tables, beds, with the arms of the parents of wheelchairs, etc., Never leave your baby alone in a place where it could fall. If you need to move away from the child at a greater distance than the stretched hand, don't be lazy, put it in the crib, stroller with borders, in the arena! One or two seconds is enough to crumb rolled to the edge of the changing table and fell.
Since 1 year, babies begin to walk. The main cause of brain injury is falling from a height of around two meters, and a little later - falling from ladders, trees, roofs, Windows, slides, etc. the episode of brain injury is not always possible to identify. It should be borne in mind that if the child remained under the supervision of relatives, neighbors, or babysitters, they can hide from their parents the fact that a fall baby.
The older children themselves, for various reasons, often conceal the injury. In addition, children may damage the brain without direct trauma to the head. These injuries usually occur when the impact on the child's body sudden acceleration or braking (syndrome "shook the child"). Syndrome "shook the child is most often observed at the age of 4-5 years and may occur during rough handling, jumping from a height of feet, and the younger children even when they are excessively intense motion sickness.
Symptoms
When the concussion it is not rude, irreversible changes, such injury being the most common, has the best prognosis and rarely leads to complications.
It should be remembered that the brain of a child (especially an infant) is significantly different from the adult brain. Picture of cerebral concussion in adults is significantly different from the flow of this injury in a child.
In adulthood a concussion is manifested by the following main characteristics: episode of loss of consciousness from a few seconds to 10-15 minutes; nausea and vomiting; headache; amnesia (loss of memory of events related to the trauma (before the injury, the injury and after the injury). In addition there are some specific neurological symptoms, such as nystagmus (jerking of the eyeballs), violation of coordination of movements, and some others. Picture of cerebral concussion, the child is completely different.
In children under 1 year of the concussion, as a rule, proceeds oligosymptomatic. Loss of consciousness often does not happen, there single or multiple vomiting, nausea, regurgitation during feeding, pallor of the skin, unreasonable anxiety and crying, increased sleepiness, lack of appetite, poor sleep.
In children of preschool age are often able to establish the fact loss of consciousness, nausea and vomiting after injury. They observed headaches, frequent or slow pulse, unstable blood pressure, pale skin, sweating. It is often marked moodiness, tearfulness, insomnia.
Sometimes kids have symptoms such as post-traumatic blindness. It develops after trauma or a little later, is stored in several minutes or hours, and then disappears. The reason for this phenomenon is not completely clear.
Features of the child's body cause prolonged state compensation can be followed by rapid deterioration. That is, immediately after the fall and he feels well, and after a while appears and begins to grow rapidly symptomatology.
Take urgent measures
What should parents do, the child received a traumatic brain injury? There is just one answer - the child should necessarily and urgently to the doctor. It is best to immediately call the "first aid", which will take the child to the hospital with pediatric neurosurgeons or neurologists. And this measure is not excessive. With minimal symptoms and complaints of the baby can be severe brain damage. Long visible welfare of the child, the absence of symptoms, especially when the hemorrhages in the brain, often after several hours and even days followed by progressive deterioration, which begins with a change of the child's behavior, it increased excitability may be nausea, vomiting, nystagmus in babies will wybodaeth spring, then you fall, there is depression of consciousness.
Diagnostics
In the hospital of the child examines a pediatric neurologist, neurosurgeon, or trauma. He carefully explains the complaints, collect anamnesis (history of disease), conducts a General and neurological examination. Assigned additional diagnostic methods. The main ones are x-rays of the skull, neurosonography (in young children), echo-encephalography (Echo-EG). If necessary, a computer tomography of the brain (CT), magnetic resonance imaging (MRI), electroencephalography (EEG), lumbar puncture.
Radiography of the skull is the most part of patients. The aim of this study is the detection of skull fractures. The presence of any damage to the bones of the skull automatically translates injured in the category of medium-heavy or heavy (depending on the child). Sometimes in young children with favorable clinical picture on radiographs revealed a linear skull fracture. To judge the state of the brain by x-ray cannot.
Neurosonography (people's Assembly) is an ultrasound examination of the brain. On neurosonogram clearly visible substance of the brain, ventricular system. You can reveal signs of brain edema, contusion, hemorrhage, intracranial hematoma. The procedure is simple, painless, fast runs, has no contraindications. It can be done multiple times. The only limitation of neurosonography - the so-called "natural ultrasonic window" - the big fontanel or thin temporal bone. The method is very effective in children under the age of 2 years. Later the ultrasound becomes difficult to pass through the thick bone of the skull, which dramatically degrades the image quality. Apparatus for performing neurosonography available in most hospitals.
Echo-encephalography (Echo-EG) is also ultrasound examination, which allows to detect the shift of the midline structures of the brain, which may indicate the presence of additional lesions of the brain (hematoma, tumor), to give indirect information about the state of the brain and ventricular system. This method is simple and fast, but its reliability is low. Earlier it was widely used in neurotraumatology, but with the availability of modern diagnostic tools, such as neurosonography, computer and magnetic resonance tomography, it can be discarded.
The ideal method of diagnosis of injuries and diseases of the brain is a computer tomography (CT). This x-ray method of research in which HD you can get images of the skull and the brain. CT scan diagnosed almost any damage to the bones of the calvarium and skull base, hematoma, contusion, hemorrhage, foreign body cavity of the skull and other Precision of this study is very high. Its major drawback is that the CT apparatus of the roads, and it is not available in every hospital.
Magnetic resonance imaging (MRI) is the most accurate, but complicated and expensive method of examination of the Central nervous system. It is rarely used for diagnosis of acute traumatic brain injury, as it allows to see the bones of the skull, is less precise for the detection of acute hemorrhage, takes longer than a CT scan, often requires anesthesia in the examination of young children - the child must lie absolutely still for 10-20 minutes, and small children are not able to do; in addition, very few clinics can boast of a magnetic resonance tomography.
Electroencephalography (EEG) allows the study of the bioelectric activity of the brain. It is used for special indications for the assessment of the severity of traumatic brain injury, identifying foci of epileptic activity. The focus of espectively - region of the cerebral cortex with pathologically altered activity of neurons (nerve cells), which can cause epileptic seizures.
Lumbar puncture is a sampling of cerebrospinal fluid (the fluid around the brain and spinal cord) from the spinal canal in the lumbar level. Changes in CSF may indicate trauma or hemorrhage (blood) or inflammatory process, meningitis. Lumbar puncture is done very rarely and only for special reasons.
Treatment
After the kid fell, before he or she sees a doctor, the child is to create a relaxed environment. To put your baby to give him a rest. If there is bleeding from a wound, to perform its processing and bandaging.
In addition to the diagnostic procedures in the hospital waiting room is the treatment of soft-tissue injuries of the head (bruises, abrasions, wounds). Children, especially young age with confirmed traumatic brain injury, including concussion of the brain, are subject to compulsory hospitalization.
Hospitalization has several purposes.
First, within a few days the child is under the supervision of physicians in the hospital for early detection and prevention of complications of trauma - cerebral edema, the appearance of intracranial hematomas, seizure (convulsive) seizures. The likelihood of these complications is low, but the consequences are extremely severe and can lead to catastrophically rapid deterioration of the child. Therefore, when the concussion standard duration of hospital stay is a week. With good technical equipment of the hospital (computed tomography, neurosonography) to prevent more severe brain damage, length of stay in hospital can be reduced to 3-4 days.
Secondly, during hospitalization the patient facilitates the creation of emotional peace. This is achieved by limit physical and social activity of the child. Of course, to achieve fully in bed for children is difficult, but the conditions of the hospitals do not allow running, noisy games, long watching TV, sitting at the computer. After discharge home mode retains for 1, 5-2 weeks, several weeks confined to sports.
Drug therapy in the concussion has several objectives. First of all, the child is assigned diuretics (often Diacarb, at least - Furosemide) mandatory in combination with drugs potassium (Asparkam, Panangin). This is done to prevent swelling of the brain. Is soothing therapy (Phenazepam, Infusion of Valerian root) and assigned antihistamines (Suprastin, Diasorin, Diphenhydramine). When headaches are prescribed analgesics (Baralgin, Sedalgin), when expressed nausea, Reglan. At a later date can be assigned nootropic drugs, improves metabolic processes in the brain, vitamins.
Monitoring children attending and a doctor on duty, as well as messaging nurses. In the event of any deterioration being re-examination of the child, are assigned additional diagnostic studies (neurosonography, CT scan, EEG).
Offering to go to the hospital, the doctor is primarily concerned about how not to concede more serious than a concussion, injury, and this is possible only under qualified supervision for the child.
When a satisfactory condition of the baby after a few days, parents can take them home as a receipt. And yet you want to follow a health-protective mode, to limit watching television, playing computer games, nature walks, visiting friends, continue drug therapy. If there is any suspicion on the worsening condition of the baby (cause nausea and vomiting, headaches, unexplained drowsiness, seizures, the appearance of weakness in the extremities, frequent regurgitation in children) should be immediately re-apply to the physician for further evaluation and possible hospitalization.
Usually after 2-3 weeks the child is completely back to normal. A concussion is usually held without consequences and complications. The child can once again visit the nursery and kindergarten, sports.
In conclusion, I cannot stress enough the importance of early treatment in a specialized children's hospital, to avoid more severe forms of traumatic brain injury.
Source:
The family site
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