A recent report in the journal ‘Pediatrics’ suggests that emergency room doctors and GPs are having difficulty in diagnosing and dealing with concussion in Children. Head & spinal injuries can be very significant and are taught in all red cross first aid courses which are 1 day or longer. First, let’s see how you would do with some test First Aid Scenarios….

 First Aid Scenario 1

• 17-year-old boy comes to First Aid a day after an apparent head injury
• Had a direct helmet to helmet with another player while playing (NFL style) football
• Stunned and confused for 10 min
• Sat out the rest of the game and did not see a doctor
• Doesn’t remember his accident
• Headaches

Does he have concussion?

First Aid Scenario 2

• 11-year-old boy is brought to your First Aid room by his mum, 5 days after an apparent head injury
• Fell over bicycle handlebars, unhelmeted
• No loss of consciousness, no amnesia, initial mild headache
• No acute medical care, returned to school the next day
• Since injury, mother noticed he has been more irritable than normal and is taking longer to complete homework

Does he have concussion?

More about concussion in children

“The shaking of the brain within the skull,” It is the most common type of traumatic brain injury and concussion in children is common. There are a variety of signs and symptoms, including

• Headache
• Nausea and/or vomiting
• Minor visual changes
• ‘Seeing stars’
• Ringing in the ears
• Doesn’t recall the event

The majority of children with concussion do not become unconscious (although brief unconsciousness is possible) although they may say they ‘blacked out’

Treatment of Concussion in Children

If you’re not sure – get an ambulance and get them evaluated in hospital!
The main treatment is simply watchful waiting – for the most part the injury will resolve within days to weeks. If any of the above signs or symptoms become worse, then get the person to hospital. (That is, if the headache is worsening, if they keep vomiting, their vision gets more blurred, etc.) Cognitive rest (resting their brain) may also help – this means no video/computer games, limit TV, limit texting & computer use, etc.

So, how did you do?

First aid scenario 1 should be obvious, he certainly has concussion with memory loss, headaches and confusion. First aid scenario 2 is less obvious, but he does also have concussion indicated by headache, behavioural and cognitive (thinking) changes.

And what about the study?

91% of the doctors had dealt with concussion in children in the 3 months before the study. The authors concluded “Although pediatric primary care and emergency medicine providers regularly care for concussion patients and value their role in management, they may not have adequate training or infrastructure to systematically diagnose and manage these patients.”  Most of the doctors in the study would value more education and guidelines on dealing with concussion in children.