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Head Injuries, Mild to Moderate

Mild to Moderate Head Injuries

Brain injuries are classified as mild, moderate or severe.

A mild traumatic brain injury (TBI), better known as a concussion, can be caused from direct blows to the head, face, neck or body or even from whiplash. The sudden injury causes the brain to shake inside the skull. The child may have brief loss of consciousness or may not notice symptoms from the concussion right away. Sometimes symptoms do not show up for hours or days after the injury.

Moderate brain injuries can occur from the same mechanisms as concussion, but the child will likely have loss of consciousness and his/her neurological symptoms will be more severe than with a mild head injury.

Medical providers use a wide variety of tests to evaluate and diagnose patients who may have a mild or moderate traumatic brain injury (TBI). These tests may include testing their memory, vision, concentration, hearing, balance, coordination, strength, sensation, reaction time, and reflexes. Not all head injuries require imaging like a CT scan or MRI. At this time we do not use imaging to diagnose concussions. CT scans are important for ruling out brain bleeds when clinically suspected, but do not show changes with concussions.

A moderate TBI is a term used when a person experiences changes in brain function for longer than a few minutes following trauma. Symptoms may be similar to a mild TBI, but the symptoms do not go away or may even get worse. A moderate TBI is diagnosed based on symptoms and CT scans or other neuroimaging which may show signs of brain trauma such as bleeding or contusions/bruising.

These symptoms may occur for weeks or months after a head injury and are part of the normal healing process.

Physical Signs

  • Fatigue
  • Headaches
  • Dizziness
  • Sensitivity to noise and lights

Learning and Thinking Signs

  • Poor memory
  • Trouble following directions
  • Slow thinking
  • Trouble concentrating
  • Poor judgment
  • Falling behind in school

Emotional Signs

  • Lack of interest or motivation
  • Mood disturbances; easily frustrated or angered or tearful
  • Impatience
  • Bolder than usual
  • Explosive temper
  • Not tolerating daily routine

Sleeping Signs

  • Changes in sleeping pattern
  • Sleeping more or less than normal
  • Trouble falling or staying asleep

The early treatment is rest, both for your child’s body and brain. Treatment in the hospital will be specific to your child’s injury but may include close neurological observations, medications, and therapies. In very rare situations surgery may be indicated as determined by the neurosurgical team.

During recovery, it is important to remember to drink fluids throughout the day, eat balanced meals, keep a consistent sleep schedule, and avoid screen time (cell phone, computer, watching TV).

Speak to your trauma surgery provider about medications your child was taking prior to their admission to the hospital and obtain approval to resume home medications. Give Acetaminophen (also known as “Tylenol") for pain or headache. Keep the use of medication to treat headache to a minimum since these can make your symptoms worse.

Your child's trauma surgery provider may also write a prescription for stronger pain medication for other injuries, but this medication is not to treat headaches. Give the stronger medication if the pain does not go away one hour after giving Acetaminophen. Follow the directions on the prescription. Your child may require a stool softener while taking prescription pain medication to prevent constipation and straining with bowel movements.

Do not give your child NSAIDs or Ibuprofen (also known as "Motrin", "Advil", "Aleve", etc.) until the trauma surgery provider says that it is okay.

Your child will not be allowed to go to gym class, recess, or play sports/practice for some time after they leave the hospital. Brain rest after an injury is the best treatment for a child with a head injury. This includes resting the brain and body. The amount of time off will depend on the extent of your child’s injury and will be directed by your provider. Your child will require clearance back to activity in all follow up prior to resuming sports, gym, recess or any other contact activities.

Once your providers feel it is safe to begin adding more activity to your schedule, they will give you a return-to-play protocol. It is important for athletes to get clearance to start and follow this six stage protocol as they begin to resume their sport activities.

Most children can return to school gradually after approximately two-three days of healing but may be longer depending on degree of injury. In general, if the child’s symptoms are getting better, try going for one or two hours and advance to full days as tolerated. See below for recommendations when returning to school. Talk with the school nurse or school personnel to make a plan for your child’s return.

You can ask for a school note with these below recommendations:

  • Alternating half (1/2) days so as not to consistently miss a group of classes
  • Increased time to complete assignments and tests
  • Additional learning resources: utilization of teachers notes or tutoring
  • Allow water bottle at school filled with sports drink or water
  • Frequent rest breaks as needed
  • Increased time to make-up missed work
  • Graded return to school as tolerated

School personnel should watch for:

  • Problems paying attention or concentrating
  • Problems remembering or learning new information
  • Needing more time to do a task
  • Not coping with stress well

If you notice any of the following, it might indicate more serious problems and you should get immediate medical attention. Contact your child's health care provider or go to the nearest emergency department:

Changes in Behavior

  • Drowsy and hard to wake up
  • Infants with increased irritability and are unable to be consoled
  • Does not recognize familiar people
  • Unable to be comforted
  • Confused speech
  • Does not know where he/she is
  • Not acting like usual self

Physical Changes

  • Persistent vomiting
  • Weakness or stumbling
  • Persistent severe headache
  • Seizures (shaking/twitching of the body)
  • Complaints of double vision
  • Blood or clear fluid draining from ears or nose
  • Infants with increased scalp or head swelling

After the injury, your child may be tired and irritable. It takes time to heal. Use this time for rest and quiet activities.

Have your child play board games, read, or do small craft projects for short periods of time. Avoid screen time. Infants and toddlers are harder to distract and will be more difficult to confine.

Try putting your infant or toddler in a large crib or playpen. Ask family and friends to visit, but for short periods of time and not at the same time to minimize activity.

After any trauma children may experience acute stress symptoms that may be reflective of post-traumatic stress disorder (PTSD). If you notice your child having nightmares, flashbacks, nervousness, irritability or any other concerning emotional symptoms please speak with the trauma surgery provider. Short term therapy can be provided to help children heal and recover emotionally after a trauma.

Your child’s follow up will depend on the severity and kind of his/her head injury. Your trauma surgery provider will discuss when and with whom you need to follow up with outpatient at time of your discharge from the hospital. Call the Trauma Clinic number 513-636-8556 with any questions or concerns regarding your child’s follow up.

Your child will require clearance back to activity in all follow up prior to resuming sports, gym, recess or any other contact activities.

It is very important to teach your child about all types of safety. Make sure your child is secured in an age-appropriate restraint every time they ride in a vehicle. Children under 13 are safer in a backseat in the correct restraint.

Make sure your child wears the correct helmet when riding a bike, using other wheeled toys, or takes part in other active sports.

Last Updated 04/2020

Reviewed by Margot Daugherty, RN, Education Specialist II

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