Concussion prevention and recognition in little ones

Toddlers often hit their heads. In many ways, they are quite resilient and quick to bounce back from minor bumps and bruises; however, some head injuries are more serious than others.

A concussion is one type of serious head injury. A concussion (also known as a mild traumatic brain injury or TBI) is a more serious head injury because it involves injury to the brain and how the brain functions.

"Compared to all other age groups, children under the age of 4 years old have the highest incident rates of traumatic brain injury," said Lizabeth Jordan, pediatric neuropsychologist, the Pritzker Department of Psychiatry and Behavioral Health at Ann & Robert H. Lurie Children's Hospital.

Not all falls result in concussions; however, a child is more likely to have a concussion or other serious head injury when they fall from more than 3 feet, fall on a hard surface, or fall with a fast speed.

"These falls tend to be more serious because the force of the fall is more likely to move or injure the child's brain," said Dr. Wee-Jhong Chua, attending physician, Emergency Medicine. "Babies and toddlers will likely be unable to explain or tell you about their concussion symptoms. So after a little one has a big fall, it is important that caregivers keep a close eye on their child and be able to recognize signs and symptoms of concussion."

Obvious signs of a concussion include seizures, difficulty waking from sleep, altered behavior or passing out.

"It is common for infants and toddlers to immediately cry after a sudden or startling event, like a fall. Signs that the child has a head injury may not become clear until a few hours or days later," said Dr. Sigrid Wolf, Advanced General Pediatrics and Primary Care, Division of Orthopaedic Surgery and Sports Medicine physician.

Caregivers need to keep a close eye out for physical, emotional, behavior and sleep changes that may be signs of a concussion.

If you notice any of the signs below, seek immediate medical attention.

Bumps, bruises, bleeding: Physical injuries on your child's scalp or head are not uncommon after falls. Swelling under the skin (known as "goose eggs" or medically as a hematoma) can occur at the point of impact anywhere on the body. If your child has a large cut or a bump that is quickly getting larger, call your doctor or seek care at an emergency department.

Vomiting, unusual movements, seizures, trouble talking: See the doctor if your child throws up, is moving their body strangely, or is not talking like they usually do.

Changes in balance and coordination: Your child is moving, crawling, cruising or walking differently (e.g., stumbling, walking with feet/legs wider apart) is cause for concern.

Changes in mood: Your child is easily tearful/crying, "more emotional," shows increased fussiness, temper tantrums, pushing, biting or is unable to be comforted or soothed with typical strategies.

Decreased engagement: Your child seems uninterested or less interested in regular toys/play. Your child's play seems "quieter" than usual.

Changes in behavior: Your child seems dazed or confused, slower to respond, more "clingy," or needs more adult help than normal.

Changes in eating: Your child is nursing less, eating less or refusing food.

Headache or other signs of pain: Your child says or shows that they have a headache, stomachache or "tummy ache" (e.g., frequent touching or rubbing of stomach or head).

Changes in sleep patterns: Your child has trouble waking up from sleep, is sleeping more or less at night or during the day, is taking longer naps, shows increased daytime sleepiness, or has increased nightmares, night terrors or sleepwalking.

Toileting accidents: Your child has new daytime or nighttime accidents, and your child was previously toilet-trained.

If you have any concerns that your child may have a concussion or head injury, bring your child to an emergency department or urgent care for an evaluation.

• Children's health is a continuing series. This week's article is courtesy of Ann & Robert H. Lurie Children's Hospital of Chicago. For more information, visit www.LurieChildrens.org.