Emergency and Urgent Care - Head Injury Advice - School aged children

Your child has suffered a mild head injury, and the Clinician that has examined them is happy for you to take them home.

However, it is recommended that you do not leave them alone for the first 48 hours; we recommend an adult is with them at home, and that you are near a phone to call for help should their condition deteriorate.

Common Symptoms of a Head Injury

It is common to experience some of the following symptoms over the first few days after a head injury. They can be unpleasant, but are not usually associated with any long-term or serious conditions:

• Mild headache
• Feeling sick (but not vomiting)
• Lack of appetite
• Difficulty sleeping
• Feeling irritable
• Dizziness or lightheaded
• Difficulty concentrating
• Difficulty remembering things

These symptoms should disappear over the next 2 weeks. If they do not, or you are concerned about how your child is feeling, then take them to see your GP.

General advice

If you follow this advice, it may relieve some of your child’s symptoms, and help them recover more quickly:

• Take simple pain relief such as Paracetamol for headache
• Encourage regular food and fluids, small sips, and small light diet if your child feels sick
• Do not return to your normal school, college, or work activity until you feel they have fully recovered
• Try to avoid stressful situations, as this may make their symptoms worse
• Do not ride a bicycle for the first 24 hours after your injury
• Do not work on a computer or play computer games until they have fully recovered; spending time concentrating on images or text on a screen may make their symptoms worse
• Do not take any drugs such as sleeping pills or tranquilizers until their symptoms have settled, unless your doctor has said they can take them. Speak to your GP if you need further advice
• Do not play contact sports for at least 3 weeks; please speak to your GP before returning to contact sport after a head injury.

Further information about head injuries can be found at:

www.nhs.uk/conditions/head-injury-minor/Pages/ Introduction.aspx

www.patient.co.uk/health/head-injury-instructions

Things to watch out for

Most head injuries do not lead to any serious complications. However, if you experience any of the following symptoms, you must attend an Emergency Department or call 999:

• Unconsciousness or increasing unconsciousness, difficult to wake up
• Any new confusion, not knowing where you are
• Drowsiness that lasts longer than 1 hour, when you would normally be awake
• Any difficulty understanding or speaking
• Any loss of balance or problems walking
• Weakness in one or more arms or legs
• Visual disturbances – blurred vision, loss of vision, floaters
• Very painful headache that is not relieved with painkillers, or worsening after painkillers
• Three or more episodes of vomiting in a 12-hour period (there must be at least 30 minutes between episodes of vomiting to be classed as separate episodes)
• Any fits/seizures or collapsing/passing out
• Clear fluid coming from your nose or ears
• Bleeding form one or both of your ears
• New deafness in one or both of your ears

Long term problems

Most people recover from minor head injuries quickly and with no long-term health problems.

However, please contact your GP if:

• Your child is still experiencing problems 2 weeks after their accident
• Or they develop new problems after weeks or months following their accident

Concussion and return to sport and school

Concussion is when an injury to the head or body transmits forces to the brain causing injury. Symptoms usually occur quickly and are short lived’ and do not require any treatment. The injury is not structural, so does not show up on any hospital scans and presents more through common symptoms of concussion as described earlier in this leaflet.

Most concussions resolve with simple rest within 7-10 days. Occasionally symptoms can take longer to resolve, so medical attention may be sought. Every case is treated based on individual symptoms.

Rest from all physical, and brain activities for 24-48 hours is recommended. This includes physical activities such as sport or exercise, and activities requiring concentration such as reading, computer games, watching TV, schoolwork, or smart phones.

Returning to these activities before symptoms have stopped can cause:

• Prolonged symptoms
• Potential long-term consequences, psychological and brain disorders
• A further concussion – which could lead to severe brain swelling (Second Impact Syndrome) and could be fatal

Return to school

You should inform your school of the head injury. If your child is struggling to concentrate after a concussion, they may need to take a few days off school to rest and build back up to concentrating for long periods of time. You can try to build up the tasks like this:

• Daily activities at home that do not give symptoms. Start with 5-15 minutes screen time and build up gradually
• Start school activities at home such as reading and homework
• Back to school - may need to start with half days or increased breaks
• Gradually progress until they can tolerate a full day

Return to play – under 19’s

A more conservative, slower approach is taken in adolescents and children due to the brain not being fully developed and the risk of re-injury.

Return to school activities is normally possible after 48 hours after injury, and prolonged time off school is not necessary. Younger people should return to schoolwork before returning to sport.
 
If symptoms return at any point, then their level of activity should be reduced to a level that does not cause symptoms.
It is recommended that all children who ride a bicycle should wear a helmet; this will help protect their brain from further injury. They should not ride a bicycle for at least 2 weeks after their injury and they are symptom free.

It is recommended that all players of sport, regardless of age, should have 2 weeks rest and be symptoms free before returning to their chosen sport.

Following this, a graded return to play (GRTP) can be followed. In under 19’s there should be 48 hours between stages as a minimum.

It is recommended that all players are seen by a doctor prior to returning to full competition, this is usually your GP.

Return to Play (RTP) outline

• Under 19
• 2 weeks rest ad symptoms free
• Return to play
• GRTP 48 hours per stage
• Clearance by doctor

Graded Return to Play (GRTP) outline:

Most people will make a full and uneventful recovery and will want to return to play as soon as possible. Following a concussion, players, coaches, families, doctors and officials must work together to ensure safe participation in sport.

• All symptoms should have gone before a GRTP is commenced
• Seek advice from people experienced in GRTP and follow it
• Ensure the advice of a healthcare professional is sought appropriately

Further advice surrounding concussion and return to sport can be found at:

www.nhs.uk/conditions/concussion

www.englandrugby.com/my-rugby/players/player-health/ concussion-headcase/resources

www.rugby-league.com

www.sportandrecreation.org.uk/policy/research-publications/ concussion-guidelines

www.mihp.co.uk/health/specialist-clinics/#concussion-clinic  

www.thefa.com

www.englandhockey.co.uk

Concussion forms

It is important that your child’s schoolteachers and coaches are aware that your child has had a concussion.

You can use these slips on the next page to give to them so that they have a record.