Head Injury Can Be Hard to Spot, Especially in Kids

Natasha Richardson's sudden death from a seemingly minor head injury is a big wake-up call for parents. If a healthy 45-year-old woman could die after falling on the bunny hill at a ski resort, what about our kids? Helmets are becoming more common on the ski slopes, but many parents, myself among them, wouldn't think you'd need one on the beginner's slope. Maybe it's time to think again.

Among children up to age 15, traumatic brain injury causes about 2,685 deaths, 37,000 hospitalizations, and 435,000 emergency room visits each year, according to the federal Centers for Disease Control and Prevention. The experts think that many more cases are never reported; kids, parents, and coaches often don't recognize the symptoms of brain injury, which is also called concussion; and many think kids should "play hurt." (A study in January's Pediatrics found that 81 percent of high school football players in Minnesota who had a concussion kept playing that day. That's a really bad idea, because a second head impact while recovering from a previous blow can cause long-term cognitive problems and even potentially fatal sudden brain swelling.)

"Parents need to be aware of certain signs and symptoms that their children may show after playing team sports or just in the back yard," Marlena Wald, an epidemiologist at the CDC's Injury Center, told me today. "They may, once they're asked, complain of a headache or nausea or feel a little unsteady on their feet. They may say they don't feel right."

The CDC urges parents to call the doctor if a child has any of these symptoms after a head injury:

• Tiredness or listlessness;
• Irritability or crankiness (will not stop crying or cannot be consoled);
• Changes in eating (will not eat or nurse);
• Changes in sleep patterns;
• Changes in the way the child plays;
• Changes in performance at school;
• Lack of interest in favorite toys or activities;
• Loss of new skills, such as toilet training;
• Loss of balance or unsteady walking;
• Vomiting.

A doctor will not only treat the injury but explain when the child can return to normal activity, including play. "Having a concussion is an injury," Wald says. "It needs to heal."

Preventing head injuries is a no-brainer: Children need to wear helmets when skiing, bike riding, scootering, skateboarding, or any other activity that gets them moving quickly, even if they're just goofing around in the driveway. (Data from the Consumer Product Safety Commission shows that more than half of the annual deaths caused by skiing are the result of head injuries.)

What about team sports? Helmets aren't going to cut it for soccer, at least not now. Realizing that head injuries often go unrecognized or untreated in young athletes, the CDC has put together a head injury tool kit with printable fact sheets for parents, coaches, and kids.