Dealing with Baby Head Injuries

Host: A very common call to a pediatrician, my little is steering, not functioning and blacks out, and they go to the emergency room and the doctor in the emergency room says, it's probably concussion. What's a concussion? Does it lead to anything bad doctor Pavlakis? Guest: Well a concussion means you hit your head, and you passed out or had a change in level of consciousness for a period of time. A single concussion in and of itself, is not worrisome. It doesn't hurt the child, has no long term repercussions and in fact, even though scans obtained of the brain, very often in a emergency rooms now a days, it's not clear that one has to do that, in a child that looks normal after they get to the emergency room. It's not usually associated with any problem in the brain and it's not usually associated with any long term problems. In an older child though, we know if you get a concussion, it's probably not good to get a second one very soon thereafter, and a second one might be more serious, indeed, even could be life threatening. So we encourage people to get a concussion, to try not to hit their heads for a while, after the first event. Host: So that's why the Boxing Academy is adamantly against boxing? Guest: Well, that's a good question, that must be one reason it could be against boxing, and other reason it could be against boxing, is you can get something called a fancy term Pugilistic Dementia, and Pugilistic Dementia is a long term -- but what it means is, you lose your intellectual functioning, because you get hit too many times and what happens in that situation, you actually get little strokes in the brain. So if you box a lot, you are going to get little strokes in the brain for sure, over time, if you do it long enough, and if you hit your head enough times. That's different in concussion. Concussion doesn't have little strokes. It's just that you hit your head, you lose consciousness, and you become normal thereafter. But if you do it again, shortly there after, the first time, it can be very serious with brain swelling. Host: If the child had a concussion, that was vomiting and vomiting afterwards, and lethargic, that kid, there's no question, needs a Neurological evaluation. Guest: Yes, and I think generally, if anybody has a concussion should probably go in the emergency room, in general we do that. You don't always have to, but they could be seen by the pediatrician certainly, but should be seen by somebody. If a child though calls up the pediatrician and says, you know, my child hit her head, and she dazed off, and now is vomiting and has a headache and is not normal, that child should be seen, and have brain imaging right away. You should probably not go to the pediatrician, bypass the pediatrician, and go in the emergency room. Host: But they seem to do CAT scans, and not MRI, why is that? Guest: Well, CAT scans are different tests. CAT scans are X-ray. MRI uses radio waves and magnets to take pictures. The reasons CAT scans are used more in emergency rooms than MRIs are really threefold. One is, CAT scans are more available everywhere. Two, CAT scans are faster, we can do almost all tests without sedation with a CAT scan. Where in a MRI, almost always needs sedation, which is a problem in a three year old that just had head trauma. You don't really want to do that. And three, CAT scans are probably better for looking at changes related to trauma, such as blood in the acute situation. So CAT scans are typically done in the acute situation. Host: You heard someone had a head injury, and they had to go to a neurosurgeon, because he had bleeding in some places here. Why is that? Guest: Well, if a child with the example that we talked about, a child is still vomiting and has a headache after head trauma, the concern is that there is bleeding inside the skull, and that can happen if there is bleeding inside the skull, if it's substantial causing neurological problems, we sometimes will have that drained, and that can be life saving and also depending where it is and how fast it's obtained, have great result with no long term consequences to the child. Host: Thank you, Doctor Pavlakis.