As pandemic restrictions eased this summer, many children returned to pastimes they had missed, including playing team sports, visiting playgrounds, riding bicycles and taking family trips by car.
These activities are fun and enriching, but also carry a risk for head injury.
"As we return to our usual activities -- which is wonderful -- we're also returning to the risks of daily life, of being active people," said pediatric emergency medicine physician Angela Lumba-Brown, MD. "It's important to remind families about safe practices to prevent head injury."
After a period in 2020 during which pediatric head injuries decreased, rates are now ticking back up. Lumba-Brown, an expert in pediatric traumatic brain injuries, including concussions, said that in addition to brushing up on their knowledge of injury prevention, parents should refresh their knowledge of the warning signs that a bump on the head needs medical attention.
Fewer head injuries: A silver lining of 2020
"Globally, scientific evidence shows that medical evaluations for various types of traumatic injuries decreased by 20%-85% during the early part of the pandemic," said Lumba-Brown. "In California, research from Los Angeles County found fewer blunt traumatic injuries and fewer blunt head injuries during the time we were sheltering in place."
Head injuries are common in children and most often are caused by falls. Mild traumatic brain injury following head injury, which can be a concussion, is defined as a period of temporary loss of normal brain function. The signs, which can last up to a month, include headache, balance problems, problems thinking, visual disturbance, mood disruption and sleep impairment.
For most of 2020, playgrounds were closed, and children were less likely to meet outdoors with friends for fun but moderately risky activities, such as rollerblading. People drove less in the spring and summer of 2020, dropping the odds of car accidents and associated injuries. Organized sports were also on hold, which reduced head injuries among kids and teens.
Even when sports returned in early 2021, players often modified the activities to promote social distancing. "For instance, I saw teens reengaging in socially distanced football, rather than tackle football, which reduced the opportunity for injury," Lumba-Brown said.
But this year, from May through July, emergency medicine experts across the country noticed that head injury rates were rising again. Lumba-Brown examined the change by comparing the number of brain imaging tests ordered in Stanford Medicine's pediatric emergency department in mid-2020 to the figures from the same period this year. All scans were ordered for neuroimaging of children's and teens' head injuries.
"From May to July of 2020, we obtained 98 pediatric neuroimaging scans for head trauma. But from May to July of 2021, we obtained 156," said Lumba-Brown.
Injury prevention tips
To reduce kids' risk for head injury, Lumba-Brown's advice for parents includes the following:
- Check that children's sports teams employ safe practices not only for COVID-19 mitigation but also for head injury prevention. Coaches should advise kids to practice ethical and less risky play, and should educate themselves about how to identify concussions and what steps to take if a head injury occurs.
- Bicycle riders -- kids and adults -- should wear properly fitting helmets. Choose safer routes when riding with children, such as streets with minimal traffic or protected bike lanes. Helmets are also needed for other activities on wheels, including rollerblading, skateboarding and riding scooters or similar electric devices.
- On car trips, use an age- and size-appropriate car seat or booster for younger children. Make sure everyone buckles up.
- Ask kids to be safe at the playground: Remind them to take turns on play equipment, for instance. Visit age-appropriate playgrounds that have soft surfaces installed below equipment.
- Model safe behavior and teach children what to do if someone is hurt, including how to call for help, make a 911 call and find care after hours.
When to call the doctor
Even with precautions, children and teens will bump their heads.
"If a child sustains a head injury and they are not acting like their usual self, they should definitely be seen by a health care provider," said Lumba-Brown. If a child has anything more than mild to moderate pain at the exact site of the injury, parents should contact their child's doctor.
The most common pediatric concussion symptom is headache, but parents should also be on alert for other symptoms including:
- Nausea or vomiting
- Irritability or extreme anxiety
- Visual disturbances, such as difficulty reading
- Sleep disruption.
Kids who exhibit any of these symptoms should be seen by a physician, and if their usual pediatrician isn't available, the family should take the child to an emergency department or urgent care center to make sure the head injury is not serious, said Lumba-Brown.
She urges parents to err on the side of getting more medical advice rather than less. A head injury that happens at the end of the day can be confusing because it's hard to tell if changes in a child's level of consciousness are the result of normal bedtime tiredness or a more serious problem.
"A parent should never have to be the one to determine whether their child is sleeping or has more ominous signs of injury like a change in their mental status or is in a coma," she said. "It should really be up to physician examination and observation."
It's also important for parents to know that a child who looks OK at first may not be well hours later.
"Traumatic brain injury is an evolving injury. It's not as though the head injury happens and five minutes later we know with certainty if something severe is developing," Lumba-Brown said.
"A severe head injury might take hours to present. If there's any question, especially if it's after hours and you can't see your pediatrician, go to the emergency department or urgent care. That's why we're here."
Photo by Bernard Chow