Much warranted attention has increasingly fallen upon severe and repetitive adult head trauma particularly in the area of sports. Despite this growing focus, little attention has been given to the more mild head traumas that show up in the daily lives of our kids. These mild head traumas have the greatest impact on the developing heads of young children and often go unnoticed. For parents, it’s important to understand what constitutes a head trauma, what symptoms to look for and what can be done if a child does have symptoms following a head trauma.

What Constitutes a Head Trauma

To best understand all the ways head traumas happen in children, it can be broken down into two distinct categories: contact and non-contact. Head trauma resulting from a contact injury is the run-of the-mill hard object meets head scenario. These types of injuries are often fast and mild. While contact injuries are obvious, non-contact injuries can be more elusive and include whiplash-type to tension-type injuries. Though we may not think of non-contact injuries as head trauma, they can actually affect the brain more directly than a mild contact trauma can.

Contact injuries can occur from infant birthing trauma, a toddler standing up under a low table, grade-schoolers colliding on the playground, a 6-year old climber careening from the monkey bars, a teenager taking a fall on the ice, or a pre-teen heading the ball in soccer. The elusive non-contact injuries may the result of whiplash from car accidents or amusement rides, dental procedures like teeth pulling, dental brace application and tightening, or the over-zealous uncle swinging a 2-yearold over his head.

Symptoms to Look For

Kid’s hit their heads all the time and not every hit requires treatment. Additionally, not every roller coaster ride or exuberant rendition of “London Bridge is Falling Down” needs to be met with a neurologic examination. If a child has had a head trauma, parents should be aware of two things: trauma to the head can present with urgent, non-urgent or no symptoms, and head trauma can result in symptoms of the head or include symptoms that would seemingly be unrelated. Here is a practical guide to determine if care is needed following a head trauma. (It’s important to note that symptoms will commonly appear within 24 hours but it is not uncommon for symptoms to take up to two or three weeks to manifest.)

Symptoms requiring urgent care:

• Loss of consciousness

• Confusion or loss of memory

• Unusual drowsiness

• Dizziness, blurred or double vision

• Nausea or vomiting

• Slurred speech

• Persistent headache Symptoms requiring non-urgent care:

• Irritability or other mood changes including depression

• Change in focus, attention or learning ability

• Low-back, mid-back or neck pain

• Difficulty swallowing or the development of gastro-intestinal reflux

• Bed wetting

• Change in sleep behavior

• Jaw pain, popping, clenching or grinding

• Ankle pain, stiffness or loss of motion including toe-walking

• Tingling or burning in the hands or feet

What Can Be Done About It

If after a few days a child is still experiencing symptoms, it’s time to consider getting additional help. What’s available is an increasing number of qualified manual therapists. Manual therapy is a specialty area that can most commonly be found within the disciplines of physical therapy, osteopathic medicine and chiropractic care. All manual therapy approaches offer their individual strengths and weaknesses, but what’s important is to find a qualified practitioner that’s the right fit for parent and child. Three questions to ask when choosing a practitioner are:

• Do they have more than five years of practice with a specialty in manual therapy?

• Do they have experience in treating children following head trauma?

• Will their treatment address the connection between a head trauma and the child’s presenting symptom?

Hopefully the conversation around childhood head trauma will continue and broaden to include even mild injuries. What’s important to remember is that even seemingly small injuries may need to be addressed, symptoms can present in a variety of unexpected ways, and if recognized can be helped by a competent practitioner. As always, the best care is prevention. Slow down, look up and wear a helmet.

Ellen Helinski, MS, PT, IMTC, is a licensed physical therapist and certified manual therapist with 20 years of clinical experience. She owns and operates Inner Bridges Physical Therapy & Wellness, in Cambridge, where she leads her team of expert manual physical therapists. She specializes in using manual therapy for the pediatric population.