Minor traumatic brain injuries – what is new?

IN A NUTSHELL • Children are more prone to developing TBIs, and recover more slowly than adults • Even minor concussions without LOC may be followed by a period of physical and cognitive dysfunction, which may last up to 3 weeks • Children with a GCS ≤ 14 and a skull fracture or focal neurological signs, with a fixed dilated pupil, children under two with a scalp hematoma and any child with a drop in GCS should have an immediate CT scan • Any child with a GCS ≤14, a skull fracture, focal neurological signs, coagulopathy or suspicion of child abuse should be admitted • The cornerstones of management of mTBI are physical and cognitive rest, education and allowing time for the brain to recover • The use of medications should be avoided in concussed children • Return-to-play or return-to-school of a concussed child should be graded • Neuropsychological and balance testing should be considered in any child recovering from a concussion.