Kids' Head Injury is Often Repeated: Study

Having one such trauma doubles the risk for a second head injury, researchers find

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HealthDay Reporter

TUESDAY, April 3, 2007 (HealthDay News) -- Kids who suffer a head injury are twice as likely to experience a second one within a year compared to kids who injure other parts of their body, a team of Canadian researchers reports.

The findings, reported in the April issue of Pediatrics, should be assessed in light of current time trends for recovery from such injuries, the researchers noted.

"Essentially, this elevated risk for a second head injury is sustained up through the first year," said lead author Bonnie Swaine, a professor in the School of Rehabilitation with the faculty of medicine at the University of Montreal in Canada.

Swaine and her team point to previous studies that indicate that head injuries make up more than 10 percent of all visits to hospital emergency rooms in the United States. According to one analysis, in the year 2000, head injuries among American children 17 or younger accounted for more than 50,000 hospital admissions.

While most childhood head injuries are mild, some are serious enough to provoke enduring cognitive, physical and emotional difficulties, the researchers note.

In the study, Swaine's group conducted telephone interviews with the parents of more than 10,000 injured boys and girls between the age of 1 and 18. The children were cared for at one of two pediatric hospitals in Montreal between 2000 and 2003.

Two sets of children were included in the study. The first group included just under 3,600 children who experienced some kind of a head injury, including skull fracture, internal injury to the cranium, concussion, facial fractures, dental or visual injuries, and facial lacerations that occurred as a result of an impact.

The second group included just over 6,700 children who had experienced a musculo-skeletal injury to a different part of the body.

Regardless of the nature of the initial injury, within six months 2.4 percent of all the patients -- or 245 children -- returned with a head injury. Within a year, that number rose to 4.1 percent, or 386 children.

The team then focused on children who had been initially treated for a head injury. They found that 3.2 percent of this group needed care for a second head trauma within six months -- a number that rose to 5.5 percent within a year. In fact, kids with initial head injuries ran double the risk for undergoing another head injury within the following 12 months, compared to other injured children.

Compared with girls, boys were at elevated risk for a subsequent head injury regardless of the nature of their initial injury. Children who sustained an initial injury of any kind during a recreational activity and children who were deemed more active than average were also at a higher risk for a subsequent head injury, the researchers found.

Pediatric guidelines on preventing a second head injury keep evolving, Swaine said. For example, during the study period, the Montreal hospitals had recommended that parents restrict full activity for a month after a child experienced a head injury. But that protocol has since been softened to a "step-wise" policy that emphasizes a gradual return to activity, depending on whether symptoms related to the initial head trauma have eased.

"There's very little research on cumulative head injuries," Swaine said. "Unfortunately, we still have many questions and we're not yet able to put our finger on exactly what accounts for childhood risk and how best to handle recovery and prevent new injuries."

"But," she added, "our research clearly does not support the use of a four-week period of activity restrictions to reduce the risk. I'm a parent of a teen and a pre-teen and I can tell you, no, you can't restrict them. They just have to learn to adapt their activities to reduce their risk in contact sports, and return to activity should be based on the presence of symptoms such as headaches, dizziness, nausea, irritability, and sensitivity to light."

Dr. Douglas B. McKeag, director of the IU Center for Sports Medicine in Indianapolis, said that education, rather than activity restriction, is the key to preventing a repeat injury.

The Montreal finding "doesn't surprise me in the least, because it's sort of what we've already found in young athletes," said McKeag, who is also chairman of the department of family medicine at Indiana University School of Medicine.

In fact, he added, "for the young athletes risk actually goes up about three to four times. But in either case, it's ludicrous to think that you're going to knock children out of play or whatever activity they are doing for a long period of time."

"We really don't know what an appropriate time off is, anyway," he added. "So if the kid is taking risks -- and there are lots of kids like that -- the question that needs to be asked is, 'What are the kids doing that is causing the head injury to begin with? Are they falling off bikes, getting hit in a game collision with another player, riding in a car not fastened with a seat belt, or even just banging their heads because of a dare?' Because if you know the answer, then there are educational things you can do without restricting the kid's overall level of activity."

The U.S. National Center for Injury Prevention and Control (NCIPC) suggests that parents encourage their child to get plenty of rest following a head injury. Activities that could lead to a second impact to the head, such as bike-riding, playing sports, or climbing playground equipment, should be avoided until the child is cleared by a physician, the agency says.

In addition, the NCIPC advises parents to discuss the injury with any caretaker, such as a babysitter or teacher, who might be responsible for the child during recovery, and to avoid the use of medications not prescribed by a doctor.

More information

For more on kids' recovery from head injury, visit the U.S. National Center for Injury Prevention and Control.

SOURCES: Bonnie Swaine, Ph.D., professor, School of Rehabilitation, faculty of medicine, University of Montreal, and researcher, Centre de Recherche Interdisciplinaire en Readaptation du Montreal Metropolitain, Institut de Readaptation de Montreal, Montreal, Quebec; Douglas B. McKeag, M.D., chairman, department of family medicine, Indiana University School of Medicine, and director, IU Center for Sports Medicine, Indianapolis; April 2007 Pediatrics.

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