Chmt in children symptoms. Therapeutic Treatment of CMT in a child

Any damage is a test for the body. She does not pass without a trace, and can not be accompanied by unpleasant feelings. Especially hard injury tolerate kids, because their body is very vulnerable, and some parts of the body due to anatomical features are most sensitive to damage. Head damage is called cranial and brain injuries, abbreviated CMT.

This is the most frequent cause Child injury, it is about 30-40% of all kinds of injuries. Most often, TSMT is subject to boys from 3 to 7 years. The main reasons for the child injuries in the child are raised to falls, household or sports injuries, traffic accidents. The head of the thoracic kids has a rapid frame, the bones of their skull are not fully fascinated. And are connected through special seams and springs - piers of cartilage tissue.

Thanks to these peculiarities, the baby was easier to appear. Such a structure ensures support of the head when passing generic ways. But entering into a new world, seams and springs can not quickly ossify to the state of adults. Therefore, the first years of the child's life are most dangerous and vulnerable to His rapid head. Even a banal head injury can play a negative role in the development of the child.

After all, in its essence, the injury is the defect of the head of the head, and in view of the compact placement of the brain in the cranial box, this lesion can affect the brain, causing, at best, its concussion. And at worst, the external injury can lead to the opposite, that is, the inner impact of the brain on the cranial box on the other side of the applied force due to the immaturity of the rapid brain shells. So there are closed brain injuries. Depending on the nature of the damage and severity of the CMT, the following shapes of the brain injury are distinguished:

• Shake;
• Bruise of different degrees of gravity - light, medium and severe;
• The hematoma, which can be located between the skull and the outer cerebral shell - epidural, between the outer solid shell of the brain and the spider medium - subdural, and between the web and the inner soft - subarachnoidal;
• Diffuse axonal violation;
• Fracture of the bones of the skull with a pressing of the brain;
• Discharge brain substance.

Brain injuries can lead to squeezing of its fabrics, tension and displacement of its substance, increase intracranial pressure. Bias brain Structures leads to the ruptures of the brain tissue and its vessels, infringement of brain formations. It disrupts the nutrition of the brain and its function. And the increase in pressure inside the skull contributes to the brain ebony and its swelling is an extremely dangerous complication.

It is in view of these anatomical features, as well as the defenselessness of babies, inability to take care of themselves, parents must extremely carefully comply with preventive measures to avoid children's head injuries. So, parents should be followed by the movement of their children. The desire to know the surrounding world and the lack of concepts about what is dangerous, and what is not, they are not playing children.

It is worth the parent to take a look at a second, as the sofa turns into a springboard, and the table in the brick wall. In addition to attentive observation of the child, you should also carefully care for it, because even a particularly intensive pointing or active baby shaking, it can harm his head.

Symptomatic toddler brain cross pattern

Since the kid's brain is able to quickly adapt to the surrounding changes, that is, its compensatory capabilities are significant, the symptomatic painting of the injury may not immediately make himself felt. This greatly complicates diagnostic events and treatment. After all, the most useful therapeutic effects There will be an ambulance provided immediately after injury, without developing complications in the form of hematomas and hemorrhages, brain edema or stroke.

Symptoms of injury will be little different from those in adults, with the exception of only the fact that the child is not able to complain to loud about it and explain where he hurts. Depending on the force caused by damage, the shock will be discussed outwardly. The severity of the injury determines its clinical manifestations. So, the bruised brain of a light degree, which is also called contusion, may have the following signs:

• Strong headache, the baby will show it painful crying;
• Dizziness, while the child will be bad to navigate in space, his movements will be unspecified, and the view is not focused;
• Nausea and vomiting not related to meals;
• Reduction of heart rate or vice versa, increase;
• Raising arterial pressure;
• Non-essential nystagm, that is, oscillating eye twitching.

The injury of lightly has a favorable outcome, and usually after a few days there is a complete restoration of the kid consciousness, it is again oriented in space. When the brain injury is medium severity, the following symptomatic picture is observed:

• Loss of consciousness for a few minutes;
• Stunning and injury to the child;
• Speech violations;
• Increased weakness and fatigue;
• Drowsiness;
• Strong headache;
• Dizziness with disorientation in space and time;
• The loss of memory of the occurrence of injury is retrograde amnesia;
• Nausea and multiple vomiting;
• Violations in the work of the Mimic Musculature;
• Nistagm and a reduced reaction of pupils into light.

With a favorable coincidence and timely rendered assistance, the consequences of the bruise disappear after 15-20 days. The injury of a severe brain proceeds in a brighter negative color. The following symptoms may be observed:

• Loss of consciousness for a couple of hours;
• Violation of cardiovascular activities in the form of an excessive increase in blood pressure, increase or decrease the frequency of heart rate;
• Respiratory disorders;
• Hyperthermia;
• Impairment of eye functions in the form of a layer;
• Pares or paralysis of the limbs;
• Disorders of swallowing;
• Nistagm, both one and both eyes;
• Excessive expansion or narrowing of the pupil;
• Convulsive seizures of varying severity;
• Violations of speech;
• Psyche disorders.

Diagnosis of head injuries in a child and their complications

With suspected brain injury in his children, parents need to cause a doctor. Due to the anatomical vulnerability and inclination to complications, the delay is simply unacceptable. Any Chmt in children is an indication for hospitalization for a reliable analysis of clinical symptoms and conduct tool methods diagnostics. In addition to instrumental researchThe neurological inspection is carried out to identify disorders of the nervous system.

Such an inspection includes checking the sensitivity of a small patient - pain, tactile, temperature. Assess the reaction of its pupils into light, their size and symmetry. Analyzes the soreness of the baby's eye, determine the voltage of its occipital muscles. Check the symmetry of the person, analyze the presence of headaches, dizziness, strength and tone of the limbs.

Instrumental diagnostics includes:

• Computer tomography (CT) or magnetic resonance imaging (MRI) of the head - it allows you to determine the smallest foci of damage, consider the brain layer layer, find hematomas or parts of hemorrhages, wherever they are hiding. However, MRI chest kids are practically not carried out in view of the need for anesthesia to ensure complete motionlessness of the child;
• X-ray refers to the discharge of the most common methods of injury diagnostics. Although the x-ray is good to determine the state of the bone system, he will not say anything about the state of the brain, since it is weakly visualizes soft fabrics;
• Echo encephaloscopy, which allows you to identify a possible bias of the brain in relation to the bones of the skull caused by hemorrhage and increase the pressure inside the skull;
• Lumbal puncture aimed at searching in the lycvore of blood traces indicating injury;
• Electroencephalography (EEG) with a record of the bioelectric potential of the brain in order to identify conduction disorders;
• An ophthalmoscopy that can show hemorrhage into the retina's retina, which is one of the complications of the CHTMT;
• Angiography aimed at identifying the evolving zone, devoid of blood supply due to CMT;
• Craneography - special view skull radiography used in cranial injuries;
• Neurosonography is a kind of ultrasound, conducted for the smallest. This is a fairly simple and painless research method, which allows you to identify pathological changes in the brain of children under 2 years old. That age limit associated with the anatomical features of the children's head. Up to 2 years, the skull bones are not dense and the image during the study is clear, but the ossification with age makes a picture of blurred. For ultrasonic method There are no contraindications, it can be performed on this hour, and almost every children's hospital is equipped with such an appliance.

The consequences after the CHTT can be divided into two large groups - intracranial and extra charge. The most dangerous intracranial complications include meningitis, encephalitis and brain abscess, which can be, as early and develop about 3 months after injury, as well as late, delayed, appearing 3 months after CMT. Most often abscess is formed as the outcome of encephalitis, therefore, in its formation, it passes the purulent-necrotic stage of encephalitis, the stage of capsules with pus - pyrogen and terminal with the organization of this capsule.

The list of extra charge complications is represented by pneumonia, acute heart failure, impaired liver and kidney functions, asthenic syndrome. This syndrome is the most frequent consequence of HTMT any age and includes increased fatigue, irritability, closure.

Against the background of CMT, vegetodistonium can develop, which is characterized by changes in blood pressure, both in the direction of reduction and increase, as well as failures in the thermoregulation system. Heavy consequences after the TWT heads epilepsy, which occurs in 10-20% of children. Most often it is formed in the first 18 months after the head injury. Often the child has a severity of the TSMT does not correspond to developing consequences due to children's anatomy-physiological features.

Treatment of brain bruises

Head injuries require a mandatory emergency call. However, to facilitate the condition of the child, you can independently give him first aid. In the absence of obvious damage to the cover of the head, the cold compress should be attached to the injury site. This reduces pain, removes the edema of the brain tissues and can suspend bleeding due to the reflex spasm of the vessels, as the reaction to the cold.

Also bleeding stop the method of tampony. Apply to the place of wounds dry clean matter, if it is impregnated with blood, impose a new one, if after 15 minutes the bleeding did not decrease, it is necessary to urgently cause a doctor, since the child has already lost a lot of blood and continues to lose. The ratio of blood loss of the baby and the adult will differ. The infant is enough to lose 150-200 ml and it will be a blow for its inconsected organism.

Any CHHMT head requires peace, however, if possible, one should not give the child to sleep next hour after the injury. Otherwise it will be impossible to determine the severity of its condition. You should even wake the baby in the middle of the night, ask him simple questions or evaluate its coordination. Attention should be paid to the pupils of the child, if they are unequal in size, then this is an indicator of the heavy state of the brain. Repeated episodes of vomiting, also an alarming bell for the parent. Need to immediately cause a doctor.

With the loss of consciousness, you should put the head of the child to the side, so that in vomiting the masses did not get to him in airways. And if an injury of the spine, conjugate with the injury, should be very careful to turn the baby's body. If possible, it is better not to do this at all.

In the hospital for the treatment of brain injuries, both therapeutic and surgical methods are used. Depending on the severity of the injury. Therapeutic assistance is reduced to the medication elimination of increased intracranial pressure, pain relief and prevention of brain edema development. Complications arising from injury, such as the compression of the brain substance, hemorrhage, the pressure in the brain of bone fragments of the skull, require urgent neurosurgical care.

Specific prophylaxis to prevent head injuries in children does not exist. There is no vaccine that will save the baby from the bruise, there is no pill that will protect it from the THMT and other injuries. Prevention fully falls on the shoulders of parents and educators, it consists of control over their children. And also for learning their caution.

Due to the characteristics anatomical structure Children's head should not reject the proposal of an ambulance in the hospitalization of the child. Even if his condition seems normal. Remote consequences of head injury are so characteristic of children. And the hospitalization in the hospital will allow you to watch the condition of the child. Attentive protecting the health of his child is the key to high-quality and happy family life.

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Features Cranial injury in children

One of the leading places in child traumatology belongs to the cranial and brain injury (CMT). In the overall structure, injuries in children damage the skull and brain are 40-50%. CMT ranks first among all injuries in which the need for hospitalization arises. With such a diagnosis in Russia, about 140-160 thousand children are located annually in hospitals. Special medical and social importance of CHMT in children is also determined by other indicators:

a) high overall death (from 9 to 38%), which is 70% among the causes of death from mechanical injuries (third place in children under the age of 1 year and the first in children from 1 to 14 years old);

b) a significant risk of residual changes - in 60-90% of children in remote period Different residual phenomena are formed;

c) Highly disability - after severe CMT from 20 to 50% of children become disabled.

Epidemiological studies have shown that children of preschool children most often suffer. This is due to relatively large sizes and weight of the head in children of younger, as well as increased motor activity In conditions of imperfect coordination of movements and the absence of a sense of hazard of height.

Up to 3 years in girls and boys the frequency of injuries is the same, and from 3 years old, it increases and at an older age is significantly dominated. For example, the ratio of boys and girls under the age of 10 is 2: 1, and after 10 years already 3: 1.

There is a seasonal fluctuation of Frequency of CHMT in children. The greatest number falls on April-May, June-July and December.

In the structure of mechanical damage to the head, the main importance belongs to household injury (60-96%), the transport accounts for only 4- 27%. Moreover, the circumstances of injury are largely determined by the age of the child. Babies most often fall from the bed left unattended, less often they fall from the hands of relatives or with babies are falling older children. In the future, the main importance is acquired by the fall of the child from the height of their growth (injury "child, student walk"), and then, aged 3 to 6 years old - drops with greater height (for example, with stairs, trees, roofs, from windows and etc.). At school age, traffic injuries (24-50%), as well as damage during games (skating, swing, cycling, playing football, etc.) (7-10%).

IN latelyUnfortunately, more and more often have to meet with cases of head injury in children as a result of violence against them (the "ill-treatment" syndrome of the child "). Common unfavorable social conditions, additional problems that bring a child in a family, defenseless to others make it an object of wrath of parents, family members, and sometimes outsiders. The child's ill-treatment should be attributed to 3.6% of CMT cases in children.

It is generally recognized that children, compared with adults, there are additional difficulties in assessing the severity of the head injury only on the basis of clinical manifestations. Moreover, what younger child, the usual more difficulties in diagnosis. Those. For children, it is characterized by "atypical" (or rather, typical pediatric) the current of intracranial damage. This may manifest itself, on the one hand, a long asymptomatic flow of damage dangerous to the child's life, and on the other - with rapid clinical manifestations even with minimal brain injury. In the latter case, the child's condition is concerned about relatives and doctors, but these alarming signs (for example, a fairly intensive headache, multiple vomiting, drowsiness) pass completely and independently within a few days. Such a peculiarity of the head injury in children is explained by age anatomy-physiological features. Even very large volume pathological objects may not be manifested by focal and general-selling symptoms due to low diffraction and polypotentiality of the bark, as well as relatively wide cerebral subarachnoid spaces and the possibility of increasing the scope of the skull. Long-term clinical compensation, especially with traumatic surround processes, is often replaced by a rapid increase in neurological disorders due to brain edema and its dislocation. This contributes to the high hydrophilicity of the tissue of the brain of children. Incomplete myelination of the brain and the features of the regulation of vascular tone can lead to diffuse vegetative reactions, convulsive supplies, as well as transient brain hyperemia. No less important in the originality of the clinic has the flexibility of the bones of the skull and their mobility in the seams.

Often, children arise difficulties even with the interpretation of etiology of neurological disorders arising. On the one hand, it is not always possible to establish the fact of transferred injury. For example, it should be remembered that if the baby was left under the supervision of relatives, neighbors or acquaintances, they usually strive to hide the episode of the suffered injury from their parents. Older children themselves various reasons Often hide injury. Moreover, children may develop structural damage to the brain without immediate head injury. Such damage is developing due to the impact on the whole body of a child of sudden acceleration and / or braking ("baby shaking syndrome"). The possibility of intracranial damage is related to relatively big sizes Heads, weak musculature weakness, increased vulnerability and brain mobility in the skull cavity. Morphologically in such cases it is possible to develop focal and diffuse brain injuries (for example, subdural hematomas). Most often, this syndrome is observed in babies and children of younger age and may arise with coarse treatment (sharp multiple shaking), jumping from height to feet or even with an excessive intense damp.

On the other hand, sometimes with injury erroneously bind the manifestations of brain diseases, which can leak without clinical manifestations (congenital arachnoid cysts, brain tumors, etc.). In these cases, injury is only a provoking factor leading to a compensation breakdown.

One of the CTMT criteria in adults is the loss of consciousness and its durability. In children, especially early ageThe loss of consciousness at the CMT is rare or may be absent even with severe injury. The bruises of the brain of medium gravity sometimes proceed not only without losing consciousness, but also without focal neurological symptoms. It turned out that breast-age children perhaps the asymptomatic flow of subarachnoid hemorrhages and linear fractures of the bones of the skull of the skull. In such cases, signs of brain's injury are found in such cases, and sometimes not only in the field of fracture, but also by the type of anti-downtrad. Despite the good condition of the child, the lack of loss of consciousness and neurological symptoms, discovered on craniograms, a linear fracture of the skull of the skull allows you to qualify damage as a CHMT of moderate gravity. It should be noted that in early age children with linear fractures of the skull, there may be a violation of the integrity of a solid cerebral shell, which intimately arrives at the bone and along the seams line is sprocketing with it. In this case, an expanded hematoma, propagating and epidural, may occur. Such a pathological situation should be attributed to a closed penetrating CMT with a rupture of a solid cerebral shell and epidural-substitular growth hematoma.

Thus, with a clinical examination of a child who has been suspected of CHMT, there are many additional difficulties that make it difficult to the timely diagnosis of brain damage. That is why special importance in children's neurotramatology is attached to the development of optimal diagnostic and therapeutic algorithms aimed at minimizing the risk of developing dangerous to health and life intracranial changes.

Anatomy-physiological features and peculiarity of reactions children's body The injury requires some change in the existing CMT classification, adopted in adults.

To easy CHMTchildren should only take the concussion of the brain.

CHHT Middle Severity in children includes:

a) brain bruises of light and moderate severity with a fracture of the bones of the skull or without a fracture;

b) Epidural-indinted hematomas without compression of the brain, as well as substandard hygromas.

Heavy group CHMTchildren make up:

a) ears of a severe brain (brain scramble);

b) intracranial hematomas (epidural, subdural, intracerebral with compression of the brain);

c) diffuse axonal brain damage.

When assessing gravity injury in babies and children

younger age, given the possibility of asymptomatic her clinical flowIt is necessary to pay special attention to clarify the mechanism of injury. It is hardly possible to correctly limit the diagnosis of the formulation of the "injury of soft tissues of the head" by a child who dropped from a height of several meters and not having any clinical signs of brain damage.

Children of the breastside more often there is an injury to medium and severe - bruises and compression of the brain; In 80% of cases, linear fractures of the bones of the arch and in more than 50% - subarachnoid hemorrhages are observed. In the younger and school ages prevailing the FMT light and moderate.

Together with progress in development medical equipment quickly change the principles of helping for the CHMT, however, not in all regions of Russia it is possible to apply modern achievements neotrowmatology in everyday practice, and health care It turns out on the basis of specific medical and social conditions.

Given all the data given, an attempt to summarize information about the CHMT in children within the present multi-volume leadership has a number of features. Some of them facilitate our task, while others, on the contrary, it is much complicated significantly. Some problems are already highlighted in detail or will be covered in other chapters of the manual, so here we do not stop at many general issues Neatrothmatology (etiologies, pathogenesis, diagnosis and treatment of CMT), as well as the basics of transcranial computers and phased neuro-imaging tactics. The anatomy-physiological features of the skull and brain of newborns and infants are also briefly discussed briefly discuss in the chapter "Generic head injury".

Significantly complicates our task the heterogeneity of the technical equipment of children's hospitals and, as a result, the impossibility of developing some uniform medical and diagnostic strategy.

Therefore, we will consider our debt performed if you manage to summarize modern data on the pediatric features of the CMT, and outline the real ways to improve the effectiveness of assistance to children in regions with various instrumental support.

A.A. ARTARYAN, A.S. Job, Yu.A. Harmashov, A.V. Banin

The main reasons for the appearance of the child of the cranial and brain injury can serve as the carelessness of the parents when moving the roadway, falls during sports, attacks.

The reasons that led to the injury of the head are diverse:

• Displacement, tear of brain tissues, due to the fracture of the skull bone;
• Damage to brain tissues as a result of concussion;
• Hemorrhage into the brain;
• Penetrating injuries in the head;
• Brain swelling, accompanied by an increase in pressure in the cranial box.

Symptoms

The form differences the following types of brain injuries:

• Brain concussion

Damage to the cranial bones does not occur. Possible loss of consciousness for a short period of time. Another sign of a concussion will be the appearance of short-term amnesia. She shares:

• amnesia, when a child does not remember what happened during the injury;
• the child does not remember anything before the injury.

The symptoms of the concussion of the brain are:

• feeling of nausea with the subsequent emptying of the contents of the stomach,
• dizziness and severe headache
• noise in the ears, weakness,
• sleep disturbance.

This symptomatics will disappear after one week.

• Brain injury

The main sign light shape The flow is a short-term loss of consciousness. Then the child may have pain in the head, dizziness, nausea, accompanied by vomiting. The child can lose memory on a short time. The freight or deceleration of heartbeat will be marked. In this form of the injury, the bones of the bones of the skull can be observed. After a week, the consciousness will come to normal, the child will be able to navigate in the surrounding space and in time. However, in the future, the child will be hard to learn due to memory disorder.

The symptoms of the brain injury will be easy to be:

• local brain swelling,
• damage to the integrity of the walls of small vessels.

After the injury of medium severity, the child can be observed:

• partial stun;
• violation of speech function;
• lethargy, reducing activity;
• drowsiness appears;
• temporal and spatial disorientation;
• small, focal hemorrhages;
• the appearance of illuminated, accompanied by nausea, frequent vomiting.

The brain injury is severely characterized by:

• loss of consciousness from a couple of hours up to 2 weeks;
• marked the increase or slowing down of the heart rhythm;
• breathing is disturbed;
• limbs are paralyzed;
• broken swallowing function;
• speech disorder;
• convulsive seizures.

• Brain compression

Compression or squeezing brain is a very serious damage to the substance of the brain. The main reason is the accumulation of blood inside the cranial box due to the rupture of the vessels.

Since the child under the year the weight of the head exceeds the weight of the body, when the child falls, first of all the parietal region. After that, redness is formed, rapidly increasing in the amount of edema.

To the compression of the cerebral of the child can lead:

• blood accumulation in the cranial box;
• hematoma;
• extensive destruction of brain fabrics.

Card and brain injuries can be:

• Closed. In this case, the integrity of the bones of the head is not changed, soft tissues are damaged slightly.
• Open. The first signs will be cracks, faults of the bones of the head, bleeding.

As a state of consciousness, the cranial and brain injuries are divided:

• if the child after injury adequately reacts to what is happening around and is in consciousness, we can talk about clear consciousness;
• oppressed consciousness while preserving adequate reactions to environment is signs of a spin;
• disabling consciousness, immunity by the child of what is happening, speaks of a comatose state.

Diagnosis of cranial injuries at the child

In order to diagnose the crank and brain injury, it is necessary to hospitalize the child and conduct a number of studies. First evaluated the reactions of the victim for the appearance pain sensations. The reaction of pupils into light, their position, symmetry is estimated. The child's reaction is checked on bright light. Pay attention to whether the muscles of the cervical department are strained, is there any convulsive seizures. To form an accurate diagnosis, doctors use computer and magnetic resonance tomography (CT and MRI). These methods help to recognize whether there is damage to the brain tissues and determine the presence of a hematoma.

Methods used for diagnostics:

• The use of echo encephaloscopy will allow to reveal whether the brain has shifted relative to the bones of the cranial box;
• To detect blood in the liquor, electroencephalography is used (EEG);
• Conducting ophthalmoscopy will show the presence of hemorrhages in the retina;
• Head X-ray for detecting brain injury.

Complications

In the cranial injury, the following complications and consequences are noted:

• The consequences and complications are practically absent;
• There is a violation of the neurological and mental state of the child;
• The child cannot serve himself without any assistance;
• There is no reaction to external stimuli. Coma state;
• Fatal outcome.

Treatment

With a competent treatment of injuries from a child, you need to evaluate how the brain functions after injury. All cases of such injuries are purely individual.

What can you do

It is necessary, first of all, to be attentive to your child during joint walks. It is clearly and intelligible to explain the rules of behavior on the street, when moving through the roadway, proper behavior at school, kindergarten.

If the accident still happened, it is necessary to provide first aid and cause an emergency.

What does the doctor do

Carefully examines the child, prescribes surveys, holds an element and assigns required analyzes. According to their results, appoints either medicia treatment, or prompt intervention.

Prevention

One of the important preventive measures of this disease is:

• do not leave the child one on the street;
• ensure that windows and balcony doors are closed in the absence of adults;
• do not put sofas, chairs, chairs near the windows;
• make sure the playground, where the child walks, is safe.

It is always necessary to be vigilant towards your children and take all security measures on time.

In the article, you will read everything about the methods of treating such a disease, like a cranial injury in children. Check how effective first aid should be. How to treat: choose medicines or folk methods?

You will also learn what it can be dangerous late treatment of the abnormal brain injury in children, and why it is so important to avoid consequences. All about how to warn the cranial injury in children and prevent complications.

And caring parents will find on the pages of the service full information On the symptoms of the disease, the cranial and brain injury in children. What is the difference between signs of illness in children in 1.2 and 3 years from the appearance of the illness from children in 4, 5, 6 and 7 years? How best to treat the disease of the cranial and brain injury in children?

Take care of the health of loved ones and be in Tonus!

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☼ This is the territory of healthy nerves and calm brains! Required information for parents first hand, works on principles evidence medicine and common sense

Did you know that ?? "Among preschoolers, mental anomalies of development - 60% of total Pupils, schoolchildren - 70-80%, "from the speech of the director of the Center for Psychiatry and Narcology. Serbian Zurab Kekelidze at a press conference dedicated to World Day mental health October 9, 2015 (TASS and RIA Novosti)

Head injuries in children

Horror horror! Save, my child fell out of the stroller!
I am alone in the apartment, what to do ??!

Why they always hit their heads or hello shock ...

The second law of Chadodynamics - if there is the slightest opportunity to hit your head,
the baby necessarily realizes it in the near future ...

The third law of Chadodynamics - inbe know that small children often fall,
but no one can predict where and when ...

The most dangerous and insidious head injuries occur on the first second year of life. Even the "experienced" adults are fairly vaguely oriented in the motor abilities of the baby, and most often, they do not imagine at all, to which they are capable of, like, a non-historical offense.

For concussion the toddler's brain all sorts! age, floor and temperament is enough to have a combination of 2 factors - the lack of parental control over the tenth second and any difference in the heights of the head and solid object:

a) right from birth - sofa, parent bed, changing table, etc. ...
everything happens instantly: Mom barely takes the look ... Graceful turn, light push with a leg ... and a baby, in the blink of an eye, gracefully, plans head down ... a bump on the forehead, daddy, the notation of grandmother, "ambulance", then in circumstances ...

b) the second half of the year - a stroller, a cot or chair ... Mom is distracted by half a second ... The child is trying to get up, turn the body, push the legs ... The center of gravity shifts ... The child is driving through the edge of the supports and ... drop, Next, the same chain of events ...

c) after a year - the kid costs, goes, climbs on the stairs, chair, table, windowsill, wardrobe, chandelier, etc. ... loses the balance ... drop from the height of its growth or elevation, hit head, then on the rolled scheme ...

Why, when in falling in children, so often suffers a poor head? Still, it would be much more "profitable" for health, when falling, hit exclusively by other parts of the body, for example, with a hand or booty. But the head is simply so lead in injuries is not inferior to anyone. From what?Everything is quite simple, the elementary laws of physics work. The child's head is relatively large and heavy, and even at the same time, it is usually located at the highest point of a very unstable system (approximately like a pyramid installed by a wide base up). A sufficiently light shock, shift, changes in the position of the body (and the coordination of the baby is also very immature), and everything, the equilibrium is lost, and the first head seeks to meet with a solid obstacle.
It is not enough that the head of the baby loves to meet with various solid obstacles, so it is also radically different from the head of an adult in its structure. The bones of the skull in the child are relatively soft, elastic and pliable, movable relative to each other; Brain immature and more hydrophilic (rich water content) in it a large number of "Temporarily dumb" zones and plots, etc.
This causes some fundamental differences between children's cranial trauma.It seems at first glance, it is pretty useful features Children's head; Theoretically, more elastic and movable skull and brain, rich in water content, relatively large above- and intracerebral spaces should more reliably protect the children's brain from the effects of mechanical injury. In fact, such compensation only works in cases of the easiest injuries. In practice, with serious impact, these features can not only be pretty strengthened, but also to significantly mask the pathological processes flowing in the injured baby brain.

So what happens when the head is hit? - Arises mechanical damage Soft tissues of the head, cranial bones and brain - Card-brain injury (CMT).

Card and brain injuries are different:

Brain concussion - relatively light version of CHMT, while the brain damage occurs on the functional (possibly molecular micro-cell level). With this injury, the brain impairment is not deep, rapidly transient (usually within a few hours or days). Damage to the cranial bones are not detected.
The main sign of the concussion of the brain is the loss of consciousness (more often a few seconds, sometimes minutes). But the fact of a short-term loss of consciousness even in children of school and preschool age Sometimes it is quite difficult to catch, especially in the absence of objective witnesses, the more difficult to establish the reality of the disconnection of the consciousness in the babies. One of the auxiliary criteria for the loss of consciousness in this case can serve as the interval between the blow and the beginning of crying the baby. Two or three, or even a few tens of silence seconds between the sound of "booze" and the cry of the baby are always suspicious in terms of losing consciousness.
It will not be further noted that children of school age and, of course, adults, relevant (but not objective), the proof of the concussion of the brain can serve as a loss of memory for events that occurred in a short period of "around" injury (before, during, or after Injuries (retro or anterograd amnesia).
Other solid suspicions on the concussion of the brain arise when the appearance of one-time, and, in particular, multiple vomiting. Older children can complain about nausea, headache, dizziness, noise in the ears or just on vile well-being. And if the child speaks poorly, and if he recently turned three months?

The best friends of parents and doctors come to the rescue: observation and logic.

If, it is after the injury that the baby clearly experiences an unpleasant feeling, it is more pale, sweating, around the eye of Syanka, the eyes "muddy" and slightly floating, it is excited, more climbing and more often annoyed, or that even worse, lethargy and drowsiness appeared (Pluckled and fell asleep in a spontaneous hour, sleeping a lot); He spoiled or disliked his appetite, he sleeps much worse and swears more often, "all this makes a doctor, first of all, think about non-specific, but rather typical symptoms of concussion of the brain.Anxious symptom during injury becomes a noticeable increase in the sensitivity to light, sounds (migree-like reaction): the child does not like the bright light, the loud sounds are clearly annoyed. In this case, with a combination with a pronounced headache, it is quite possible to assume dysfunction of intracranial pressure (gained doubtful known under the label of hypertension syndrome). Vegetative violations when concussing the brain can manifest itself to an increase in temperature, and then it is difficult to understand: "We are talking about the cranial and brain injury or the beginning of the ARZ."If, with everything, it is possible to detect the "running eyes" in the child, involuntary horizontal oscillatory movements of the eyes, (nystagm) or a light asymmetric expansion of pupils, the diagnosis of traumatic brain damage becomes very reliable.The fence and multiformity of children's cranial injuries lies not only in the poverty of objective information, the erase of the brain symptoms in connection with the age-related immaturity of the brain, but also the high frequency of the period of the false-favorable course of the post-traumatic period (the bright interval of injury). For example, the development of intracranial hematoma or the compression of the brain can flow for a long time without external manifestations of infants with open spring and moving bones of skulls compensating for an increase in intracranial pressure.
It seems that you will think, - the baby shouted his head (and not very much!), I didn't cry at once, I pulled two times, I slept after crying a little, but then, everything in "order". I was attempted, played, lay down as usual ... And at night re-vomiting, cramps, a trip to the "Emergency" to the neurosurgical department, an operation on intracranial hematoma, and a long-term rehabilitation ...Z. employs the situation and the lack of accurate coincidence of the strength of impact and gravity of the effects of injury: the baby can fall from the height of the growth of an adult, and get rid of light fright; And it may unsuccessfully ride a sofa and "earn" a fracture of the bones of the skull.
It happens often and so: the episode of the injury itself remains unnoticed for the parents, and only a huge bump on the head, which emerged instantly, and nowhere, stimulates the traveling of parents and a child to the hospital, and there is a interesting discovery of them there, it turns out that the child is traumatic Damage to the skull (asymptomatic cranial fracture). So, the discovery of anyone, even the most minimal, bone cranial fracture in our country, automatically entails the diagnosis of the "brain injury".Head injury in a child, especially in a baby, is the absolute necessity of a medical examination (pediatrician, neurologist, surgeon, traumatologist, etc. any children's doctor It may suspect the concussion of the brain). If, parents see the above, typical symptoms of concussion of the brain, it is already serious, the consultation of the neurologist or neurosurgeon is obligatory, perhaps in hospital conditions, and perhaps the hospitalization of the child.Sometimes medical care is needed urgently, the bill goes to hours minutes. The easiest I. effective method Solutions of the problem - a challenge of the ambulance brigade to the house, the "ambulance" doctor will quickly decide whether emergency medicineswhether it is necessary to inspect a narrow specialist if there is a need for hospitalization, etc.

Parents, be alert! Children's head injuries are very cunning, and even hundreds of thousands of right telephone councils or Internet consultations with a convincing and optimistic appeal "Do not worry, all children fall", do not outweigh the tragic events of one not wounded intracranial hemorrhage or late diagnosed brain edema.

Brain injury (contusion) - medium-heavy and heavy variants of CMT, while the depth of brain damage is determined by the local destruction and necrosis of the brain tissue of varying severity. With such an injury of impairment of brain functions, deep and long flowing, the main sign is the emergence of one or more centers of cerebral damage to the most different localization. Pronounced, long-term general-selling symptoms (listed above in the section concussion the brain) are often combined with the fractures of the bones of the skull and intra-and extra charge hemorrhages (a large bump on the head is a very serious symptom!). Mandatory for bruises of the brain are significant focal neurological disorders, often epileptic cramps, coordination disorder, symptoms of the defeat of the cranial nerves, the development of paralysis, disruption of breathing, heartbeat and the oppression of consciousness.The concussion of the brain, the brain injury and the compression of the brain belongs to the closed cranial and brain injury (ZCHMT) - brain traumatic damageIn which the integrity of soft tissues of the head and bones of the skull is not significantly violated.
Much less often, but are found in children and open cranial injuries (Ochmt) - when a tendon helmet is damaged (the central part of the abandoned muscle is damaged), and maybe the bones of the skull and the solid brain shell (penetrating cranial injury). Naturally, the severity of such injuries enhance abundant bleeding and the high probability of developing an infection.Shocked, bruised and other traumatic damage to the brain in children in the first minutes, and even hours, sometimes it is quite difficult to distinguish, and the tactics of treatment and forecasts differ fundamentally. That is why the utmost consultation of a specialist is obligatory.

Brain injury - urgent hospitalization In the neurosurgical hospital!

So, parents read a large bunch of books on education and technology of child safety, received a lot of advice, notations and recommendations from children's specialists and grandfathers, but the baby fell still and, as it should, hit his head (see the second and third chadodynamic laws) … What to do?

Memo parents of a threatened child

1. Do not panic! Do not fall into a stupor! Do not fuss!
2. Call the "ambulance", accurately and calmly fulfill the instructions of the medical office or a doctor.
3. Notice and memorize all the smallest details and sequence of occurring events ("work in the video camera mode"), remember Time and detailed circumstances of injury
4. If the place of impact is known, redness has appeared and edema develops (bump), it is desirable to use cold. Carefully attach, press the place of the bump something cold (if there is no ice package, even frozen chicken's leg, most importantly, wrap ice with cloth; At worst, suitable with a towel moistened with cold water). It is advisable to use the minimum for a long time for 10-20 minutes. Most likely, your child will be outraged, or even yelling, push your ice mark, is not scary, but try to agree with it in kind, using the entire arsenal of sedative parental tricks.
5. If there is a long loss of consciousness, you need to turn the head of the baby's head and, if possible, a little book. This needs to be done so as not to wait the language, and did not get saliva into the airways
6. If you occur vomiting to keep the position on the side, with lowered a little head end
7. If convulsion occurs, see here -What to do during and after the attack?
8. If after falling, I dreamed, the baby gradually plunged into the usual dream, wake it every 5 minutes it is quite optional, it is better to wait for an independent awakening
9. But, in the case of special suspicions, if, after injury, the child instantly "retired" into the deepest sleep, it is desirable to make sure that the response adequacy of the responses is pregnant, slightly harshing it and, then constantly observe his sleep.
10. If the injury mechanism also implies the possibility of damage to the neck (for example, the ducklings down with a stroller) of the child before the arrival of the "ambulance" is better not to touch, only the case of acute necessity, move and rotate the child very carefully, avoiding the slightest movements in the cervical.
11. Even in children of preschool, especially, older, in the case of suspicion of loss or violation of consciousness is the following checking consciousness and memory

"Look at me!" "Can you hear me?" "Where is your mom (dad)?" "Who am I who are next to you?"
"Do you feel anything?" "What do you feel where?" "What's your name?" "Are you now where you are?"
"Open (Close) Eyes" "Show Language" "Raise up right (left) hand" "Remember the word I will name"
Show item: "What is it?" "Remember this subject"

Violation of consciousness and memory:

* Lack of answers to questions and non-fulfillment of teams at the time of testing
* Full or partial memory loss (the inability to remember the events before, during and after injury)

Until the items are performed yet. "Memo parents of a threatened child" Saving "ambulance" comes, and the doctor offers hospitalization. Agree! I repeat: Children's head injuries are very cunning, and even hundreds of thousands of "successful" falls and injuries of other children in a similar situation do not allow one hundred percent guarantee of the happy end of your adventure.
No need to fear hospitals! This is not a prison, and even not a government house - no one will keep your child there! If there is no need for observation and treatment, you will immediately offer a reverse walk home.

Hospitalization is carried out in a neurological or neurosurgical department (if such is nearby) or to the usual surgical department. Friendly sick doctor will quickly hold a standard neurological inspection, if necessary, appoint additional surveys (skull radiography,

neurosonography, Computer or, for cramps -video EEG-monitoring etc.)
Sometimes if intracranial hemorrhage is suspected, for the study of the spinal cord fluid, it is necessary for a lumbar puncture - a fence of a liquor using the introduction of the needle at the lumbar level into the cavity between the soft and sputum shells spinal cord (Subarachnoid space). Afraid of this, quite ordinary, neurodiagnostic procedure is not at all, when proper technique Performance, the likelihood of unwanted effects is extremely small.

When the exact diagnosis is set, treatment begins. In light cases, it consists of a strict protective-bed mode (easy to advise - try to keep chusola e-egen in bed!), In heavy - medical therapy and neurosurgical intervention.

Exodes of brain injury Different things happen: in easy cases - complete recovery without consequences, in heavy - serious and persistent lesions of brain functions.

Children have another feature, the forecast of the consequences does not very exactly depends on the depth of traumatic damage, sometimes severe injury ends quite safely, sometimes, the opposite happens. The intensity and completeness of recovery depends on many factors, it is not only the severity of injury, but also the adequacy of therapy, state of health before injury, age, floor, etc.

In conclusion: having such "deep" knowledge of children's neurotramatology, it is good to be reasonable and calm, at the time of injury you can care about the child and yourself, but even better, to warn injury!
Parents, be alert!

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The practice of healing in a distant past required a certain classification of the cranial injury (CHMT) for tactical constructions of therapeutic process. Apparently, the first separation of the CMT was built on the principle of the presence or absence of damage to the bones of the skull with the excretion of injury to closed and open, penetrating or impervious into the cavity of the skull. The following millennia was characterized by a more in-depth study of the open CMT (Hippocrat, A. Seels, Galen, Gi de Sholiak, V. Carpi, A. Pare) with the classification of fractures of the skull bones, damage to a solid brain sheath, brain substance. For the first time, attention was drawn to the concussion of the brain, its edema, intracranial hemorrhages. Only at the beginning of the XVIII century Boville, and then J. Pet was proposed to divide the CMT into three main forms - "comotio,contusio,cOMPRESIO.cerebri. " This classification has withstood a three-year test and underlies all modern classifications CMT. Only the introduction of new non-invasive methods of brain visualization (CT, MRI) clarified a number of provisions, putting forward the character of brain tissue defeat.

Considering any classification of the body injury, the mechanism of injury, type, type and nature of damage, the severity and phase of traumatic disease, periods and outcomes are distinguished. Accounting of these moments is especially important for CMT, because They often make it possible to identify tactical buildings and therapeutic activities.

According to the mechanism of the traumatic impact, he is divided into shock-shock, acceleration-deceleration and mixed. According to features external influence Highlight a group of action to a limited section of the head (stone, stick, ax, nail, etc.), head compression (obstetric tongs, collaps, etc.), headbands about fixed items (drop from height, accident and t .d.). Special group Make up firearms and explosive damage to the skull and brain.

By type of traumatic effects, isolated CHMT is distinguished, combined (the damaging effect of mechanical power except the head to other systems and human organs) and the combined (the impact of mechanical and other types of energy - thermal, radiation, chemical, etc.).

According to the nature of the CMT, divided into closed and open. Closed CMT includes brain damage without or damaged skin Pokrov Heads, but without damage to the aponeurosis with fractures or without fractures of the skull bones, but with the obligatory lack of a message of intracranial space with an external environment. Open TBMT includes observations where there are damage to the aponeurosis or the message external environment with the cavity of the skull. In the open CMT, it is distinguished by impenetrable (without damage to the solid cerebral shell) and penetrating (with its damage) injury.

In terms of brain tissue damage distinguishes diffuse (brain shaking, diffuse axon damage), focal (bruises, scramble, hemorrhage, compression) and combined damage.

The clinical forms of CMT are based on the form, gravity and morphological substrate of brain damage. Allocate the following clinical forms CMT: concussion of the brain, brain bruises of varying degrees of severity (light, medium, heavy), squeezing of the brain (hematomas, rented fractures, intense pneumpetiam, etc.), diffuse axonal brain damage and head squeezing.

In terms of gravity, the CMT is conditionally divided into a light (concussion of the brain, the brain bruises of an easy degree), the middle (ears of the brain of the average severity) and the heavy (injuries of the brain of severe, sharp brain compresses, diffuse axonal damage and head squeezing).

During the CHMT, three periods are distinguished: acute (up to two weeks), intermediate (up to 6 months) and remote (later time).

According to CMT outcomes, it is necessary to distinguish: good restoration of functions (recovery), moderate disability, coarse disabilities, vegetative status and death. Exodes are directly related to the severity of CMT, its period and measures carried out at various stages of treatment.

All these principal provisions of the CMS classification are basic and reflect modern views on traumatic brain injuries. However, the age of victims, the premorbid background and other combinations of factors make it possible to use such a CMT classification with some reservations.

Clinical classification of CMT in children

Anatomy-physiological features and the originality of the reactions of the child's growing body at the THED justify some changes in the traditional classification of CMT. Differences are available not only in comparison with adults, but also inside the children's age group They are so striking that they often spend comparison of newborns and adolescents as boys and long-livers. Features of clinical manifestations and currents of CHMT in children are largely due to the huge compensatory capabilities of the emerging nervous structures, readiness of intracranial content to sharp fluctuations in liquor pressure and, at the same time, increased vulnerability and hydrophilicity of the cerebral tissue of the child.

Summarizing a huge material on the CHF in children in the literature, and the experience of one's own work we offer the following clinical classification of CHMT in children, comparing it with the severity of patients's condition:

I. Card-brain easy Easy Severity:

1. Shaking brain.

II. Card and brain injury to medium severity:

1. Ears of the brain of the mild-moderate severity, combined with the fractures of the bones of the skull or without them.

III. Heavy severity crank and brain injury:

1. Ears of the brain of severe severity.

2. Brain compression:

a) intracranial hematomas (subprove-epidural, epidural, subdural, intracerebral, intraventricular, multiple);

b) the depressed fractures of the bones of the skull;

C) "growing" fractures of bones of the skull;

D) hydromes;

E) "tense" pneumpetiam.

3. Diffuse axonal brain damage.

4. Long squeezing of the head.

The main difference of the proposed classification is the transfer easy bruises severity in a group of CHHT Middle degree gravity and allocation in the ChMT group of severe severity of such forms as "subprove-epidural hematomas" and "growing" fractures of bones of the skull, which are found only in childhood.

The transfer of bruises of lightweight gravity from the Light CMT group is due to the fact that, in contrast to adults, it is almost impossible to carry clinical differential diagnosis of the brain and ears of gravity. The criteria for the duration of the loss of consciousness and the depth of disturbances after injury in children, especially younger age, are not adequate, because They do not only have an easy TMT, but also a high-depth severity, and sometimes even severe CMT can leak without losing consciousness or this fact cannot be fixed. Often, only the detection of fractures of the bones of the skull and the data of the CT allow you to be bowed to the brain's injury diagnosis. Only the severity of changes in the stem caused potentials can often be distinguished to the concussion of the brain and the brain injury is lightweight. Perhaps this is the inclusion in the lightweight brain bruises of light gravity explains such a high frequency in children of remote consequences of Lightweight gravity, which makes up 60-80% of observations. Almost the same motives are grounds for combining bruises of light and moderate severity in one group.

Only in childhood there are substate-e-epidural hematomas, caused by migration of bone fragments, an increase in intracranial pressure and blood passage to epidural and substandoremny space. Only children detect "growing" fractures of the bones of the skull, arising from fractures with a gap of solid and spider cerebral cerebral shells, the flow of liquor in the subprove space, the "sliding" of the skull bones, followed by the formation of extra-intracranial cysts and even brain hernia.

A significant moment in the diagnosis, determination of the ingrediency and tactics of therapeutic measures at the CMT is an assessment severity of statevictim. It is determined mainly by the severity of CMT, but does not always coincide with it, especially in children. The severity of the state is a more dynamic concept and is largely correlated with the outcomes of the treatment of victims. The need for a single approach to the assessment of the results of treatment, depending on the severity of injury and severity of the victim, led to the emergence of various quantitative and qualitative estimates of the severity of the state.