From the Guidelines
After a child experiences a head injury, it is crucial to monitor them closely for the next 24-48 hours, watching for concerning symptoms and providing guidance on rest, pain management, and follow-up care, as recommended by the Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children 1. The child's parents should be informed about the potential for postconcussive symptoms, which can include headache, sleep disturbances, dizziness, nausea, fatigue, and emotional changes, and advised to seek immediate medical attention if any concerning symptoms develop 1. Some key points to include in the discharge instructions are:
- Monitoring the child closely for 24-48 hours for signs of severe headache, repeated vomiting, unusual drowsiness, difficulty waking, confusion, slurred speech, seizures, weakness in limbs, or clear fluid from the nose or ears
- Allowing the child to rest, but not necessarily keeping them awake if they're tired, and waking them every 2-3 hours during the first night to check responsiveness
- Limiting screen time and physical activities for 24-48 hours, then gradually returning to normal activities as symptoms improve
- Ensuring adequate hydration and nutrition
- Providing pain management with acetaminophen (Tylenol) at age-appropriate doses, typically 10-15 mg/kg every 4-6 hours, while avoiding ibuprofen or aspirin initially due to the risk of increased bleeding
- Returning to the emergency department immediately if any concerning symptoms develop, as children's developing brains are particularly vulnerable to injury, and symptoms of serious complications may appear hours after the initial injury 1.
From the Research
Discharge Instructions for a Child with a Head Injury
The following discharge instructions should be provided to the parents of a 1 year 7-month-old child who had a witnessed fall down the stairs and was observed for 4 hours in the emergency department with no abnormalities:
- Monitor the child for any signs of Reye's syndrome, such as unexpected vomiting and disturbed brain functioning following a viral illness, as aspirin use has been linked to this condition 2, 3.
- Ensure the parents understand the importance of not giving the child aspirin for pain or fever reduction, and instead use alternative medications such as acetaminophen 2, 3.
- Provide the parents with clear instructions on how to care for the child at home, including any necessary follow-up appointments and return precautions 4, 5.
- Assess the parents' understanding of the discharge instructions and ensure they are able to confidently provide safe care to the child at home 6, 4, 5.
- Consider the parents' health literacy and language proficiency when providing discharge instructions, and provide additional support or resources as needed 4.
- Emphasize the importance of monitoring the child for any signs of complications or worsening condition, and provide guidance on when to seek immediate medical attention 5.