From the Guidelines
A seven-year-old with a concussion and continuous vomiting requires immediate emergency medical attention, as this can indicate increased intracranial pressure or more serious brain injury, and thus, the child should be taken to the emergency department right away. The Centers for Disease Control and Prevention (CDC) guideline on the diagnosis and management of mild traumatic brain injury among children, published in JAMA Pediatrics in 2018 1, emphasizes the importance of prompt medical evaluation in such cases. While waiting for medical help, it is crucial to keep the child calm and lying down with their head and shoulders slightly elevated. Monitoring for worsening symptoms such as increasing drowsiness, confusion, severe headache, seizures, or unequal pupil size is also essential, as these could necessitate calling 911.
The child's condition necessitates careful observation, and after medical evaluation, they may need observation for 24-48 hours, with limited screen time and physical activity. Recovery typically requires a gradual return to normal activities under medical guidance. Continuous vomiting is concerning because it can lead to dehydration and may signal complications like bleeding in or around the brain, which is why prompt medical assessment is essential. The healthcare provider will likely perform neurological examinations and possibly imaging studies to determine appropriate treatment, as outlined in the CDC guideline 1.
Key considerations in managing the child's condition include:
- Prompt emergency medical attention
- No medication before medical evaluation
- Monitoring for worsening symptoms
- Limited screen time and physical activity during observation
- Gradual return to normal activities under medical guidance
- Addressing potential complications such as dehydration and bleeding in or around the brain.
Given the potential for serious complications, it is critical to prioritize the child's safety and well-being, and thus, immediate emergency medical attention is the most appropriate course of action, as supported by the CDC guideline 1.
From the Research
Concussion with Continuous Vomiting in a Seven-Year-Old
- A concussion with continuous vomiting in a seven-year-old requires careful evaluation and management, as it can be a symptom of a more serious condition 2.
- The use of ondansetron for nausea and vomiting in children with concussions has been studied, and one study found that it was associated with a higher risk of persistent post-concussion symptoms at 1 month 3.
- Another study found that ondansetron use in children with head injury was associated with a higher likelihood of return visits within 72 hours and subsequent admission, but did not find significant differences in rates of missed skull fractures, intracranial injury, intensive care admission, or operative intervention 4.
- The diagnosis and management of acute concussion in children typically involves a comprehensive assessment and a gradual return to activity, with guidance from consensus guidelines 5.
- While ondansetron has been compared to other antiemetic medications in adults with nausea and vomiting, its use in children with concussions requires careful consideration of the potential risks and benefits 6.
Treatment Options
- Ondansetron may be considered for use in children with concussions and nausea/vomiting, but its use should be carefully evaluated and monitored 3, 4.
- Other treatment options for concussion and nausea/vomiting may include rest, hydration, and other antiemetic medications, with the goal of managing symptoms and promoting recovery 2, 5.
Important Considerations
- Children with concussions and continuous vomiting should be closely monitored for signs of worsening condition, such as increasing headache, confusion, or difficulty walking 2.
- The use of ondansetron or other medications should be carefully considered in the context of the individual child's condition and medical history 3, 4.