By Cynthia Bennett, MSN, CNP, ATC
Engagement Insider

Severe and  worsening symptoms that should be evaluated in the  Emergency Department:  Severe headache, repeated vomiting, severe drowsiness,  inability to awaken, severe confusion or disorientation that is worsening, or lasts longer than 24 hours, slurred speech or other changes in speech, vision or eye disturbances, changes in breathing pattern, severe dizziness, blood or fluid discharge of nose or ears, loss of consciousness, seizures, severe behavioral changes, severe irritability or inconsolability, severe neck pain, weakness in arms or legs.

The more common symptoms that are expected to occur either immediately or within 1 – 7 days after a concussion will require a physician office follow up visit.  These symptoms include headaches, nausea, drowsiness, sleeping more than usual, problems remembering, feeling slowed down, feeling mentally foggy, trouble concentrating, irritability, balance problems and dizziness.  These symptoms should lessen each day with rest, hydration and good nutrition.  As the drowsiness begins to resolve, sensitivity to light, noise, nervousness, sleeping difficulties, emotionality, irritability, or sadness may become more noticeable.   

Six Steps for optimal healing:

Get as much mental and physical rest as possible in the first week.   Sleep is essential, allow for a dark and quiet environment, making sure they are awake in the daytime enough to eat and drink every 3 – 4 hours.  In the first 24 hours check on them regularly to assure that they awaken and are in no distress.

Good quality sleep is a key element to healing a concussion.  Create the perfect space for sleep, your bed and bedroom should be dark and quiet and comfortable for sleeping.  A cooler room with enough blankets to stay warm is best.  Use curtains or an eye mask to block out early morning light and earplugs if there is noise outside your room.  Leave all cell phones, computers, TVs, and anything with lights turned off or out of the room.  Avoid caffeine (in coffee, tea, cola drinks, chocolate, and some medications), nicotine (cigarettes), energy drinks or herbal products. These substances act as stimulants and interfere with the ability to fall asleep.

*Avoid activities that compete for the energy the brain needs to heal including athletics, texting, talking on the phone, watching TV, using the computer, excessive reading or excessive homework.  If the child/teen is able to attend school without worsening of symptoms, they should rest after school and take frequent rest breaks when doing homework.  Teenagers should not drive unless they are totally symptom free and cleared by a doctor.

*Drink plenty of fluids to avoid dehydration.  To aid in healing, drink fluids to avoid dehydration.   Dehydration will worsen the concussion symptoms.   Avoid artificial sweeteners, caffeine, and energy drinks.

Drink water as well as other liquids, avoid high sugar content beverages.  Fluid needs vary depending on age, for 4 – 8 years, 1 – 1 ½ Liters, 9-13 years, 2 Liters, 14 – 18 years, 2 ½ Liters for girls and 3 Liters for boys.  Dehydration occurs when the amount of fluids that a person is drinking is less than the amount of fluids lost through sweating, urination, diarrhea, or vomiting.  Dehydration is very common when you have a concussion due to nausea and drowsiness that prevent drinking.  It is important to awaken them to take sufficient food and fluids throughout the day.  Avoid caffeine, artificial sweeteners, and energy drinks since they cause further dehydration and headaches.

*Headaches may also be reduced by using ibuprofen, Aleve, or Tylenol.  Adhere to over-the-counter dosing, and avoid giving regularly for more than 3 days/week.  Use Tylenol in the first 24 – 48 hours.

*Make sure that your child/teen stays well nourished, eating at least 3 meals a day and 2 snacks, combining protein and carbohydrates with each meal.  Good nutrition with high protein intake will speed healing.  Low blood sugar will slow healing and worsen fatigue and headache. 

Concussions cause an intense need for energy that is used to heal injured brain tissue.  Eating a healthy, well balanced diet of whole grains, proteins, fruits and vegetables will provide the necessary energy and essential nutrients.  Junk foods and processed foods do not provide as many nutrients and may increase symptoms due to chemical additives.

While maintaining a healthy diet is important for healing, your child/teen may feel nauseous for a few days after the injury. Have them eat small meals that won't upset their stomach, such as oatmeal and whole grain wheat toast. Encourage them to chew their food thoroughly to help with digestion. If they have a headache and can't chew easily, puree food or try softer sources of fruits and vegetables such as applesauce and fruit cocktail. Scrambled eggs are an effective source of protein and are easy to chew. You may need to fortify them with fluids in the early stages of healing using high protein shakes or other nutrient-rich drinks for nourishment.

*Avoid junk food and processed foods with chemical additives like MSG, nitrates (in foods like hotdogs, bacon, and sausage) and artificial sweeteners,  since these may worsen headaches.

Source: Akron Children’s Neurodevelopmental Science Center