My fourteen year old son fell down the stairs New Years Eve just before 1:00 a.m. on the 1st. I was in bed and I heard a lot of thumping on the stairs. I figured he was just running up and down while getting ready for bed. I sent my daughter to investigate. She came back in a bit worried, and told me she thought he had fallen down the stairs as he was laying at the bottom not moving.

They are steep stairs and not the widest. They are also just bare wood stairs. No carpeting.

Anyway, I sat with him on the floor for an hour while he sorted himself out. We got an ice pack for his forehead, propped him up with a pillow after I ruled out a spinal injury, and I just kept talking to him and feeling different bones and joints to make sure he hadn't broken anything.

He finally sat up and managed to get upstairs into my bed. I set my alarm to go off hourly and I kept waking him to ensure he hadn't gone into a coma or anything.

We took him to the walk-in clinic the next day (word to the wise, if your kid falls down the stairs and takes a long time to get up, just go to the nearest children's hospital...at least you'll be seen quickly and have X-rays done immediately) and it was determined based on his symptoms (bump on the head, unconsciousness, amnesia, headache, vomiting) that he had suffered a concussion. We were advised to come back the next day for X-rays as the radiology at the walk-in was closed as it was New Years Day.

So another trip on Monday was made. No dice. Radiology was closed. We called the hospital. Nope. They were closed as well (again, just go to the hospital to be seen...they will do X-rays on in-patients). So Tuesday he went in. No broken head.

We were advised no physical activity until 48 hours after headache disappears.

No dice.

Kid has been suffering with headaches since it happened and has only been given extra strength ibuprofen to help.

We went back to see our primary care physician yesterday and she advised at least another two weeks from physical activity but gave us the go ahead for starting the concussion protocol with the school.

She did advise if headaches aren't better in two weeks to come back.

We are going to meet with the school counsellor tomorrow to get an idea of how this concussion protocol will work. He's slept the past two days away because the headaches were so bad he didn't want to be awake.

This is also his second concussion. The first was about 2.5 years ago. Our doctor said it will take longer for this one to heal because of the history of the first. Both were blackout/amnesia ones.

So...I don't really have any questions...advice would be good, what I can expect, when to push him, when not to, that kind of thing.

He swims competitively, and he's been out of the pool now for three weeks (Xmas holidays included). He's been scratched from his next competition. I'm wondering when to pull the plug on the season so at least I'm not spending my money for no reason.

Thanks for listening.




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swim4life,

Welcome to NeuroTalk. Sorry to hear about your son's fall. My first concussion that I remember was falling down wood stairs in 1963. I did not get knocked out. That happened a year later in a serious bike accident. I was 10 years old.

My suggestion is you get him to a concussion specialist. His primary car doc sounds like a "I took an online concussion CME course." I get annoyed at any set time lines. With his LOC and amount of time getting his wits back, I think he needs to be assessed and followed by a specialist. If you have a neuro rehab hospital, they may have a more experienced doctor. A physiatrist can often be worthwhile (Physical Medicine and Rehabilitation doctor). If you have a children hospital, they would likely have a concussion specialist.

At 10 days post injury, he should be up and about enough to cause good blood flow to his brain. Rest is only advise for the first 2 days. He should not be sleeping all day especially if his sleep is sporadic and with poor head and neck posture. Walks, even some non-stress swimming if he tolerates it without increasing his headaches. Like a warm down swim. I swim 45 minutes of head up breast stroke.

Freestyle with the head turning might not be good until his neck is stable and his headaches are gone.

He may and likely did suffer a subtle neck injury. They can be the cause of headaches. If he is sore to the touch behind his ears at the bony part, that is a good sign of muscles spasms radiating from his upper neck. Neck injuries are part of 80% of concussions.

A gentle physical therapist can do some gentle traction and mobilization. No range of motion until his headaches are gone. A gentle chiropractor may be able to help but finding a gentle chiro is a challenge. No twist the head and pop the neck chiro adjustments. They are too aggressive. An upper cervical chiro may be helpful. Read the Vitamins sticky for information about upper cervical chiros.

btw, If someone in your charge suffers a LOC concussion with the other symptoms, be safe and call an ambulance, especially for this son. If your insurance does not provide good ambulance coverage, in many areas you can insure the whole family for ambulance for a reasonable fee.

It is far safer for him to be observed in an ER for 8 hours that at home.

Did he just have an X-Ray or was it a CT Scan ? Did they do a full neuro work-up ? Most concussion bleeds do not show up for 48 to 72 hours. Only a CT Scan will show them.

He should be taking the ibuprofen 3 times a day to keep the anti-inflammatory effect working. If he needs more pain relief, ask his doctor if there is any reason he cannot take Tylenol/acetaminophen and aspirin at max dose instead. The combined effect will be much better than ibuprofen. My doctor told me to combine them. btw, This is what is in Excedrin but Excedrin adds caffeine. He should not have any caffeine so Excedrin should not be taken.

Acetaminophen is fine as long as he does not take it continuously for more than a few weeks without his doctor's approval. Aspirin can be taken in the enteric form so it is easier on the stomach. Not buffered, enteric.

When I have strong head aches, that is what I take. Better than acetaminophen and codeine and no drowsy feeling.

Find somethings for him to do with his hands that do not strain him. No video games. Solitaire with real cards. Puzzles. Anything where the main focus is around using his hands. Coloring, drawing, painting. The hands cannot do anything faster than a concussed brain can tolerate as long as it is not video games. Even learning to knit or crochet. Many athletes knit and crochet to focus away from competitive stress. The mild mental stimulation are good and can get his mind off his headaches and other frustrations.

Try to keep the house sounds to a minimum. Sound can be a stressor.

I'm interested to hear what the school concussion protocol is.

My best to you both.

Thank you. I appreciate your response. We live in Canada...we will need to be referred to a concussion clinic - doctor said if the headaches still persist after two weeks (because this is a second one) she will re-assess and we will be referred. Unless headaches get worse, in that case we go back immediately.

He had an orthodontist appointment at 9:10 today, and then a meeting with the school guidance counsellor at 10:15 which we just returned from.

He's now back in bed...it was a lot of cognitive activity for him.

She wanted to see if he could tolerate 45 minutes of science class, but he was exhausted so we brought him home.

He will go to science tomorrow, but likely that will be the only class he attends. We will probably stagger his re-entry to school, one subject a day. It will be difficult with working full-time, but my work is good about family commitments. They stress that the kids always come first.

My husband and I were talking about a chiropractor today on our way back from the school. I didn't know there were different types. I'll bring that up with the doctor as well.

Our primary care physician is not necessarily bad, she's just not as pro-active toward some things unless it's a repeat visit, or it's clear from the get go what needs to be done. Her thoughts are just to see if this will resolve first on its own before getting us to go down the path of specialists. She is very good at referring though when the time is right.

The original doctor we saw at the walk-in did some initial cognitive testing on him in the office. The X-ray he sent him for was just that - an X-ray. No CT or anything else just yet.

So...for now...he's back in bed because he's exhausted.

We will just try and take this one day at a time.

I will definitely speak to the doctor about things you've mentioned though when we return.


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What part of Canada do you live in ? There are some good clinics in Ontario and some other areas.
I doubt the doctor will agree at all about a chiro. Most doctors are very anti-chiro.

If he is exhausted so easily, he is likely not getting good sleep. He needs quality sleep to heal. Quantity sleep can actually limit quality sleep. I got my best sleep in a recliner with a nice blanket. The recliner helped me keep my head in a good posture. I would get deep sleep and wake up alert. I would do a light activity then nap for a short while then repeat with a light activity.

He needs to get good REM and slow wave sleep. That is where healing happens. Without it, he will feel groggy all day. The brain can only flush toxins during slow wave sleep. It only heals neurons during REM sleep.

As I said, he also needs to stimulate blood flow to the brain without increasing his headache.

With his level of symptoms, I don't think school should even be an issue. The sights and sounds of school are likely far more than he can handle. Maybe the school can send home some light work so he feels like he is moving forward.

He should be free of headaches and not have any foggy brain feeling before he returns to school. He should be able to tolerate TV and doing a school assignment at home before he returns.

Since Sidney Crosby and a few others, Canada has developed a bunch of competing protocols for concussions. The guidelines put out by ParachuteCanada are weak about how to handle your son's current stage. They miss the importance of stimulating brain blood flow with low stress activities and think quantity sleep is appropriate even if it is not quality.
US research shows these to be most important.

One of the issues is that bed sleep during the day disrupts his normal sleep cycle. Quality sleep happens best during his normal sleep cycle at night. A few short naps during the day are OK if they are not restless toss and turn naps.

If you have a hour available, sit and observe him sleep, paying attention to his breathing. His breathing should be regular, not shallow then gasping for air then shallow. Ask him about his dreams when he awakes. If he has any stressful dreams or night mares, take note and tell the doctor. They are often a sign of poor blood flow to the brain or poor oxygen.

A Fit Bit can track his sleep a bit. It will show how much he stirs.

I hope he starts feeling better soon. I know his frustration.

My best to you both.

I would wait before I let a chiro work on him.

Bud

McMaster concussion clinic won't see him unless he has had a month of symptoms.

It's all wait and see at this point only being 11 days post concussion.

My brother told me I should get blood work done for him to rule out a brain bleed before getting a CT.


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Blood work will not rule out a brain bleed. At this point, unless his symptoms increase to include a severe headache and/or loss of motor control and/or slurred speech, a CT Scan looking for a brain bleed is not indicated.

The more important issue is an assessment to help keep track of his improvement so you know how to reintegrate him into school. Pushing him into activities and school can slow his recovery. But, as I've said, he does need mild stimulation to encourage good brain blood flow. I was hoping a concussion clinic would also encourage mild stimulation and give you a secure sense of his condition. The 'close is good enough' primary physician attitude can leave parents feeling at a loss.

I read the McMaster protocol. Odd that it does not mention a month wait. They may be very busy, especially during hockey season. You might want to keep a journal tracking his struggles after any activities. It will be helpful. Don't feel a need to track everything. Just, day to day, good day, bad day, what activities on what days. More than that would be counter-productive.

My best to you both.

I ended up taking him to Mac because he had an atypical headache. Emerg dr there alleviated any worries I had.

He will return to school today full-time, but with the knowledge that he can take it as slow as he needs. He will meet with guidance this morning to discuss what he needs to get back to class. He will then attend 3/4 classes (no phys-ed).

He's been instructed by the dr in emerge if his headache is bad in class or starts to feel nauseous to go take a walk outside. If it's still continuing, find a quiet dark room and take a break there. But keep at it. No more napping.

We took him off Advil on Saturday to give him a rest and it worked fine, but Sunday he went back on as the headache got bad again.

It will just be a long road to hoe right now.

It's all good.


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Good to hear his headaches are giving him a break. I agree with the no napping but he should not be pushing through the headaches. Has he tried any gentle swimming or other mild effort exercise ? The Buffalo Protocol rule is to do activities that stay below the headache or other symptom threshold but not to be seriously cognitively active with a headache or other symptom. He may benefit from wearing foam ear plugs at school to lower the cognitive load. Sitting at the front of the class would also be best.

My best to you both.

If he can start swimming maybe have him build up slowly.

I still have headache problems as well as others when I get up into the aerobic range for extended periods but I am older and had a pretty severe accident impact.

Anyways, my point is that if he experiences symptoms swimming don't be locked into the idea that it is the swimming causing the difficulties...it could be the level of exertion.

Experiment when he is ready.

Bud