19 month old blacked out after banging her head. Advice PLEASE!

[HoneyNutLoop]

Please help!
My 19 month old daughter banged her head this evening, just your typical childhood injury, running around with her big bro, legs went too fast, bang on the floor...
I didn't see exactly what happened but she had a red mark on her left temple so there was obviously a head injury, after the injury I picked her up from the floor and comforted her, she was crying a little, then she went floppy, her eyes glazed and went upwards a bit, her breathing slowed or stopped, then after a few seconds she started crying again...she was pale and clammy, and not quite herself for about 10 mins or so (I'm guessing, felt like forever)...
I took her to A&E and was dismissed with the usual head injury stuff by a harrassed and busy house officer, who told me to take her to GP tomorrow to get referral to consultant for further invetigations...in his defence she was fine by this point, running around, playing, good colour.
This is not the first time this has happened, it's the 3rd. The first she was very small, she was crying alot, stopped went floppy, then cried somemore, I wasnt sure if anything had happed, and MIL who was dr who was there said probably from crying. The second was with my husband, again, crying alot, few seconds, he said she winded herself and was just holding her breath with the crying, FIL - surgeon said fine, normal...
This time it was more defined, she was more in control, not screaming, the floppyness came before the eyes and breathing...
I'm worried sick, feel fobbed off by A&E, and was hoping that there may be a insomniac neurologist or someone with similar experience in their kid's (not that I'm wishing this on anyone else - but you know what I mean!), or a mum in the know, who may be able to offer constructive advice...

It does rather sound like it needs further investigation - take her to the GP as suggested, tell the GP about the previous times (leaving out the bits about "knowledgeable" GPs - you know the old saying about "doctors' wives die young, don't you?) and say that you want her checked over properly, pref with a referral to a paed or a neurologist because you want to know WHY she is passing out at this age!

Thanks thumbwitch, yes Dr's wives do die young LOL, and said Dr's sons are deaf in one ear for a couple of years without diagnosis! Why did I listen...I don't know? I just can't make the hours go fast enough right now, I'm worried sick!
It doesn't help that I am more than a bit synical about A&E dept we went to tonight (have avoided it thus far with dc's but had no choice tonight), my mum was admitted with an aneurism 15 years ago to the same hospital, they left her for nearly 12 hours without CT or transfer, by the time they got their act together and transferred her for CT (cos their Unit was then closed) it was too late. You can see where my panic is taking me here...
Having read NICE guidelines for seizure following head trauma it indicates need for CT referral on admission...may have misread in my current state, but well I'm panicing

My understanding, and this is not medical advice just based on the fact that my daughter had a really bad head injury at four months (bilateral skull fracture, thankfully no brain bleed) is that the immediate paling and floppiness indicates that your daughter's gone into shock, and is a standard response for a head injury.

The fact that it only lasted ten minutes and then she regained her colour and became alert is a really good sign, though. I'm not too surprised that A&E didn't admit her. When my daughter had her serious injury, she stayed pale and floppy and unresponsive for a much longer time, and she also vomited a lot and repeatedly (again, standard head injury response) - I mean, it was very very obvious that something was wrong.

Your daughter's not vomiting and not having seizures, by your description above, so I don't think there's immediate danger.

I think the thing to do is to stay with her tonight so that if she does have another reaction you're right there to know about it, and take her into the GP in the morning. What you want to ask the GP about, IMO, is why such a minor standard fall is causing a shock/head injury reaction? I have no idea what the answer could be, but I'd push for an MRI or a CT scan to investigate further, because it's odd that she's having shock reactions like that.

Good luck.

Is there some other hospital you can take her to?

I am going to tell you this story, NOT because I think the actual diagnosis is relevant to you, but because it demonstrates how you need to keep pushing.
My niece started to have a few problems in Nov 2006, aged about 18m. She was sick (vomiting), she was a bit wobbly on her feet, there was something wrong. My sis took her to the GP - was told it was teething. It carried on - she went to the hospital and was admitted overnight - was told it could be tonsilitis. Discharged, nothing got better but it wasn't all the time. Random floppy listlessness (but not actual passing out) and vomiting and general unwellness. I saw her on Christmas Day - by then she couldn't walk, she was too shaky on her feet, she couldn't put her feet flat on the ground. I said then that there was definitely something neurological and it needed to be seen to asap - and DN confirmed this to me by having a fit after doing "row your boat" on my sis's lap. Apparently the docs had told my sis that "oh it was just febrile convulsions, if she's even having the fit, you should video it to show us as we don't really believe you" (paraphrasing). However, they hadn't pointed out that to have febrile convulsions, you need to have fever!!

So - sis takes DN to the GP again - this time the suggestion is ear infection and antibiotics (ridiculous as middle ear infection would HURT and inner ear infections are usually viral). Finally in the second week of Jan, a nurse friend of my MUm's saw DN and convinced my sis to take her to University COllege Hospital walk-in Paediatric A&E.
They went and the staff there did a scan (CT or MRI, can't remember which) and they found a tumour the size of a walnut on her cerebellum, which was blocking one of the ventricles and causing immense pressure in her brain. She went to KCH (no room at UCH or GOSH) where they put a shunt in on the Saturday (apparently the fluid jetted clear across the room) and removed the tumour on the Monday. DN is fine now but is checked every year.

The neuro consultant told us that he knew of another neuro surgeon whose own son had a brain tumour that went undiagnosed for ages because he thought his son's morning headaches were school avoidance tactics, instead of recognising one of the classical symptoms.

So - my point? Something isn't quite right with your DD - the GP and the local A&E may be ill-equipped to deal with it - push for a specialist referral to eliminate possible causes. And don't be fobbed off by grandparents - even if they were neurosurgeons, they could still miss things!

I hope it turns out to be nothing but even if it is something, the best thing is to know and then it can be dealt with. Best of luck and I'll keep everything crossed for you.

Totally agree with Thumbwitch, in my experience Mums DO know best, if you sense there's a problem then follow your instinct... I hope it is nothing but best to know that you responded to your inner voice anyway, even if you're wrong

Me too, try to keep calm. You are going to need to push tomorrow to get some proper answers, but you will. You are a very good mum. Everything crossed for you and your dd.

Thank you thumbwitch, and thank God your DN is ok...How the hell can a doctor suggest febrile convulsions when a child has no fever? ...as for the tonsilitis diagnosis?!?!?! I AM going to push this...I do have concerns that this is something neurological, once - ok, twice - maybe, three times? and as tortoise pointed out, these are not significant head injuries, just your usual rough and tumble bumps, in fact the first incident was so insignificant I can't even remember what actually happened to trigger it, as I said, I wasn't even sure that it happened! I know that I will now not be 'happy' until a head CT is done.
Tortoise, thank you for your advice, I hope that your dd is now doing well...what happened to my dd was actually described by the Dr as a seizure, in the fact that she lost neurological control to some degree...the sudden limpness, eyes rolling, and in my mind stopping breathing - though breathing can slow during a 'seizure' and be hard to see - quite possible, I was a panicing mum at that point - are all possibly related to neurological disturbance. I hope to God that you are right though and it was shock.

HoneyNutLoop -

Two of my children have something called reflex anoxic seizures, exactly like you describe, a smallish bump, floppy, tries to cry, stops breathing, starts fitting. Then is usually very tired for a few hours later.

both of my children who have had this have had ECGs and EEGs but nothing have ever been found. DS is now 20 months has has small RAS about every month or so. It's scary, but not dangerous is itself.

I usually put my child into the recovery position when this happens, and make sure they are safe.

This is a website, if you google it, called STARS I think.

and just to give you an idea, dd1 had her first one at age 10 months and last one at age four. One time she had one when I wiped her nose; other times it was falling over.

DS had his first one at 11 months, and is now 20 months and has had a few, too many for me to keep count of.

I also have a dd2 who has never had a RAS but has had a febrile convulsion, with a very high temperature. It was very similar to the RAS but caused by the temperature rather then a bump.

thanks too, to wabbit, and KickArseQueen...mumsnet server went down on me last night in the midst of posting the last msg, so only just got your posts now...was probably a good thing as forced me to bed...
Anyway, dd is up this morning, a bit quiet and sleepy probably due to last nights excitement, i'm hoping she'll perk up in a bit...have already called the GP and am currently waiting for the nurse to call back, after already being told it'll probably wait til later - read next week or the week after for a routine appt...wish me luck...

i would second reflex anoxic seizures.

Thanks belgo, will google...

DD2 used to do the hideous breath-holding thing after a bump - she would do a big cry, then hold her breath so that her head would loll back, eyes rolling, then she'd take a big gulp of breath and start crying again. Afterwards she'd be all pale and clammy.

It happened 3 or 4 times between the ages of 1 and about 2.5, and now (touch wood!) she doesn't seem to do it any more. I found that it also seemed to help if I was very matter of fact about it when she had a bump, and didn't give in to my inner urge to panic (easier said than done!).

Hope you get some answers soon.

well we have an appt for 9.15 monday...it's gonna be a long weekend!

Thanks Bramshott, touch wood it doesn't happen again to your dd, and mine! I generally am quite matter of fact about bumps and scrapes...I shall TRY and keep it up, but with this I don't quite know how you did it!

Just a bump in case anymore of you could offer advice, ta.

Agree - reflex anoxic seizures (my dd does it too)

If it does happen again, is there another hospital you can take her to? I would plan for this, as having a plan always keeps me calmer. But it probably won't this weekend.

Reflex anoxic seizures sounds most likely to me too.

Hi,
My daughter does this - at least it sounds very similar. Just to reassure you she has been checked numerous times by paediatricians and consultant neurologists at the Children's Hospital and it has been regarded as breath holding - something she needs no treatment for and will hopefully outgrow.

Did your dd cry differently from normal? My dd has a specific cry which I now know means she's going to pass out. It often involves what I can only describe as a silent scream. It seems that she pushes all her air out and doesn't take that big breath that she needs. Sometimes I can stop her from doing it if I blow hard onto her mouth to make her take air in.

Does she stay fainted for long? My dd started being "out" for couple of seconds and as she's got older it's got up to about 20/25 secs. She's now nearly 3. The doctors seem to be less concerned if it is for a short time and they recover themselves fairly quickly afterwards and are not tired straight away.

Is there always an obvious trigger? With my dd it used to happen when she got very angry and frustrated. SHe did it once in a shoe shop, as she hates trying on shoes, and terrified the shop assistant! Now it is more likely to be if she hurts herself. The hospital ruled out epilepsy, or anything more sinister, as they say that it would happen randomly, not as a result of something specific.

I hope you get good news from the doctors.

I had to do the same - thesecondcoming - not pander to it when she did it as it was becoming a "learned response". I ignored the fact that it had happened when she came round and just carried on as normal. I'm sure people thought I was mad!

When she started pre-school I had to stay for loads of sessions so she was completely settled in as they didn't want her to get angry/upset, then breathhold and then cause me to come running back to rescue her as she would have started doing it repeatedly.

The only problem is that if she starts breath holding someone has to pick her up quickly as otherwise she just falls backwards like a felled tree and bangs her head hard.

She didn't do it from Christmas up until May this year - but since May she has done it maybe 8 times. It seems to go in phases - almost as if she's remembered how to do it!

Can I ask how old your dd is now TSC - and do you think she's outgrown it?

Agree with RA seizures

Oh my goodness...so many little mummy terrifying monsters out there, and one thing seems to be a pattern...mostly girls! Is RAS more common in girls?
Runoutofideas...I know what you mean by 'the silent scream' dd does this...but strangly enough it doesn't normally end in unconciousness! She does this when she has been particularly fustrated by a situation but then just keeps on screaming.
The blackouts seem to be associated with a fall, and not what I would class as a significant fall; she is by nature a clumsy child, this is something I had previously put down to her age and having a big brother that she tries to imitate, but I am now, obviously, watching it more closely...she's the baby who always comes home from nursery with an accident form, and goes in with explanations from me about the various bumps and bruises she's got! She's really banged herself on occaision and is fine with it. The 'blackouts' don't seem to be pain related, obviously I can't guage her pain accurately, but I am thinking what would hurt me....maybe more shock related, as they seem to follow a fall when she is really running. The previous 2, she had been really screaming, this time not so much...the blackout was much more defined though, I hope you are all right and it is RAS, it certainly seems like a possibility. They follow the silent falls if that makes sense, the ones where they take stock for a moment and then cry...
I will, if it happens again take her to another hospital...
fingers crossed it wont.
Thanks for all your responses, you've reassured me alot!