Your child may lose consciousness after the brain injury. If it is a brief loss of consciousness, then it is called a concussion. If it lasts for several hours, days, weeks, or even months, it is a coma. A coma is a state of unresponsiveness when the person does not speak or follow commands and is unaware of surroundings.
However, a child in a coma may move or groan in response to touch or pain and may even move on her own. Parents sometimes see signs that their child is able to hear and understand. Often these signs are simple reflexes like squeezing a hand or sucking in response to a touch. The child may also seem calmed by the familiar voice of a parent. It is not known how much is heard, understood, or felt during a coma. Due to this uncertainty, it is a good idea to talk to your child and behave as though he could hear and understand what is being said.
Medical staff commonly describe a brain injury with the words mild, moderate, or severe. The length of coma is one factor used to determine the severity of an injury.
Mild brain injury — No loss of consciousness or very brief coma
Moderate brain injury — Coma lasts for up to 24 hours
Severe brain injury — Coma lasts more than 24 hours
No one knows how long a coma will last. Recovery can not be predicted precisely. Many families find this uncertainty frustrating, but the brain is very complicated. Much is still unknown about what happens after it is injured. Each brain injury is different and so is each child's recovery. Testing and observation help determine the degree of injury. The next two sections describe how professionals evaluate the alertness and responsiveness of a child who has had a brain injury.
This is a tool used to evaluate the level of consciousness. It is based on three measures:
Each measure has a numbered score. Total scores range from a high of 15 to a low of 3. The lower score indicates the more complicated brain injury. When the score is 13-15, the brain injury is considered mild; 9-12 indicates a moderate brain injury, and 8 or less reflects a severe brain injury. The Glasgow Coma Scale is used for all ages, although it is slightly different for infants and very young children. For more information, see the Glasgow Coma Scale.
Ask your child's doctor or nurse if the Glasgow Coma Scale has been used to evaluate your child. If the answer is yes, ask staff:
This is a more detailed scale that describes the behaviors and abilities of a person who gradually is coming out of a coma. It is often referred to as the Rancho Scale and includes 8 levels of response. These levels describe your child's awareness and ability to function as well as his response to light, sound, touch, and commands.
Children rarely progress in a straight line through the different levels of consciousness. It is common for some overlap, or back and forth between stages of coma. The time frame for coma recovery is also different for each child, because each brain injury is different.
The basic Rancho Scale is for patients age 14 years and older. Although this scale has been adapted for younger children, it is not as widely used with them. For more information, see the Rancho Los Amigos Scale.
Ask your child's doctor or nurse if the Rancho Scale has been used to evaluate your child. If the answer is yes, ask staff:
— I kept hearing the word "coma," but I didn't know what it really meant.