For years athletes and non-athletes were told to “just tough it out” following a head injury. We now know this was a mistake. A blow to the head can cause a concussion, which is a serious condition that requires medical attention and time to recover. As a parent, it’s important that you know the signs and symptoms so you can be prepared if your child suffers a concussion.
What Is a Concussion?
Unfortunately, there isn’t one simple definition. Any changes in a person after a head injury should be considered a concussion.
Common symptoms of a concussion include:
- Ongoing headache
- Increased emotional lability (mood swings)
- Visual changes
- Poor memory
- Inability to concentrate
A simple mechanism of injury liking hitting one’s head on a door, head contact with a dodge ball, or falling even a short distance can cause significant symptoms.
Although rare, it is important to know when a head injury requires immediate emergency care. Symptoms like unconsciousness, neck pain, confusion, repeated vomiting, or acting incoherent are just a few of the signs that warrant an immediate emergency room evaluation.
If an injury occurs during a game, the child should not return to the game until cleared by a medical professional. All the providers at Northside Pediatrics routinely manage concussions in the office. When needed, we refer to specialists, such as neurologists or concussion clinics.
Concussions by the Numbers
- There are currently 1-3 million concussions in the U.S. per year.
- Nine percent of all high school sports injuries are concussion or head injuries.
- Concussions are the number one high school football injury. They also represent one of the most common soccer and basketball injuries for female athletes.
- Loss of consciousness only occurs in 10% of concussions.
It is important to note that very few head injuries require a CT (or CAT scan), and as a parent you should not “pressure” the medical provider into having one done. We now know there is a significant radiation exposure with a CT. Some reasons for a CT include focal findings (having a problem on only one side of the body), being incoherent after the injury, and repeated vomiting. If there is an ongoing concern 48 hours after the injury, an MRI is often the preferred test.
What to Do After a Concussion
Please contact our office any time you have a concern after your child has had a head injury. We will take a complete history and perform a complete exam, including special neurologic maneuvers. Assuming the child has any of the symptoms mentioned above, like nausea, headache, or sluggishness, we will recommend complete rest (aka cognitive rest). This means no school, homework, video games, or television. Even normal lights and sounds can exacerbate the symptoms. Usually with complete rest, we will see marked improvement in one to three days.
Once all symptoms have resolved, your child can very slowly return to daily activities. This may include a short time reading, watching television, or a short walk near your home. If symptoms return, it means your child requires more rest. Once a patient can handle these light tasks, they may be ready to return to school. Often, they only need to go for half the day, as being around people and even being in a noisy cafeteria can make a concussion worse. We are happy to write a letter needed to excuse a child from school and give them extra time to make up tests or assignments. If these steps are followed initially, it is rare that a child will miss more than several days of school. However, when people push forward inappropriately, we have seen kids miss weeks of school.
When to Return to Play
As far as physical activity and sports, we expect resolution of all symptoms before starting a “return to activity” plan. Each sport may have its own set of requirements, but in general they follow the same plan. First we allow walking, then advancing to brisk walking and jogging over a few days. Next is non-contact, sport-specific activity like dribbling a soccer ball or shooting a basketball with no other teammates around that could possibly cause a collision. If children can pass this advancement test, then they can return to practice with time for rest as needed. Only after full practice is tolerated can they consider return to game participation. At the very least, one should expect NO game participation for at least five to six days after the initial injury.
There is evidence that a second injury can be much more serious if it occurs soon after the initial one. That’s why we use so much caution from the beginning!
Prevention of head injuries and concussions is difficult, but we can decrease the likelihood that they will occur. Proper techniques of tackling in football or heading in soccer can be helpful. Of course, proper helmets for sports like football, lacrosse, and hockey are mandatory. If your child suffers three concussions, they will be referred to a specialist to determine the need for prolonged cessation of an activity for months or even permanently.
There is no cookie-cutter approach to diagnosing or treating head injuries. Northside Pediatrics is here to help each family make the safest decision for the long-term health of their child.