A concussion is a head injury that happens most often to children. Young children's head sizes are disproportionately large compared to the rest of their body. As children reach adolescence, they experience rapid height and weight growth. Both of these factors make children more prone to accidents than adults.
A concussion or closed head injury may be caused by a sudden fall, jolt or blow to the head. According to the National Dissemination Center for Children with Disabilities, concussions happen to one million children each year. More than 30,000 of these children incur long-term disabilities as a result of this brain injury.
New research regarding concussions
Although concussions previously were thought to be trivial brain injuries, recent scientific studies have demonstrated that even the most minor concussion can produce serious negative effects on an athlete's concentration, memory, reaction time and emotions, says Laurence Kleiner, MD, a pediatric neurosurgeon at The Children's Medical Center of Dayton.
Concussions are often the result of:
- Motor vehicle accidents
- Cycling
- Skates, skateboarding, scooters
- Sports: football, soccer, boxing or any contact sport
- Falling
- Violence
When a concussion happens to a child
An adult should stay with the child for the first 24 hours, monitoring changes in vision, headaches, nausea, vomiting, drowsiness, loss of memory or dizziness.
Brain tests (scans) can work to determine the severity of a concussion, but many times they do not show signs of concussions, so it is important to observe the child's behavior after an injury.
Do not give medications to the child without consulting a physician first (avoid aspirin as it may cause bleeding).
Watch for:
- Confusion or if the child is easily distracted and cannot do normal activities
- Stares blankly
- Delayed answering of questions
- Slurred speech
- Stumbling or clumsiness, uncoordinated or cannot walk a straight line
- Cries very easily or becomes angry easily or exhibits extreme emotions
- Problem with memory, repeats self, repeatedly asks questions, unable to recall words or objects
- Loss of consciousness
- Other symptoms of a concussion:
- Confusion
- Loss of memory about accident
- Headache
- Nausea
- Difficulty with memory
- Slowed thinking
- Tiredness
- Change in sleep
- Unbalanced
- Dizziness
- Ringing in ears
- Increased sensitivity to light or sounds
- Mood changes — sad, irritable, non-motivated
- Blurred vision
- Ringing in ears
- A headache that will not go away and is severe
- Not waking up; very sleepy
- Seizure
- Repeated vomiting
- Personality change
- Loss of coordination
- Weakness in arms or legs
- Ringing in ears
- Blurred vision
- Sensitivity to loud noises or bright lights
- Younger children may have difficulty communicating how they are feeling. Watch for:
- Listlessness, being overly tired
- Irritability
- Change in sleep or eating patterns
- Change in play
- Change in their school performance (a sudden decline in grades or disruption in school)
- Not interested in toys
- Unsteady walking
- Losing newly learned skills — eg, potty training, reading
Sports and concussions
Children who are involved in sports frequently are victims of concussions. Many of these children continue to play and experience repeat concussions.
"Concussions are a widely recognized sports injury, but they are more common — and subtle — than people might think," says Dr. Kleiner.
Concussions happen frequently among athletes, especially those engaged in contact sports such as football, hockey, rugby, soccer and lacrosse. The incidence of concussion ranges from 10 percent to 50 percent of participants per year. The risk of a repeat concussion is as high as 50 percent per season.
In addition to playing organized sports, active children also are at risk for concussions during recreational activities that include skateboarding, biking and skating.
Post-concussive syndrome has been well validated as a debilitating condition that can affect children, adolescents and young adults who have been repeatedly traumatized during the course of playing sports. Because many people only recognize loss of consciousness as a symptom of concussions, many concussions go dangerously unrecognized.
Dr. Kleiner suggests the following grade scale to determine the best way to deal with a child's concussion:
Grade 1 — Symptoms are noticeable for less than 15 minutes. Generally, return to play is not recommended until the next day.
Grade 2 — Symptoms are noticeable for longer than 15 minutes. Generally, clearance by a health care professional is recommended before return to play.
Grade 3 — Any loss of consciousness. Child needs immediate medical attention.
If a child might have a concussion, it is important for him or her to sit out from play for at least 15 minutes. During this time, the coach can evaluate the child's concussion grade.
Repeat concussions
When a child has suffered from more than one concussion at any point in time, it is known as a repeat concussion. The effects on the brain are more serious than the effects of the first concussion. Other effects of repeat concussions are: symptoms last longer, chronic headaches, slower response rates and decreasing test scores.
Even with single Grade 1 concussions, problems frequently last for a week or even longer.
To appropriately manage repeat concussions within the same season, the child athlete should consider not participating in that sport for the rest of the season, Dr. Maugans says.
Prevention is the best strategy for avoiding repeat concussions, according to Dr. Kleiner. Wearing the proper protective equipment during activities is important. Highly effective helmets are even available for soccer players (Full Ninety). Equally important are staying in shape, staying hydrated and following the rules of play.
Returning to play
The athlete or child with a concussion most often wants to know "When can I play again?"
Half of children with concussions have post-concussive symptoms. Most concussions recover over three to seven days. Before returning to play, it is important to determine the number of most recent concussions. This is one of the best indicators of a whether or not to return to play.
Those who return to play too soon may risk a serious brain injury be having a second impact, especially within the first two weeks. This can be associated with devastating outcomes, even death. This is called second impact syndrome. Second impact syndrome occurs when the already swollen brain is re-injured and swells further.
Physicians and athletic trainers should be conservative about return to play. The key is good follow-up through the primary care physician, who will assess the child individually, evaluating the entire pattern of injury — the initial physical symptoms, how long the symptoms lasted, how the injury happened and the recovery time to being symptom-free.
If needed, a neurologist, neurosurgeon or neuro-psychologist may evaluate cognition, attention and concentration. This means evaluating the speed of information processing, memory and learning. The child may have no symptoms, but still have deficits in learning, memory and processing information.
A computer software tool is now available to assist certified athletic trainers and health care professionals with the evaluation of an athlete suspected of having sustained a concussion. This is most valid when the athlete has taken a pre-season "baseline" test to which post-injury scores can be compared. A decline in scores connotes concussion, while improvement in scores suggests recovery. This information combined with complete resolution of symptoms can lead to a confident return-to-play decision.
Returning to play within one season
Use the following scale to determine if a child may return to play:
Grade 1 — May return to play when symptom-free for one week
Grade 2 — May return to play when symptom-free for two weeks
Grade 3 — May return to play when symptom-free for one month
Preventing concussions
Help kids prevent concussions with these tips:
Children should be in car seats, booster seats or bucked up
Always have kids wear a helmet for high-risk activities such as biking, horseback riding, skiing, skateboarding
For more information: Contact Dayton Children's neurosurgery department — 937-641-3461. Speakers on this topic may be available.
To appropriately manage repeat concussions within the same season, the child athlete should consider not participating in that sport for the rest of the season, Dr. Maugans says.
Prevention is the best strategy for avoiding repeat concussions, according to Dr. Kleiner. Wearing the proper protective equipment during activities is important. Highly effective helmets are even available for soccer players (Full Ninety). Equally important are staying in shape, staying hydrated and following the rules of play.
Returning to play
The athlete or child with a concussion most often wants to know "When can I play again?"
Half of children with concussions have post-concussive symptoms. Most concussions recover over three to seven days. Before returning to play, it is important to determine the number of most recent concussions. This is one of the best indicators of a whether or not to return to play.
Those who return to play too soon may risk a serious brain injury be having a second impact, especially within the first two weeks. This can be associated with devastating outcomes, even death. This is called second impact syndrome. Second impact syndrome occurs when the already swollen brain is re-injured and swells further.
Physicians and athletic trainers should be conservative about return to play. The key is good follow-up through the primary care physician, who will assess the child individually, evaluating the entire pattern of injury — the initial physical symptoms, how long the symptoms lasted, how the injury happened and the recovery time to being symptom-free.
If needed, a neurologist, neurosurgeon or neuro-psychologist may evaluate cognition, attention and concentration. This means evaluating the speed of information processing, memory and learning. The child may have no symptoms, but still have deficits in learning, memory and processing information.
A computer software tool is now available to assist certified athletic trainers and health care professionals with the evaluation of an athlete suspected of having sustained a concussion. This is most valid when the athlete has taken a pre-season "baseline" test to which post-injury scores can be compared. A decline in scores connotes concussion, while improvement in scores suggests recovery. This information combined with complete resolution of symptoms can lead to a confident return-to-play decision.
Returning to play within one season
Use the following scale to determine if a child may return to play:
Grade 1 — May return to play when symptom-free for one week
Grade 2 — May return to play when symptom-free for two weeks
Grade 3 — May return to play when symptom-free for one month
Preventing concussions
Help kids prevent concussions with these tips:
Children should be in car seats, booster seats or bucked up
Always have kids wear a helmet for high-risk activities such as biking, horseback riding, skiing, skateboarding
For more information: Contact Dayton Children's neurosurgery department — 937-641-3461. Speakers on this topic may be available.
