A Heads Up About Concussions

from School Health Reporter, Winter 2006

Mild traumatic brain injury, commonly known as a concussion, is one of the most common neurological disorders. Early symptoms of a concussion, following a blow or injury to the head, may appear mild and cause no harm, but sometimes they can lead to serious, long-lasting problems, even lifelong disability.

The statistics reflecting the seriousness of traumatic brain injury (TBI) are staggering. Each year in the United States , approximately 1.5 million people experience a TBI. There are approximately 50,000 deaths from TBI every year. More than 200,000 people are hospitalized for treatment. Most people sustaining a head injury are treated in the emergency room or a doctor’s office. More than 5 million Americans are living with a disability as a result of a TBI. (Centers for Disease Control and Prevention.) The best way to protect a child from brain injuries is to prevent the injuries from happening in the first place. 

The following are some tips from the CDC and The Brain Injury Association of America to reduce the chances of brain injury:

1. Wear a seat belt while driving or riding in a motor vehicle.
2. Always buckle a child into a safety seat, booster seat or seat belt (according to the child’s height, weight and age) while in the car.
3. Never drive under the influence of drugs or alcohol.
4. Wear a helmet and make sure children are wearing helmets while riding bikes, motorcycles, snowmobiles or all-terrain vehicles and while skating, skateboarding, skiing, snowboarding, riding a horse, playing contact sports, and playing baseball.
5. Avoid falls in the home by using safety gates at the top and bottom of stairs and by installing window guards to prevent children from falling out. Also, use non-slip mats in bathtubs and under rugs.
6. Make sure the playground surface is made of shock-absorbing material (sand, wood or mulch) and has adequate depth.

Signs of a brain injury or concussion may be subtle. Some warning signs may appear immediately, and others may not show up for days, weeks or even months after an injury. If a child does fall or sustain an injury to the head, it is important to be able to recognize the signs and symptoms. When should a doctor be called? When must 911 be called? (See below for symptoms of concussion).

When a child is in the doctor’s office or emergency room, it is important that the parents ask the following questions: How long will the symptoms last? What other symptoms must I be aware of? What can I do to prevent further injury or to prevent making the concussion worse?  When can my child return to regular activities (for example, school or child care)? When can he or she return to playing sports or other physical activities?

It is important that children with concussions do not return too soon to sports activities. Too often they do and put themselves at risk for further injury and more serious medical complications.

The decision to return to sports often is made subjectively by asking the child if he or she feels ready to play, for example, or erroneously, because symptoms of headache and confusion go unreported by the child or teenager.

To keep the thousands of children who are seen at The Children’s Hospital in Colorado from returning to sports before fully recovering from a mild brain injury or concussion, neuropsychologist Michael Kirkwood, PhD, and Pam Wilson, MD, launched the Concussion Program with a research institute grant. Before the program, there was not a program at the hospital devoted exclusively to the children with concussions, despite the numbers of children treated for this medical condition. As a result, The Children’s Hospital is now the only pediatric hospital in the Rocky Mountain region with such a clinic. The program is part of the Department of Physical Medicine and Rehabilitation.

Dr. Kirkwood said the program’s goal is to evaluate and treat children and teens with sports-related concussions and other traumatic brain injuries and to provide clinical services and education to community physicians, school personnel and parents. After a child gets a concussion, he or she may have headaches, dizziness, fatigue and neurological changes. Drs. Kirkwood and Wilson developed the program for kids who are still symptomatic and should not return to playing sports.

Dr. Wilson attends to the medical problems associated with concussions, such as headaches. Dr. Kirkwood assesses the neurological symptoms or, as he describes, the child’s “emotional functioning.”

Dr. Kirkwood puts each child through a series of tests.  For example, he shows the child words on a computer screen and asks him or her to remember them to test the child’s reaction time and his or her ability to hold information in the mind.

The results of the tests are reported to the child’s pediatrician or primary-care provider (PCP), giving the PCP information he or she needs to determine if the child is ready to return to playing sports. The psychological testing is more objective and tells the “real story.” It avoids asking the child how he or she feels about returning to sports activities.

Allowing a child to return to sports too soon after a concussion increases his or her risk of further injury and possible death. It is the responsibility of all of the adults involved in the child’s life to engage in preventive behaviors, know the signs and symptoms of a mild traumatic brain injury, and support the child in recovery.

For more information and resources, check out the following:

1. The Centers for Disease and Prevention. (CDC) General TBI information and other injuries. A tool kit is available at the site for coaches.  http://www.cdc.gov/ncipc/tbi/
2. Brain Injury Association of America . (BIAA) Information about statistics and prevention.  Resources for services. www.biausa.org.
3. Dise-Lewis, J.E.; Calvery, M.L.; and Lewis, H.C. (2002). BrainSTARS - Brain Injury: Strategies for Teams and Re-education for Students. Denver , CO :  Jeanne Dise-Lewis, PhD.

Symptoms of Concussion in Children

• Feeling tired or listless
• Changes in behavior or personality
• Irritable or cranky (will not stop crying or cannot be consoled)
• Changes in eating or will not nurse
• Changes in sleep patterns
• Changes in play behavior
• Changes in school performance
• Lack of interest in favorite toys or activities
• Loss of new skills, such as toilet training
• Loss of balance, unsteady walking
• Vomiting
• Changes in speech or difficulty speaking

Dial 911 Immediately if the Child:

• Is vomiting
• Is unable to speak clearly, is confused, or does not recognize the parent
• Complains of blurred vision or double vision
• Has pupils that are different sizes
• Has a severe headache
• Has blood or clear fluid coming from the ear or nose
• Has difficulty walking or keeping balance
• Has seizure activity
• Is unconscious

Tips for Coaches: If You Suspect That a Player Has a Concussion:

1. Remove the athlete from play.
2. Ensure the athlete is evaluated by an appropriate healthcare professional. Do not try to judge the seriousness of the injury yourself.
3. Inform the athlete’s parents or guardians about the known or possible concussion.
4. Allow the athlete to return to play only with the permission from an appropriate health-care professional.

If You Think Your Child Has a Concussion:

1. Seek medical attention right away. A health-care professional will be able to decide how serious the concussion is and when it is safe for your child to return to sports.
2. Keep your child out of play. Concussions take time to heal.  Athletes who return to play too soon, while the brain is still healing, risk a greater chance of having a second concussion and cause permanent brain damage.
3. Tell ALL of your child’s coaches about a recent concussion.  Your child’s coach may not know about a concussion your child received while playing another sport or activity unless you tell him.
4. Remind your child. It’s better to miss one game than the whole season.