Signs of concussion in children

This article discusses concussions in children and how parents can spot them.

What is a concussion?

A concussion is an injury to the brain that may be caused by a blow, bump, or jolt to the head. Concussions may also happen after a fall or hit that jars the brain. A blow elsewhere on the body can cause a concussion, even if an athlete does not hit his/her head directly. Concussions can range from mild to severe, and athletes can get a concussion even if they are wearing a helmet.

Signs and symptoms of a concussion

Athletes do not have to be "knocked out" to have a concussion. In fact, less than one out of 10 concussions results in loss of consciousness. Concussion symptoms can develop right away, or up to 48 hours after the injury. Ignoring any signs or symptoms of a concussion puts your child's health at risk!

Signs observed by parents or guardians

* Appears dazed or stunned

* Confused about assignment or position

* Forgets plays

* Unsure of game, score or opponent

* Moves clumsily

* Answers questions slowly

* Loses consciousness (even briefly)

* Shows behavior or personality changes (irritability, sadness, nervousness, feeling more emotional)

* Can't recall events before or after hit or fall

Symptoms reported by athlete

* Any headache or "pressure" in head (how badly it hurts does not matter)

* Nausea or vomiting

* Balance problems or dizziness

* Double or blurry vision

* Sensitivity to light and/or noise

* Feeling sluggish, hazy, foggy or groggy

* Concentration or memory problems

* Confusion

* Does not "feel right"

* Trouble falling asleep

* Sleeping more or less than usual

Be honest - your child must be honest

Encourage your athlete to be honest with you, his/her coach and your health care provider about his/her symptoms. Many young athletes get caught up in the moment and/or feel pressured to return to sports before they are ready. It is better to miss one game than the entire season - or risk permanent damage!

No athlete should return to activity on the same day he/she gets a concussion.

Athletes should NEVER return to practices/games if they still have ANY symptoms.

Parents and coaches should never pressure any athlete to return to play.

The dangers of returning too soon

Returning to play too early may cause Second Impact Syndrome (SIS) or Post-Concussion Syndrome (PCS). SIS occurs when a second blow to the head happens before an athlete has completely recovered from a concussion. This second impact causes the brain to swell, possibly resulting in brain damage, paralysis, and even death. PCS can occur after a second impact. PCS can result in permanent, long-term concussion symptoms. The risk of SIS and PCS is the reason no athlete should be allowed to participate in any physical activity before they are cleared by a qualified health care professional.

Recovery

A concussion can affect school, work, and sports. Along with coaches and teachers, the school nurse, athletic trainer, employer, and other school administrators should be aware of the athlete's injury and their roles in helping the child recover.

During the recovery time after a concussion, physical and mental rest are required. A concussion upsets the way the brain normally works, and causes it to work longer and harder to complete even simple tasks. Activities that require concentration and focus may make symptoms worse and cause the brain to heal slower. Studies show that children's brains take several weeks to heal, following a concussion.

Read more here

Children's concussion symptoms stay after injury

A study shows that the symptoms of concussions in children stay long after the injury occurrence.

Kids who suffer a concussion can have lingering effects long after the physical symptoms fade away, U.S. researchers report.

In a study from the emergency medicine division at Boston Children's Hospital, doctors found that, while headache, dizziness and blurry vision can appear right after a concussion, emotional and mental symptoms, such as irritability and frustration, show up much later and stay longer.

"Patients and their families should expect the physical symptoms that they experience after a head injury to get better over the next few weeks, but that emotional symptoms may come on later, even as the physical symptoms subside," said lead researcher Dr. Matthew Eisenberg.

"Only by knowing what symptoms can be expected after a concussion can we help reassure patients and families that what they experience is normal, know when to seek additional help, and make sure that children are taking appropriate precautions in regard to school and sports to achieve a full recovery," Eisenberg added.

For the study, published online May 12 and in the June print issue of Pediatrics, Eisenberg's team used questionnaires to keep track of 235 children and young adults, aged 11 to 22, who suffered a concussion and went to a pediatric emergency department.

The patients were followed for three months after their injury, or until all their symptoms were gone. During that time they were asked about symptoms, sports activity, and school and athletic performance.

The most common physical symptoms were headache, dizziness and fatigue, which tended to start right after the injury and got better over time. Most also had mental symptoms, such as difficulty concentrating and taking longer to think, the researchers found.

While most children recovered within two weeks after the injury, 25 percent still had headache a month after their injury, the investigators found.

In addition, more than 20 percent suffered from fatigue, and nearly 20 percent reported taking longer to think for a month after their concussion.

For many, emotional symptoms -- such as frustration and irritability -- were not as common right after the injury, but developed later, the study authors noted.

Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children's Hospital, said, "It takes longer than people think to fully recover from a concussion. My experience is that kids who still have symptoms two weeks after a concussion are going to have a very hard time, and it's going to be a struggle to get them to the point where they have no symptoms."

In addition to physical and mental rest, Kuluz believes in treating the symptoms. He prescribes ibuprofen and other medications to relieve headache, and melatonin and other drugs to help patients sleep.

Kuluz also recommends physical therapy to help children recover. Therapy includes working on balance and helping with any vision problems. "Therapy also helps you find your threshold for exertion. Many of my kids find that very helpful," he said.

He also recommends keeping children out of school for a couple of days after the injury and then gradually letting them get back to a normal routine.

"Keeping a child out of school for too long will have a negative effect on their mental health. They will become anxious, they'll become irritable, because they worry about falling behind," he said. "But if they go back too soon without teachers being aware of their condition, they can fail, and it happens a lot."

Kuluz tries to get kids back to school for half a day or as much as they can tolerate until they get better. Children should not start sports again until all symptoms have disappeared and then only gradually, he added.

If a child still has symptoms two or three days after a concussion, Kuluz recommends seeing a doctor who is experienced in dealing with concussions or going to a concussion clinic.

Read more here

There's no such thing as a concussion-proof helmet

This article explains why parents should be weary of helmets claiming to be "concussion-proof"and what to do about concussions in their children.

Football season is upon us and many parents of young players may be swayed by helmets claiming to be "concussion-proof." There is no such thing, experts warn.

Some manufacturers are promoting aftermarket add-ons for football helmets – such as liners, bumpers, pads and electronic devices – that promise to reduce the risk of concussion. However, there is little research evaluating the effect of physical impact on young athletes, and risk-reduction claims about helmets designed for adult players may not be relevant to younger players, New York Attorney General Eric Scheiderman warned. 

“It’s important to remember that no helmet can fully prevent a concussion,” Schneiderman said, as he cautioned manufacturers against making claims they can't back up. “Ensuring that manufacturers don’t mislead the public and endanger young New Yorkers is a key concern for my office."

Head injuries, including concussions, can happen at any time on the field of play, regardless of the type of helmet being worn. False claims may give players and parents a false sense of security. Instead, parents, coaches and young football players should rely on a number of tips and strategies to help reduce the risk of head injury, including: learning and recognizing symptoms of a concussion; minimizing head-to-head hits on the field, and enforcing stronger and stricter penalties against such behavior.

What to do

Although the age, condition, type and fit of the helmet are important factors, reducing the risk of concussion is not “all about the helmet.” Schneiderman issued these tips to reduce the risk of concussion and head injury in youth football:

• Players, parents and coaches must be trained on the symptoms and risks of concussion.
   
• Recognizing the signs of concussion and removing a player immediately is extremely important.
   
• New York State law requires that players be removed from play until they are asymptomatic for a minimum of 24 hours and have written approval from their physician to return to play. Many other states have similar laws.
   
• The number of concussions can be significantly reduced with modifications to practice format and an emphasis on penalty enforcement.
   
• Reducing the number of hits is instrumental to reducing the risk of concussion because of the cumulative risk from repeated hits. Limit the amount of contact in practice and forbid drills that involve full-speed, head-on blocking and tackling that begins with players lined up more than three yards apart.
   
• Players need to be trained to focus on techniques that minimize head-to-head hits. Coaches and referees must strictly enforce penalties against such behavior.

Read more here

Mild, moderate and severe traumatic brain injury symptoms

This article discusses the symptoms of mild, moderate and severe traumatic brain injury. Knowing these symptoms are important to know when to seek medical attention.

TBI symptoms vary depending on the extent of the injury and the area of the brain affected. Some symptoms appear immediately; others may appear several days or even weeks later. A person with TBI may or may not lose consciousness—loss of consciousness is not always a sign of severe TBI.

Symptoms of mild TBI

A person with a mild TBI may experience:

• Headache
• Confusion
• Lightheadedness
• Dizziness
• Blurred vision
• Ringing in the ears
• Tiredness or sleepiness
• A bad taste in the mouth
• A change in sleep habits
• Behavior or mood changes
• Trouble with memory, concentration, attention, or thinking
• Loss of consciousness lasting a few seconds to minutes¹
• Sensitivity to light or sound
• Nausea or vomiting²

Symptoms of moderate or severe TBI

A person with moderate or severe TBI may have some of the symptoms listed above. In addition, the person may experience any of the following:

• Headache that gets worse or won’t go away
• Repeated vomiting or nausea
• Slurred speech
• Convulsions or seizures
• An inability to wake up from sleep
• Enlargement of the pupil (dark center) of one or both eyes
• Numbness or tingling of arms or legs
• Loss of coordination
• Increased confusion, restlessness, or agitation
• Loss of consciousness lasting a few minutes to hours³

A person who suffers a blow to the head or another trauma that may have caused a TBI should seek medical attention.⁴

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ACSM on Sports Concussions - Two Steps Forward, One Step Back

The American College of Sports Medicine (ACSM) released the following information on sports concussions. I appreciate them raising awareness of brian injury. With all due respect to my colleagues, their advice on "brain rest" is neither biologically possible nor data based. 


They write "

Like any other injured body 

part, the concussed brain should be 

rested in order to recover. D

uring recovery, athletes should have no physical exertion that will raise the heart rate, and they should also perform no mental work, such as school or other tasks, that require concentration. Doctors commonly prescribe periods of reduced schoolwork and tests after a concussion, but they may need to start with complete brain rest, including no thinking, texting or video games." 

If you or your child get a prescription for total "brain rest", you should ask why. 

I still recommend that people with a brain injury should seek a BRAIN specialist.  JR


WHAT IS A CONCUSSION?
A concussion is an injury to the brain caused by a sudden acceleration or deceleration force, and concussions occur in many different sports. While an athlete does not need to hit his or her head to suffer a concussion, hits to the head— against another person, a ball, or the ground—are a common cause. The brain moves inside the skull, and the sudden movement can cause the brain to swell. Helmets protect against more serious head injuries, but they do not necessarily prevent concussions. It may not be obvious to parents, coaches, trainers and athletes immediately how bad the head injury is, so if a concussion is at all suspected, the athlete needs to stop with the practice or the game.

SYMPTOMS OF CONCUSSION

The most serious concussion symptoms could be associated with a more severe head injury, such as bleeding into the brain. People with the following “red flag” symptoms need emergency care:
• Increasing confusion or headaches;
• Vomiting, double vision or unequal pupils;
• Irritability or behavior change; and
• Drowsiness or fading in and out of consciousness.

Other concussion symptoms are less obvious and are split among four categories:

• Physical symptoms—headache; nausea; dizziness; vision or balance problems; sensitivity to light or noise.
• Cognitive symptoms—feeling mentally slow or foggy; trouble concentrating; trouble remembering.
• Emotional symptoms—irritability; sadness; nervousness; feeling more emotional than usual.
• Sleep-related symptoms—sleeping more or less than usual; drowsiness; trouble falling asleep.

CONCUSSION DIAGNOSIS

Assuming the injured athlete does not have any of the most serious symptoms, he or she will not need a head CT scan or MRI. There is currently no imaging test that can diagnose a concussion. The doctor will ask about symptoms, complete a neurological physical exam and possibly balance testing, and may opt to perform mental agility testing known as neuropsychological testing. These tests are best if there is a pre-injury baseline for comparison, and this may be a service offered by your local school, club or hospital.

CONCUSSION TREATMENT

Unfortunately, people with a concussion usually look and act normally, so it is difficult for them and their family, teachers and coaches to tell they’ve suffered a concussion. Like any other injured body part, the concussed brain should be rested in order to recover. During recovery, athletes should have no physical exertion that will raise the heart rate, and theyshould also perform no mental work, such
as school or other tasks, that require concentration.

Doctors commonly prescribe periods of reduced schoolwork and tests after a concussion, but they may need to start with complete brain rest, including no thinking, texting or video games. As the brain recovers, cognitive activity can be gradually returned. Only when the brain is working normally at rest, with no recurrence of the symptoms listed above, is the athlete ready to return to play.

Most people with concussions recover in 7-14 days. Some individuals require significantly longer times, and some are never quite back to normal. Repeated concussions can be associated with more
severe injury and longer recovery. A repeated concussion before the brain is fully recovered can be fatal, causing rapid brain swelling and second impact syndrome.

RETURNING TO PLAY

A progression of return-to-play after a concussion begins only after all symptoms have cleared at rest and with mental exertion. Then an athlete can begin a five-day gradual return, stopping and waiting
at any point when exertion causes symptoms to return.

• Day 1: Low-level activity, such as walking or slow jogging.
• Day 2: Increased intensity of jogging, running or biking.
• Day 3: Heavy non-contact activity, including sprinting.
• Day 4: Contact activity in controlled practice situation.
• Day 5: Full participation.

Read more here

Concussion Videos for Coaches, Students & Parents

From the AAN Sports Neurology Section:

1.     Dr. Anthony Alessi and Backus Hospital are educating local youths on the signs, symptoms and treatments for concussions, which impact so many young athletes:

http://www.backushospital.org

2.     Dr. Marc DiFazio and Shady Grove Pediatric Neurosciences are caring for children and adults with neurologic disorders. See the video about a young athlete’s concussion and treatment:

http://www.youtube.com/watch?

v=OF53WElg7K0&feature=player_
embedded&noredirect=1 or http://www.pedsneurosciences.com/Concussion_Center.html 

Consider showing these educational videos at events where you are capturing the attention of coaches, students, parents, etc.

If your facility is also considering creating a video on concussion, or if you would like more information from Drs. Alessi and DiFazio on creating a video, please let me know. If you have a video to share with the section, please let me know that as well. Thanks.

Concussions may be on rise in high schoolers: study

Concussions may be on rise in high schoolers: study

NEW YORK Sun Feb 27, 2011 8:27pm EST
NEW YORK (Reuters Life!) - High school athletes are four times more likely to suffer a concussion today than they were about a decade ago, with football players leading the pack, according to a study.

What was more, concussions appeared to be an issue not only in sports long thought of as high impact, but also those thought of as low impact, with some high school athletes suffering from two or more concussions.

In 25 public schools from 1997 to 2008, and six different sports each for girls and boys, there were about five concussions for every 10,000 times high school athletes were on the field, the research -- published in the American Journal of Sports Medicine -- found.

That's up from slightly over one per 10,000 times on the field in 1997.

Read the rest of the article here.