Concussions

How do you prevent concussion in children, and what are the signs of a concussion?

Our Daddy MD Guide’s reply: When we think of sports injuries, we think of sprains, strains, pulls, and breaks — the usual orthopedic suspects. It’s easy to forget that sports can cause brain trauma, too, in the form of concussions. Concussions are the mildest form of brain trauma, and they are so frequently caused by contact sports that they account for about 5 percent of all sports injuries. Thankfully, the symptoms of concussions, which are mostly minor neurological impairments, usually subside within weeks, days, or even hours. That said, children and adolescents are at particularly high risk for concussions. Because their brains are still developing, children might have a greater harmful impact from concussions. Thus, concussions may make their maturing brains more vulnerable to re-injury and other trauma.

If a child is hit on the head by a projectile, a ball, or another player, parents should be on the lookout for changes in behavior, fatigue, and thinking in their child. Most parents know to watch for concussions when their child has taken an impact to the head, or gets “knocked out.” I frequently remind parents that a child does not need to be knocked out or lose consciousness to have had a concussion, and for that matter, children frequently bump their heads without getting concussions. Usually the most indisputable symptoms of concussions are the neurological ones — they cause children’s brains to work differently. Children might think more slowly, have a poor attention span, and have difficulty completing complex (but reasonable) tasks.

But the neurological signs are often more subtle than physical ones, so it’s important to know the other symptoms of a concussion, too. Signs and symptoms of a concussion can include dizziness, headache, vomiting, confusion, acting dazed, forgetting what happened before or after the injury, and of course, being “knocked out.” After head trauma, parents should be especially vigilant about a headache that gets worse, lasts for a long time, or is exceptionally severe. They should also observe for confusion, extreme sleepiness, or trouble waking up. If the child vomits three or more times, has trouble walking or talking, or has a seizure, get medical attention immediately.

Although serious injuries from concussions are rare, it is important to prevent re-injury in children who have had concussions. I like to recommend parents consider using helmets in all contact sports.

Luckily, children have their own kind of resilience– it takes a stronger force, usually two to three times the impact that an adult might endure, to produce clinical symptoms. This does not mean that children should take greater risks and play even rougher, though, even if they are wearing a helmet. As a parent myself, I know that it is best to keep an eye on children for about two weeks after their symptoms subside before having them to return to play after a concussion. Because children literally have their whole lives ahead of them, it is best to err on the side of caution.

Moshe Lewis MD, MPH, a dad of a four-year-old son, a pain management specialist, and the director of Physical Medicine and Rehabilitation at the California Pacific Medical Center, St Luke’s Campus, in San Francisco.

Q&A by Wyatt Myers