Safe play: recognizing and treating concussions in kids and teens

Between contact sports and playing with friends, the risk of injury and concussion is a worry for parents of children and teens.

A concussion is a type of mild traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body causing the head and brain to move quickly back and forth. This fast movement can create chemical changes in the brain and sometimes stretch and damage the brain cells. A person does not need to be “knocked out” or lose consciousness to have a concussion.

While serious problems after a concussion are rare, it’s important to know they may occur. Observe your child in the first two days after the injury. If symptoms last longer than 24 hours after the injury, more than likely, the child has sustained a concussion.

Common concerns after a concussion:

• Physical: Headaches, sick to stomach, dizziness, low energy level, trouble with vision, bothered by light, sleeping problems
• Thinking (cognitive): Slowed thinking, trouble paying attention, difficulty remembering, acting like “in a fog,” easily confused, academics may suffer
• Behavioral (emotional): Irritability or grouchy, easily upset or frustrated, nervousness, sadness, acting without thinking, personality changes

“Red flag” symptoms of a concussion:

• Unequal or changes in pupil sizes
• Drowsiness or inability to wake up
• A headache that gets progressively worse
• Loss of consciousness
• Slurred speech
• Decrease of motor function

Dr. Devesh A. Patel, a primary care sports medicine physician with Sentara Sports Medicine Specialists in Virginia Beach, says, “Red flag symptoms are the ones that concern me the most. I recommend that the patient be seen in the ER for further evaluation if they show those signs.”

Healing after a concussion

Dr. Patel compares healing after a concussion to healing a broken bone. “The brain is working to heal itself, so you need to let it rest and recover,” he adds. “We can’t just shut down the brain – instead, we have other options to help the brain recover.”

To ensure enough healing time after a concussion, most athletic programs, whether school teams or not, have protocols to ensure the child or teen is ready to play again. Teams typically provide education at the beginning of the season as well as baseline neurocognitive testing for each player. Before returning to their sport, the player should be tested again and compared with their baseline neurocognitive test to see if they are ready to play again.

Helpful steps after a concussion may include extra rest, relaxation, and learning accommodations such as additional time for homework. Dr. Patel says some athletes may want to talk to their athletic coach and doctor about research that suggests that for non-severe concussions, children and teens may benefit from non-aerobic exercise such as walking or riding a bike – as long as their heart rate is less than 100 beats per minute and it does not exacerbate symptoms.

The following may help after medical treatment of a concussion:

• Have your child rest. Doing too much too soon after a concussion can make problems worse. In the first days after a concussion, don’t expect too much from your child. They will probably need lots of “downtime” to rest and relax.
• Make sure your child gets enough sleep and eats properly. Some children will need more sleep than usual. Allowing naps during the day and ensuring they sleep well at night should help. You should also ensure your child eats healthy foods and drinks plenty of water.
• Be patient. After a concussion, your child might seem cranky, more easily upset, or more tired and forgetful. The concussion is probably causing this behavior. Try to be patient and understanding when this happens.

How long does healing take?

There’s no “one” answer to how long a child or teen should wait before returning to their full schedule and sports. “That’s always the hot topic,” explains Dr. Patel. “We want to see the concussion symptoms fully resolve before we start exerting the athlete again,” he adds.

Most concussions resolve within ten to fourteen days, according to Dr. Patel. Follow-up neurocognitive testing compared to their baseline will help determine if they’re ready to begin playing again.

To ensure enough healing time after a concussion, most athletic programs, whether school teams not, have protocols to ensure the child or teen is ready to play again.

What about repeat concussions?

Chronic traumatic encephalopathy (CTE) is a rare disorder that is likely caused by repeated head injuries and is a concern for athletes who suffer from multiple concussions. According to Dr. Patel, CTE can lead to changes in emotions and mood, cognition and many other parts of a person’s daily functionality. There are also concerns that repeat concussions increase the risk of Alzheimer’s and dementia later in life.

“When I counsel families and patients who have had two or more concussions, I do let them know that increased number of concussions can increase the risk for CTE,” says Dr. Patel.

He explains that he can’t provide a set number of concussions that may be worrisome, and, often, the effects of head injuries will show up later in life. “It’s like smoking cigarettes – we don’t know how many might lead to cancer, but we know the more you smoke, the higher your risk.”

Dr. Patel says repeated concussions become concerning when more time is needed to recover, or the athlete is getting concussions more easily – as they are signs the brain is not able to tolerate trauma. The risk of developing CTE has been associated with second impact syndrome, in which a second head injury happens before the previous head injury symptoms have fully resolved.

“I tell parents it’s good for their child to play a sport,” Dr. Patel summarizes. “There are many upsides such as social development and physiological and mental benefits of playing sports. The fear of concussion should not dissuade a student from sports.”

He adds that the most significant way to lower the risk of a concussion is always wearing the appropriate equipment for the sport.

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