Concussions in Children

The term concussion conjures up the image of a child knocked unconscious while playing sports. A concussion leads to a temporary loss of brain function and it can happen with any head injury, often without any loss of consciousness. Many head injuries occur off the playing field — in car and bicycle accidents, in fights, and even routine mishaps and falls.

Children who sustain concussions usually recover within a week, without lasting health problems, by following certain precautions and taking a breather from sports. However, a child with an undiagnosed concussion is at risk for brain damage, disability, and even death.

If your child does sustain a head injury, even without a loss of consciousness, it's important to be on the lookout for these symptoms.

• a change in mental state
• a bad headache
• confusion
• repeated vomiting

A child with these symptoms should be taken to the emergency room immediately.

WHAT IS A CONCUSSION?

The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. The brain can move around inside the skull but sometimes it hits against the skull. When the brain hits against the skull, for example, if a child hits his or her head on the sidewalk, the brain gets bruised, blood vessels can be torn, and the nerves inside the brain could be injured. These injuries lead to concussions.

There are three different types, or grades, of concussions. The severity of a concussion determines the length of time needed for full recovery.

• Grade 1 concussions: There is no loss of consciousness but a temporary change in mental state, like confusion, disorientation, and trouble focusing, which resolves within about 15 minutes.

• Grade 2 concussions: Do not lead to loss of consciousness, but the change in mental state lasts longer than 15 minutes.

• Grade 3 concussions: There is a loss of consciousness, which can vary from a few seconds to a few hours or even weeks.

CAUSES OF CONCUSSIONS

Head injuries that result in concussions can be caused by

• car, bike, and motorcycle accidents;

• falls and assaults;

• contact sports (football, ice hockey, volleyball, lacrosse, basketball, wrestling, field hockey, rugby, soccer, softball, baseball, etc.).

SIGNS AND SYMPTOMS OF A CONCUSSION

A child with a concussion could lose consciousness, but this not the one and only sign of a concussion. Other signs of a concussion include:

• feeling confused and dazed
• temporary memory loss
• blurred vision
• headache
• slurred speech or saying things that do not make sense
• difficulty concentrating, thinking, or making decisions
• difficulty with coordination or balance
• vomiting
• feeling anxious or irritable for no apparent reason

Young kids have the same concussion symptoms as older kids and adults, but changes in mood and behavior may be more subtle.

WHEN TO CALL EMERGENCY SERVICES:

• The child cannot be awakened
• One pupil — the black part of the eye — is larger than the other
• The child has convulsions or seizures
• The child has slurred speech
• The child seems to be getting more confused, restless, or agitated

Most kids recover fairly quickly from concussions, but some symptoms, including memory loss, headaches, and problems with concentration, may linger for several weeks or months. It is important to monitor these symptoms and to contact your doctor if they persist.

DIAGNOSIS

If a concussion is suspected, the doctor will ask about how the head injury happened, when it happened, and what symptoms the child has. The doctor also may ask basic questions to determine your child's consciousness, memory, and concentration e.g.: "What is your name?", "Where are you?", and "What day is it?".

The doctor will perform a thorough examination of the nervous system, including testing your child's balance, coordination, nerve function, and reflexes. Sometimes a doctor may order a CT scan of the brain or an MRI to rule out bleeding or other serious injuries that the brain could have sustained.

TREATMENT

If the concussion is not serious enough to require hospitalization, the doctor will provide instructions on how to take care of your child at home. The doctor may have you wake your child up at least once during the night. If your child cannot be easily awakened, becomes increasingly confused, or has other symptoms (such as continued vomiting), it may mean there is a more serious problem. This requires contacting the doctor again.

The doctor will probably recommend that your child take aspirin-free medications for headaches.

AFTER CARE

After a concussion, the brain needs time to heal. It's very important for kids to wait until all symptoms of a concussion have cleared up before returning to normal activities. Recovery time will depend on how long the symptoms last. Healthy kids can usually resume their normal activities within a few weeks, but each situation is different. A doctor will monitor your child closely to ensure that recovery is going well.

A child diagnosed with a concussion should not participate in sports or other physical activities until the doctor says that it is safe. Even if your child pleads that he or she feels fine or a competitive coach urges you to go against medical instructions, it is essential to wait until the doctor has given the OK. Even mild concussions require the player to sit out for the remainder of the game. It usually takes less force to sustain a second or subsequent concussion. Repeated concussions can result in lasting brain damage, even when the injuries occur months or years apart.

If your child sustained a concussion while playing sports, the doctor will advise you when it is OK to return to play. After a Grade 1 concussion, a patient is usually cleared to play once symptoms go away. After a Grade 2 concussion, the individual should not play again that day and should only return after being symptom free for at least a week. After a Grade 3 concussion, a child is typically told to wait for 1 to 2 weeks after symptoms have subsided, before returning to play.

PREVENTING CONCUSSIONS

Childproofing your home will go a long way toward keeping an infant or toddler safe from concussions and other injuries. Babies reach, grasp, roll, sit, and eventually crawl, pull up against furniture before they walk. Toddlers may pull themselves up using table legs; they'll use bureaus and dressers as jungle gyms; they'll reach for whatever they can see.

All of these activities can result in a head injury that leads to a concussion. Be sure your child has a safe place to play and explore, and never leave a baby or toddler unattended.

In vehicles, children younger than one year should be placed in rear-facing infant-only seats or convertible child safety seats. Children older than one can be safely restrained in forward-facing child safety seats. Children between four and eight years of age can use belt-positioning booster seats or combination seats that allow the harnesses to be removed. Children older than eight should always wear a seat belt.

The time you spend taking these safety precautions, and getting your child into the habit of abiding by your safety rules and regulations, will help keep your child safe and sound!