- As a parent, what can I do immediately to help my child with a concussion?
Be encouraged that over 90% of concussions will heal completely in a matter of days to weeks. According to CHOC Children’s Concussion Program, “The first 24-72 hours should include cognitive and physical rest, limiting screen time and mentally challenging tasks. Look for symptoms every day for the first week and then at least three times a week after that, and continue to monitor symptoms for signs of improvement.”
Insist that your child get plenty of sleep, quiet time and rest, immediately after a concussion. Limit mental and academic stimuli as well as physical activity. This includes limiting everything from television and texting to reading and doing homework. Your child should avoid loud events; even going to sports games or attending practices might make symptoms worse. Also, don’t let your teen drive until cleared by your doctor because a concussion usually slows reaction time.
This was the toughest for me as a mom…how do I keep a VERY active 8 year old away from sports AND from TV, XboX, iPads…even books? We went to a lot of malls, yes, we bought some new toy planes, and my son and husband looked at lots of trucks and RVs! (another story altogether, but I was happy they spent 4-5 hours a day doing that!). Make sure you keep an eye out for returning symptoms; if your child starts watching TV and complains a new headache, turn it off and give it another day or two. You will need to monitor symptoms for the first couple of weeks and adjust activity, even school days and homework. Talk to the school and have a plan for adjusting the school day, rescheduling tests, and no homework or standardized tests while your child experiences any symptoms!
Do I need to take my son/daughter to the Emergency Room? What about CT or MRI?
After your child is seen immediately after sustaining the blow to the head on the field or the ice by a trained professional, it would be prudent to call your pediatrician’s office for advice. Bring your child immediately to the Emergency Department if he/she experiences any of the following:
- Changes in alertness and consciousness
- Convulsions or seizures
- Muscle weakness on one or both sides
- Persistent confusion
- Remains unconscious
- Unequal pupils, unusual eye movements
- Problems walking
- Repeated vomiting (more than 2 times)
Most parents believe a CT or MRI is necessary for every child after a concussion. The American Academy of Pediatric’s 2010 Clinical Report on Sports-Related Concussions and the American Medical Society of Sports Medicine have both stated that a CT or MRI is not needed or even recommended in the vast majority of concussions. Studies have shown imaging of the brain is likely to be completely normal after most concussions. If your child is being evaluated by a physician for any of the above symptoms, he or she will determine the need for a CT or MRI.
Return to School and Play: a Step-Up approach
If your child suffers a concussion and has symptoms after 24-48 hours (headaches, dizziness, trouble sleeping, mood swings, etc) consult with primary care physician and ask him or her for help with communicating to the school that the child might need to adjust schedule, homework assignments and exams. He or she might need a shorter day, especially if being at school produces or worsens symptoms.
For safe return to play, guidelines have been published as to how a child should safely return to play after a concussion. These have been adapted from the International Concussion Concensus Guidelines
Baseline (Step 0): As the baseline step of the Return to Play Progression, the athlete needs to have completed physical and cognitive rest and not be experiencing concussion symptoms for a minimum of 24 hours. Keep in mind, the younger the athlete, the more conservative the treatment.
Step 1: Light Aerobic Exercise
The Goal: only to increase an athlete’s heart rate.
The Time: 5 to 10 minutes.
The Activities: exercise bike, walking, or light jogging.
Absolutely no weight lifting, jumping or hard running.
Step 2: Moderate Exercise
The Goal: limited body and head movement.
The Time: Reduced from typical routine
The Activities: moderate jogging, brief running, moderate-intensity stationary biking, and moderate-intensity weightlifting
Step 3: Non-contact Exercise
The Goal: more intense but non-contact
The Time: Close to Typical Routine
The Activities: running, high-intensity stationary biking, the player’s regular weightlifting routine, and non-contact sport-specific drills.
Step 4: Practice
The Goal: Reintegrate in full contact practice.
Step 5: Play
The Goal: Return to competition
It is essential that after each step has been reached, you ask your child if symptoms have returned: if they have, back down and wait another 24 hours, if they haven’t, proceed with each step every 24 hours. Remember that your child might still be a little off balance, and more prone to another injury, so be cautious!
When and How should I contact a Concussion Specialist?
You should contact a Concussion specialist if your child has prolonged symptoms (more than 2 weeks), worsening symptoms after a few days or at the recommendation of your primary care physician. For more about the CHOC Children’s Concussion Program go to CHOC Concussion Program and for immediate advice regarding your child’s concussion, call the Concussion Hotline at (714) 509-4054.
Stay safe kids, and good luck parents!