I have a 12 year-old figure skater working on double jumps and a 7 year-old ice hockey player who strongly believes faster is better. So I worry about head injuries. I worry A LOT. Maybe because in the past 13 years working at the hospital I’ve seen too much; maybe because I have seen the long-term impact of multiple concussions in kid’s lives. So I felt a need; a responsibility even, to share what I know as a pediatrician and what I’ve learned over the years so all of you; young athletes, coaches, parents, and medical professionals become more aware of the significant danger associated with ignoring or minimizing concussions.
What exactly is a concussion?
The definition of a concussion, in medical terms (sorry, have to do this) is as follows: “a complex pathophysiological process affecting the brain, induced by biomechanical forces and resulting in the rapid onset of short-lived impairment of neurological function that resolves spontaneously.” Whoa, not quite a “head bonk.” In other words, a concussion is a traumatic brain injury that alters the way your brain functions. Effects are usually temporary, but can include problems with headache, concentration, memory, judgment, balance and coordination. Most concussions are caused by a direct blow to the head, face or neck, and they occur often; reports state concussions in young athletes account for anywhere between 150,000-250,000 ER visits per year!
What are the symptoms of a concussion?
It is so important for parents and coaches to realize that concussions have a wide range of symptoms, and we must pay special attention to not just physical changes, but also emotional, behavioral, cognitive and sleep abnormalities that often occur with even mild concussions.
Physical Signs: headache, nausea, dizziness, visual disturbances, light or sound sensitivity, loss of consciousness, vomiting, memory-loss, loss of balance/coordination.
Emotional/Behavioral Changes: irritability, mood swings, sadness, anxiety, inappropriate emotions.
Cognitive Impairment:(Learning and Concentration) slowed reaction times, difficulty concentrating, difficulty remembering, confusion, feeling dazed or in a fog.
Sleep Disturbances: drowsiness, trouble falling asleep, sleep less or more than usual.
What is the adequate management of concussions?
1) Get your child evaluated by a medical professional – whether in the emergency room or your physician’s office, the young athlete should be immediately removed from play and evaluated as soon as possible. Once home, make sure your child is not left alone for at least 24-48 hours. Even though you should check on him or her throughout the night, there is no need to wake the child up, as more evidence shows that sleep is very important in recovery from concussions.
2) REST- this is the MOST important aspect of concussion management, and both physical and mental rest are both essential to healing. Concussed athletes should not play sports, exercise or participate in activities with potential for re-injury until symptom-free and cleared by a medical provider. It is essential that athletes have “cognitive rest;” limiting activities that require mental concentration, such as reading, texting, watching TV and playing electronic games is as important as physical rest.
3) Return to Play and School- “When in Doubt, sit them out!” Return to play has always been a tough decision, and athletes should always be evaluated and cleared by a physician or medical professional prior to return to play. Recent studies have focused on what’s been called “return to learning.” Cognitive rest, or rest from learning, may include a temporary leave of absence from school, shortened school days, or even allowance of more time to complete assignments and tests. Standardized testing is discouraged during this period of recovery. As parents, I feel we need to be educated and feel empowered to address these issues with coaches and school officials, and there is good data to support the importance of graduated return to both sport and school. Care must be individualized and a team approach involving the student-athlete, parents, coaches, physicians and school administrators is most effective. Symptoms from most concussions should resolve in 7-10 days. For additional information, refer to these helpful links below.
I will continue to hold my breath as I watch my son and daughter on the ice, and I hope everyone stays safe!
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Concussion 101: EXCELLENT! http://www.youtube.com/watch?v=zCCD52Pty4A
REAP Concussion Program http://www.rockymountainhospitalforchildren.com/sports-medicine/concussion-management/
Return to Play Guidelines http://www.idhsaa.org/concussions/report/Safe Return To Play.pdf
CHOC Children’s Hospital Concussion Program http://www.choc.org/concussion/