Kids and Concussion: Early Recognition Is Key to Recovery

A new school year has begun. Unfortunately, sports-related concussion is a common injury among children and adolescents, and symptoms can seriously intrude on children's lives, especially if not recognized and addressed early on.
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Shannon Babineau, MD
Assistant Professor of Neurology and Pediatrics, Icahn School of Medicine at Mount Sinai
Director of Pediatric Headache Medicine, The Mount Sinai Hospital

A new school year has begun. Playgrounds are full of children chasing, tumbling and climbing. Sports fields teem with young athletes practicing football, field hockey, and soccer. And, emergency rooms this fall will see thousands of pediatric concussions resulting from head injuries sustained during these and other activities. Unfortunately, sports-related concussion is a common injury among children and adolescents, and symptoms can seriously intrude on children's lives, especially if not recognized and addressed early on.

What is a concussion?
A concussion results from either a direct blow to the head, face, or neck, or to another part of the body where the force transmits to the head. Because it changes the function -- not structure -- of the brain, we cannot see a concussion by taking a picture of the head with a CAT scan or MRI. It's as if the nerve cells are shocked and their electrical signals malfunction for a time; with proper treatment, the brain eventually will "reset" itself and the concussion will end.

What symptoms does concussion cause?
In concussion, short-lived impairment of neurological function will quickly follow the head injury. This can range from feeling dazed or "out of it" to experiencing such symptoms as headache, dizziness, nausea, or changes in personality or levels of awareness, such as temporary loss of consciousness; however, one does not need to be knocked unconscious to have suffered a concussion.

What should I do if my child shows signs of concussion?
Fortunately, most athletic trainers and coaches have been trained to identify concussion, and know to immediately remove the child from the sport or game. If your son or daughter suffers a blow to the head or has a big fall during an unorganized sport or on the playground, immediately stop the activity. If he or she is awake and communicating well but complaining of symptoms like headache and dizziness, consult your pediatrician and try to get your child evaluated in the next couple of hours. If your youngster loses consciousness or seems confused and not aware of who or where they are, it's time to call 9-1-1.

How is concussion treated and how long will it take my child to recover?
When a child breaks a leg, we put a cast on it and tell the patient not to walk on it for several weeks. With concussion, we can't apply a cast and tell children to stop using their brain entirely. Like a broken limb, their brain needs rest and time to heal. It's difficult to predict which children will take a couple of days and which will take several weeks to recover from concussion. On average, most kids recover in 10 to 12 days, but it can vary from three days to a month or more, according to a recent study in Pediatrics.

Usually in the beginning, we want them to avoid all the stressors and stimuli of school, so we recommend they stay home and rest for at least a couple days. This means no physical activity, no homework, no reading, and limited screen time. It's difficult to get kids to quit their electronics altogether, so we try to give reasonable limits, such as an hour a day in 15- to 20-minute increments. But if light aggravates their headaches, dizziness, or nausea, we recommend that they stay away from all screens -- smart phones, computers, television -- and instead try a more restful activity like listening to books on tape.

When can my child go back to school?
One of the more frustrating aspects of recovery is that every kid heals at a different rate. Headaches can linger, and children may have difficulty paying attention and concentrating. Typically, we want children's symptoms to improve before they return to school. We often will recommend they start on a modified schedule, such as a half day, with no homework assignments, and build up from there as symptoms allow. Communication among the child, parents, doctor, and teachers is critical during this period.

When is it safe to return to sports?
Light aerobic activity, such as walking, is okay as long as their dizziness has abated and their headache is mild or gone, but children should be 100 percent symptom-free for one week before returning to their sports program. Most athletic trainers and coaches know about the "return to play" protocol in school sports, which calls for a graded approach, rather than putting the kids back into full competition mode. For instance, youngsters may start with basic running and if their symptoms don't return, they progress through sports-specific drills, then practice, then -- if still symptom-free -- they can return to the full game.

We know that children who receive a second concussion while already suffering from an initial concussion have more symptoms and take longer to recover. Some schools screen their athletes at the beginning of the year with a computerized "baseline test" to evaluate a child's ability to pay attention and focus. Then, if the child suffers a head injury, subsequent tests can support a concussion diagnosis, and help in determining the child's readiness to return to sports.

How can concussions in youth be prevented?
Accidents will happen -- as will concussions. The risk for concussion is greater in certain sports, such as football, ice hockey, lacrosse, and soccer. If you are worried about concussion or if your child seems accident-prone or has previously suffered multiple concussions, you may want to choose a lower-risk sport, such as swimming or cross-country. Beyond that, we don't have good preventive measures. We think helmets may help, but there is no data yet to suggest they dramatically change the concussion rate, and we don't want to give a false sense of security. The most important thing to remember is that early recognition and management of concussion symptoms are vital to helping your child recover fully and return to school and play.

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