Gone are the days when my friends and I would try to bounce each other off a trampoline and over the neighbors fence. Safety is always on the forefront of our minds these days, but as we all know, things happen. More and more kids are enrolling in competitive sports (instead of doing dumb tricks in their own yards) and concussions are becoming more frequent. On more than a few occasions, head injuries have resulted in controversy between kids, coaches, parents, and medical professionals. Caregivers and players have a wide range of motivations to minimize or ignore a sports related injury, but according to the CDC in 2011, there were at least 1.6 million ER visits due to sports-related brain injuries. Interestingly though, brain-injury-related deaths are actually decreasing in number due to more emphasis on wearing helmets in the past 15 years. Yay!
What is a concussion?
Once I overheard a fellow mom giving advice to another mom. It went about like this… “Oh honey, don’t worry about your child’s goose-egg. If the bump goes out, you don’t have a problem. If your child has a dent though, then you need to see a doctor.” As well educated readers, I’m sure that red flashing alarms are now going off in your head. Heavens to Betsy, a dent?!?
Does a real concussion have external signs? Maybe, but not always. It is an internal injury with internal symptoms. However, if your child has a dent, by all means please move it on down to the local ER. You are then free to panic and scream uncontrollably as anyone in your circumstance should. Here is your actual definition though… A concussion is a type of brain injury caused by a sudden impact or blow to the head, a whiplash insult, or shaking-type injury, which disrupts the way the brain functions. Concussions are a type of traumatic brain injury (TBI), but the key to differentiation is that symptoms are temporary and imaging scans appear normal.
Besides vicious neighbors on trampolines, what type sports are considered the most likely to cause a problem? Contact sports have the highest incidence of concussions, but you may be surprised to find that the number 1 culprit behind ER visits for brain injury is from bicycle riding. Following biking in incidence are: ice hockey, lacrosse, soccer, and cheerleading. Most professionals agree that it is a good idea to avoid tackle football, body checking in hockey, and “heading” in soccer before the age of 14. Also, restricting headfirst sliding in youth baseball and requiring helmet use in lacrosse may decrease risk.
What tells us that a child’s injury may be more than a simple bump? While symptoms of a concussion range in duration and intensity, they usually show up within 1 hour to 3 days of the injury. Symptom severity also depends on the age and gender of the child. A child under 10 will have a more significant chance of serious injury due to having a rapidly developing brain, and girls will tend to heal much slower and experience more symptoms than boys. Some symptoms are indicative of more serious brain injuries and require a trip to the ER. These include symptoms that most parents or coaches would be very uncomfortable watching such as; loss of consciousness, REPEATED nausea or vomiting, slurred speech, a difference in pupil size, convulsions, weakness, numbness, or a decrease in coordination, and any symptom that increases in intensity and does not go away.
Here are the more commonly seen symptoms of concussions that tell us our kids are in need of a little more than hugs and kisses:
- Headache (71%)
- Balance problems or dizziness (55%)
- Double or blurry vision (49%)
- Sensitivity to light or noise
- Concentration or memory problems
- Nausea or Vomiting
So steps for prevention have failed, and your child has experienced a concussion. You will encounter no judgment here. I, the PT writing this blog, had a 4 year old with a skull fracture after running across my just-mopped floor. (He’s fine now, thank you for asking.) After seeing any of the above symptoms, you will want to pursue medical treatment and advice for your child. Symptoms will typically resolve within 7-10 days, but medical providers will be able to prescribe the proper medications and activity restrictions for your child. During this time period however, it is absolutely critical that no recurrent injury occur. The results of “second impact syndrome” are not pretty and I do not feel like discussing it.
The CDC recommends that when a head injury is suspected, manage the child by following a 4 step plan:
- Immediately remove the child from play.
- Pursue an evaluation by a health care professional trained in the care of individuals with concussion.
- Allow physical and cognitive rest (restrict activity, limit school, TV, computer, music, and keep the child in a low light setting.)
Modify the school environment with a 504 plan if necessary.
- Follow a return to play protocol guided by a heath care provider.
The CDC has a wealth of information on the subject for parents, coaches, teachers, and even has training videos for people preparing to assume these roles. As a parent, one of my hardest jobs has been helping my kids balance risk and freedom. My hope is that God will give us all wisdom, and give our kids lots of heavenly bubble wrap. :