Concussions

School is back in session! What that means for some parents is, time to coordinate hectic work, school and even sports schedules! Aside from the nuances of driving this child here and there, could be the thrill of cheering on your child on the field. But with all this excitement also comes the fear of head injuries. According to the AAP, a concussion is “any injury to the brain that disrupts normal brain function on a temporary or permanent basis” either from a bump, blow or jolt to the head or body1. Concussions most commonly occur with collision sports such as football but also common in non-helmet wearing contact sports like soccer, basketball. It may also occur with normal activities on the playground or in the home.

The infant, toddler even the teenage brain is still developing sometimes into the second or third decades of life2, 3. In general, following a mild traumatic brain injury, children may have symptoms in four primary categories according to the CDC4, 5:

1. Physical: headaches, dizziness, vision problems, early nausea/vomiting
2. Cognitive: memory problems, concentration or difficulty focusing
3. Social-Emotional: emotional, irritable, anxious
4. Sleep: difficulty falling asleep, sleeping more/less than usual

Some symptoms may occur right after the injury whereas others only appear when the child resumes usual activities therefore it is essential that the parent pay attention and ask the child if he or she experiences any symptoms. Concerning symptoms would be worsening headaches, recurrent vomiting, altered mental state (worsening confusion, slurred speech, unable to wake up), convulsions or seizures and the healthcare provider should be notified.

Not all children with head injuries need imaging such as CT scans. Healthcare providers must weigh the risks and benefits of scanning your child’s head following the injury based on a combination of risk factors such as age, type of injury and clinical presentation. There are various validated clinical decision-making rules and validated scales used to evaluate symptoms which assist the provider in assessing and managing the concussion5. Therefore, it is important to be seen by the provider if your child experiences a concussion.

Most children with concussions will feel better within a couple of weeks however functional recovery in the majority of children (70-80%) may be within 1-3 months and further prolonged in children with risk factors such as underlying neurologic or psychiatric disorders, family or social stressors5.

The important point would be to make sure your child takes things slowly. Recommendations are to have physical and cognitive rest for 2-3 days then slowly return to light aerobic activity followed by non-sports regular activities such as school if it does not significantly exacerbate the symptoms. Restrictions are primarily symptom dependent. If an activity does not worsen the symptoms, then that activity is acceptable. Allow your child to take daytime naps as needed and have a good night’s rest following the injury. Make sure that your child has the maximum night time sleep by limiting screen time (TV, videogames, texting, internet) and caffeinated drinks. He or she may return to school gradually within a few days and should have some outside time such as taking short walks. Breaks are needed if symptoms worsen. Acetaminophen and Ibuprofen are acceptable for headaches if approved by the provider. Regarding sports, it also depends on the child’s symptoms e.g. gradual return with increasing physical exertion as tolerated. No contact sports are allowed until the child is symptom-free with exertion without the aid of pain medications5.

The CDC Heads Up website has plenty of resources for parents to review including concussion recovery tips tailored to individual symptoms. See below for additional resources. In general, children are supposed to be active and play hard but it also important to understand how vulnerable their brains are. Prompt identification and management of concussion symptoms will help your child recover quicker and avoid lifelong consequences.

Resources

1. American Academy of Pediatrics. Concussions. HealthyChildren.org. Page last updated November 21, 2015. https://www.healthychildren.org/English/health-issues/injuries-emergencies/sports-injuries/Pages/Concussions.aspx
2. The University of Utah. NeuroLogic Examination for Pediatrics: Videos and Descriptions A Neurodevelopmental Approach. Last updated August 2016. https://library.med.utah.edu/pedineurologicexam/html/dev_anatomy.html
3. Stiles J, Jernigan TL. The Basics of Brain Development. Neuropsychology Review. 2010;20(4):327-348. doi:10.1007/s11065-010-9148-4.
4. Lumba-Brown A, Yeates KO, Sarmiento K, et al. Diagnosis and Management of Mild Traumatic Brain Injury in Children A Systematic Review. JAMA Pediatr. Published online September 04, 2018. doi:10.1001/jamapediatrics.2018.2847
5. Centers for Disease Control and Prevention. Traumatic Brain Injury and Concussion: CDC Pediatric mTBI Guideline. CDC.org. Page last updated September 4, 2018. https://www.cdc.gov/traumaticbraininjury/PediatricmTBIGuideline.html
6. Kansas State High School Activities Association. KSHSAA Concussion Guideline & Educational Resources. http://www.kshsaa.org/Public/General/ConcussionGuidelines.cfm