Dr. Bob: Both of my children play sports where there is a risk of head trauma or a concussion – football and soccer. Are there special precautions I should take? How serious are concussions in childhood? What do I do if they get a concussion?
Answer: Your questions are common ones from parents during childhood. Almost any activity could potentially lead to a concussion – sports, bike riding, playing on the playground, tree climbing and so forth. We want children to be active and recognize that we cannot remove all potential dangers, but we want to try to take steps to protect them when we can. Let me breakdown your questions.
- What is a concussion? It is a mild brain injury. Even though the brain is sheltered in the skull and surrounded by a layer of liquid, it can still be “shook up” and alter its activity. Altered brain activity is manifest by symptoms as noted below. Fortunately, there is rarely direct injury to the brain that can be seen on imaging testing.
- What are the symptoms? The symptoms can be quite variable but in addition to (or instead of) a loss of consciousness, they can include appearing dazed or stunned, moving awkwardly, slowed or slurred speech, some degree of amnesia, or behavioral changes. More serious symptoms are usually obvious, like headache, vomiting, dramatic behavioral changes, confusion, or weakness. The degree of the symptoms does not necessarily correlate to the seriousness of the concussion, so if there is any concern seek medical attention.
- What testing is needed to make a diagnosis? Contrary to popular belief, brain imaging isn’t necessarily performed on every child who has a concussion. A thorough physical examination to include a neurologic examination and appropriate monitoring are often sufficient. Each case is unique so the physician will need to know the history, the symptoms, any underlying medical problems, and a family’s resources for monitoring after the concussion. I have admitted children to the hospital overnight for observation in the past if the circumstances merit it. A neurosurgeon isn’t necessary unless the symptoms, examination and imaging suggest a more serious problem.
- Will there be lifelong consequences? Fortunately, childhood concussions are usually isolated events without lifelong effects. Most children recover quickly and resume normal activities in a short period of time. The medical guidelines for concussions have changed several times in my career so be sure to follow the advice of your pediatrician for returning to school and returning to sports activity. Some lingering effects after several weeks can occur so be sure to have your child be honest with you about how they feel.
- Should the children report to the parents or coaches if they had a possible concussion? Yes! Only by reporting the problem can proper testing be done to ensure no further damage. I am very excited with the heightened awareness about concussions and removal from play when necessary to be on the safe side.
- What can be done to prevent concussions? In football, proper fitting head gear and learning the proper way to tackle is very important. In soccer, heading the ball is definitely discouraged under age 10 and taught with appropriate supervision over that age. Wear a helmet when riding a bike.
It is estimated that around 5% of children get a concussion. Seek medical attention. Protect your children when they are engaged in an activity where it is more likely to happen.
Dr. Saul is Professor of Pediatrics (Emeritus) at University of South Carolina School of Medicine – Greenville and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.