Concussions

While recent news coverage has focused extensively on the issue of concussions in professional athletes, the fact remains that kids get concussions, too – and not only from sports.

A concussion is a traumatic brain injury that:

• is most often caused by a direct blow to the head, but can also result from body blows that snap the head forward or backward
• sends the brain into a spinning motion 

What happens when a child gets a concussion?
Concussions usually cause:

• headaches
• difficulty falling or staying asleep (insomnia) or excessive sleepiness
• dizziness
• nausea
• fatigue
• difficulty concentrating, remembering and paying attention
• problems with balance and coordination 

How are concussions treated?
Rest (both physical and mental) is usually the best treatment for a concussion, and symptoms typically improve within a few days and are gone within a month. After symptoms have cleared up, children can resume their normal school, home and sports routines as long as they have been evaluated and given the ok by their doctor.

How do I know if my child needs to see a specialist?
It is possible that a child with a concussion will need more specialized treatment. If your child is not getting better – or is actually feeling worse – after the first few days, you should ask for a referral to a specialist. 

Rarely, a child with a concussion will experience serious complications. You should seek immediate emergency care if your child:

• has blood or fluid coming out of her nose or ears
• has a seizure
• loses consciousness
• has worsening headaches
• vomits repeatedly
• experiences difficulty breathing
• has trouble walking or standing
• experiences a change in pupil size (one is bigger than the other, or both are abnormally enlarged)
• starts slurring her speech or experiencing difficulty speaking
• develops noticeable bruising or a large bump anywhere on her head

Why is there such a focus on concussions in student-athletes?
While children frequently sustain concussions for other reasons – falls or car accidents, for example – student-athletes are at particular risk. According to the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention, as many as 3.8 million concussions happen each year in the U.S. during sports or recreational activities. This is especially troubling because:

• an athlete who has had a concussion is at increased risk of suffering another
• athletes can develop second impact syndrome if they sustain another concussion before a prior concussion has fully healed. This is a rare but severe syndrome that can cause swelling in the brain, brain damage, coma and even death.

Here at Children’s Hospital Boston, we treat concussions with a multidisciplinary approach – combining our clinicians’ expertise in sports medicine, neuropsychology, neurology, and neuroradiology. Our experts are fully equipped to assist your child – and each member of your family – at every step of the way. 

Causes

What causes a concussion?
A concussion is caused by the brain going into a rapid spinning motion. This most often happens because of a direct blow to the head, but it can also happen if the head is snapped forward or backward by a blow to the body (for example, a hit to the chest or facemask during sports).

Signs and symptoms

What are the symptoms of a concussion?
Most children with concussions will have headaches and difficulty falling or staying asleep (insomnia). They can also experience:

• dizziness
• excessive sleepiness
• nausea
• fatigue
• confusion
• memory loss
• difficulties concentrating
• problems doing their schoolwork
• difficulty with balance and coordination

All of these symptoms should start to improve after a few days of rest and refraining from any strenuous physical or mental activity.

It’s important for parents to recognize possible symptoms, because younger children don’t always realize that what they are experiencing could be linked to a concussion. Parents should watch for any evidence of their child:

• being slow to acknowledge or respond when spoken to
• struggling with balance and coordination
• looking or acting “spaced-out”
• appearing “glassy-eyed”

If you suspect your child may have sustained a concussion, you should always seek treatment from a qualified medical professional right away. Even if the trauma your child experienced appeared very minor – for example, a collision during a game that he quickly got up and walked away from – and his symptoms don’t seem “serious,” it’s essential that he be evaluated by a doctor.

FAQ

Q: Will my child be OK?
A:  Most likely, he will be just fine. The vast majority of children who have sustained a concussion make a complete recovery with no complications. However, it’s crucial that a child with a concussion is diagnosed and treated properly, and that he avoids physical and mental exertion for the period of time recommended by his doctor.

Some children with concussions do develop more serious complications. It might be months before they regain normal brain function and feel “like themselves” again. This is especially true of children who experience a second concussion when they have not fully recovered from their first.

If your child has suffered a possible concussion, the most important thing you can do to maximize his chances of a full recovery is to seek immediate medical treatment. Always follow prescribed recommendations for rest, monitoring and follow-up care. And, if your child plays sports, be sure to adhere to the restrictions and gradual schedule for return to play outlined by his doctor.

Q: Is a direct blow to the head the only way of getting a concussion?
A: No. Concussions occur when the brain is sent into a sudden "spin," which can also happen when there's a blow to the chest or torso that causes the head to snap forwards or backwards.

Q: Which sports carry the highest risk of concussion?
A: Football tends to attract the most attention in the media, but ice hockey players are just as likely – if not more likely – to suffer sports-related concussions. And virtually any sport or physical activity can result in concussions: here at Children’s, we have seen patients with concussions sustained during baseball, softball, rugby, wrestling, lacrosse, soccer, basketball, field hockey, horseback riding and even swimming!

Q: Is a concussion always obvious right away?
A: Most of the time, warning signs show up shortly after the initial impact. However, it’s also possible that symptoms won’t emerge until later  (or that they will be subtle enough to be overlooked, especially if the child has also suffered a more visible injury like a fracture or laceration).

For this reason, it’s a must that – even if your child has received immediate treatment from a coach, athletic trainer, school nurse or EMT, or in the emergency room – he also see his regular doctor as soon as possible. He should be monitored closely for the next few days.

Q: Is there any way to prevent concussions? Can’t helmets and mouthguards stop them from happening?
A: Nothing can prevent a concussion altogether. Helmets were designed to guard against catastrophic brain injuries, not concussions (and mouthguards, although very good at protecting the mouth and teeth, don’t lower the risk of concussions, either.)

Neck-strengthening exercises can likely reduce the chance of your child’s head snapping forward or backward if he sustains a blow to the body. Talk to your doctor about recommended exercises for your child’s age, size and (if applicable) the sport he plays.

Finally, if your child has already suffered one concussion, the best way to prevent another is to make sure he has recovered fully (getting plenty of mental and physical rest) and has been cleared by a doctor before returning to his normal routine, including athletics.

Q: What is chronic traumatic encephalopathy? Could my child develop it as an adult?
A: Chronic traumatic encephalopathy is a relatively new diagnosis. It is a rare syndrome that has been observed in some former athletes – most notably, football players – who suffered multiple concussions during their sports careers, and went on to experience severe mental health and memory problems later in life. Autopsies have revealed changes in their brains that are very similar to the changes caused by Alzheimer’s disease.

Doctors and researchers believe that sustaining repeated concussions on the playing field may have caused irreversible brain damage in these athletes. However, since the disease is so newly discovered, and research is still in the very early stages, it is entirely possible that other factors beyond multiple concussions were involved.

Q: What is second impact syndrome and is my child is at risk?
A: Second impact syndrome happens when someone who has not completely recovered from a prior concussion sustains another blow to the head, even a minor one.  For reasons that doctors do not fully understand, some of these individuals experience massive brain swelling that can lead to a coma or even death. 

Although second impact syndrome has received widespread news coverage, it is a rare phenomenon. It can be avoided by reporting concussions, and being honest with medical personnel.  It’s always essential that a child who sustains a concussion is given plenty of time to heal and rest – and gets formal clearance from his doctor before returning to playing sports and the rest of his daily routine.

Q: Does my child need to give up sports if she’s suffered a concussion?
A: Most likely, no. Nearly every student-athlete who experiences a concussion can eventually return to sports – but only gradually (after getting the prescribed amount of rest), and only with a doctor’s explicit permission. Talk to your child’s doctor about the approach that will work best for her.