Concussions

A concussion is a type of traumatic brain injury caused by a rapid acceleration of the brain. Concussions are often the result of a direct hit to the head but can also result from any blow to neck, face, or body that places a rotational force on the brain. The symptoms, which include headaches and trouble with concentration, memory, and balance, are usually temporary.

You’ve probably heard about athletes having a concussion and needing to sit out a game or even the rest of the season. But concussions happen to plenty of non-athletes, too. In fact, millions of children have a concussion each year. Most children recover completely within several weeks.

If you think your child may have suffered a concussion, it’s important to seek treatment right away. Even if the injury or symptoms seem minor, they need to be checked by a doctor. Most concussions don’t cause a loss of consciousness. In some cases, a child who seems fine at first will develop symptoms later.

If your child has any of the following symptoms, seek emergency care right away:

• Blood or fluid coming out of their nose or ears
• Symptoms of a seizure
• Lost consciousness (passing out)
• Worsening headaches
• Repeated vomiting
• Trouble breathing
• Trouble walking or standing
• A change in pupil size (one is bigger than the other, or both are unusually large)
• Slurring words or trouble speaking
• Noticeable bruising or a large bump anywhere on the head

Most kids, if their concussions are managed properly and they avoid risky situations until they’ve fully recovered, will be fine. Typically, children fully recover from sports-related concussions within 10 days. Most regain normal brain function and do just as well in school and at sports as before. However, some patients take months to recover completely. Children who get a second concussion before fully recovering from the first are at risk for serious, long-term problems.

The most common long-term problem is delayed or incomplete recovery. This can happen after multiple concussions, or when a child has another concussion before fully recovering from a previous one. In some cases, repeated concussions can cause massive brain swelling and permanent brain damage. Such cases are extremely rare, however.

Recently, something called chronic traumatic encephalopathy (CTE) has been described in pro athletes, like wrestlers and football players. After multiple concussions, they went on to have serious depression and struggle with memory and basic activities of daily living. Boston Children’s Hospital is leading a five-year study of former NFL football players that aims to shed light on the long-term neurological health of these players. We believe, this study will help us develop better treatment and prevention methods for athletes of all ages.

People who have already sustained a concussion are at greater risk for subsequent concussions. The effects are likely to accumulate, in other words, each concussion causes more severe symptoms and requires longer recovery times.

If your child has just one concussion, you probably won't see a change in their physical or intellectual abilities. If they have multiple concussions, the risk for long-term changes increases. Every child is different, however, and there is no way to know when any given child will experience long-term effects. Some children have five or six concussions with no measurable long-term change in their abilities.

Children can get concussions from any hard hit to the head, neck, face, or body that cause a rapid acceleration of the brain. This typically happens when they are struck in the head. It can also occur if an athlete is hit on the facemask or chest, causing the head to snap forward or backward.

Some of the most common causes of concussion in children include:

• Falls
• Sports injuries
• Motor vehicle accidents
• Being hit by an object or another person

Is it possible to reduce a child’s risk of concussion?

The most important way parents and athletes can prevent serious injury from a concussion is to allow time for proper recovery. If your child has had a concussion, it is important to follow their doctor’s recommendation for when it is safe to return to vigorous exercise or other high-impact situations. In addition, neck-strengthening exercises can help keep an athlete’s head from snapping backward or forward during impact and reduce the chance of sports concussions.

Do helmets prevent sports concussions?

Helmets are not designed to prevent concussions. They are made to prevent catastrophic brain injury, which they're very effective at. Every athlete who plays football should have a new, properly fitted, undamaged helmet. But parents and athletes should understand that this will not decrease the risk of concussion.

Mouth guards have been proposed as a way to decrease the risk of concussion, but they don't help either. Mouthguards are an important way to prevent facial trauma during some sports, but they will not reduce the risk of concussion.

Most children and young athletes don't recognize their symptoms as a concussion. Parents can look for signs, like their child being slow to respond verbally, being off-balance and looking spaced-out or glassy-eyed. The bottom line is if you suspect your child has a concussion, take them to see a doctor. It's critical that patients are evaluated after sustaining a concussion.

Possible signs and symptoms of concussion include:

• Being slow to respond
• Headache
• Changes in sleep habits, such as sleeping more or less than usual
• Changes in play habits
• Dizziness
• Fatigue
• Trouble concentrating, remembering, or paying attention
• Changes in eating habits
• Persistent crying or crankiness

If your child has any of the following symptoms after a fall or hit, seek emergency care right away:

• Trouble with balance or walking
• Excessive vomiting
• Slurred speech
• Extreme tiredness or trouble being awakened
• Seizures or convulsions
• Loss of consciousness (passing out) for longer than 1 minute
• One pupil (black center of the eye) is larger than the other
• Problems with balance or coordination

There’s no way to see a concussion so, doctors look for signs of injury to brain function. The doctor will examine your child and take a full medical history. They may also check your child’s balance, coordination, and ability to think and process certain types of information. Your child may also need other tests depending on their symptoms.

What is baseline testing?

A baseline test can measure your child’s normal brain function and balance before any injury. This baseline measure can then be used as a comparison to help diagnose a concussion after an injury. For example, the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) test creates a record of a child’s physical and mental abilities. In the case of a concussion, this helps doctors track the child’s progress and back to their previous abilities.

We recommend that all student athletes, especially those who play high-impact sports like ice hockey, football, rugby, and soccer, get baseline testing before the start of the season.

The most important treatment for a concussion is physical and mental rest. This gives the body a break from moving and thinking, so the brain can heal. Depending on your child’s symptoms, they may need to stay home from school for a few days.

Physical and mental rest includes:

• Getting plenty of sleep
• Taking a break from the computer, phone, and reading
• Keeping stress levels low
• Modified or no homework
• No contact or collision sports, limited physical activity, and/or no gym class
• For older teens, no driving or operating any type of machinery
• Doing too much before the brain has fully healed can slow recovery. Your child’s doctor will tell you when it’s safe for your child to resume normal school, home, and sports routines.

Returning to sports after concussion

It's very important that a child with a sports concussion not return to sports until they have regained normal brain function. A second concussion is more likely and can have a more serious long-term impact.

Returning to sports after a concussion is a gradual process that involves a series of steps. Your child’s doctor will explain the specific steps for your child’s recovery, but they usually include:

1. A period of total rest from all physical activity, until all concussion symptoms have disappeared. This may take anywhere from a few days to several weeks, depending on your child's symptoms.
2. Clearance to start light aerobic activity, such as walking or riding an exercise bike.
3. Clearance to resume warm-up activities related to the child's sport (for example, jogging on a training track or swimming laps).
4. Clearance to take part in non-contact training drills.
5. Clearance to resume resistance training, gradually upping the level of difficulty with each session.
6. Clearance to return to full-contact training/practice. This can only begin after your child’s doctor has deemed it safe.
7. Clearance to take part in games or meets.

If concussion symptoms start again, your child should see the doctor right away. They may need to go back to the previous step (or several previous steps) until the symptoms go away and the doctor gives the OK to move forward. Don’t let your child's coach, trainer, or fellow athletes pressure them to returning to play too soon.

Medication

Although no medication can “cure” a concussion, your child's doctor may prescribe medication to manage symptoms such as headaches or trouble sleeping. If you have questions about any medication or are concerned about side effects, call or see your doctor right away.

Some children with a concussion need more specialized treatment. If your child is not getting better or is feeling worse after a few days, you should ask for a referral to a specialist.

How often your child will need to see the doctor for follow-up care depends on your child’s specific injury and symptoms. Some children need only annual check-ups, while others may require ongoing assessments and testing. Ask your doctor for a detailed follow-up plan.

• What to expect after a concussion (patient education brochure)

The clinicians and researchers at Boston Children’s are leaders in the field of concussion prevention and treatment and play an instrumental role in setting treatment guidelines that hospitals and clinics around the country use with their patients.

Our Brain Injury Center provides comprehensive care for children and adolescents with concussions and any other type of head or brain injury. Our Sports Concussion Clinic treats sports-related concussions and works with parents, athletes and coaches to ensure safe return to play.

We collaborate regularly with our clinical experts in sports medicine, neuropsychology, neurology, and neuroradiology. Whether a concussion is the result of an accident, fall or sports injury, our experts are fully equipped to assist your child every step of the way.