Concussions in Children and Adolescents: What You Need to Know As a Parent From A Practicing Pediatric Emergency Physician

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by Dr. Christopher Haines

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05.07.2022

As a child, adolescent and through college, I have always been an athlete and adventurous. This has led to a fair amount of injuries and a few concussions along the way. And I am old enough, to have had concussions prior to medicine fully understanding the impacts of concussion. I always joke that maybe I would have been a neurosurgeon had I not been hit in the head so much, but I think I’ve done pretty well.

My last concussion (in retrospect I likely a few prior at a younger age) was while I was playing soccer. I went to head the ball and was kicked in the head by another player. I was knocked unconscious. Two to three minutes later (or at least I was told this and watched on video later), I woke up to the eyes of the trainer and did not remember what happened. And what happened next most parents (and physicians) would gasp in horror, I was told to run around a bit and sent back into the game. It was a state championship and I was not coming out and my coach wanted to win as well. After going back in, I don’t remember much but remember having trouble focusing on the ball, felt nauseous and threw up. I don’t even remember finishing the game (we lost), getting a CT scan in the emergency department or even the ride home. I do remember waking up the next morning and immediately losing my balance, feeling fatigued (honestly like I was hit by a truck), and feeling in a fog. These symptoms continued for several weeks and worsened every time I went to school or played sports. They gradually got better but I had ringing in my ears for 5 or 6 months. So why do I tell you this story? Because it is the polar opposite of what should have happened, what coaches and trainers are taught now, and why we have guidelines for concussions.

What is a concussion?

Concussions are a type of mild traumatic brain injury that can occur when the head and brain collide or move quickly back and forth. They are caused by a bump, blow, or jolt to the head, and can also happen when the body is shaken violently. Concussions in children differ from those in adults, and girls have a higher concussion rate than boys.

Symptoms of concussion?

Symptoms of concussion include:

  1. Headache
  2. Blurred/double vision
  3. Dizziness, balance problems, or trouble walking
  4. Answering questions slowly
  5. Amnesia (not remembering what happened)
  6. Not feeling well
  7. Nausea/vomiting
  8. Confusion
  9. Memory problems
  10. Difficulty speaking or understanding others
  11. Sensitivity to light or noise
  12. Fatigue

Symptoms can vary between boys and girls, with girls experiencing more concussion symptoms, longer concussion recovery times, and consequences of concussion. Concussion can impact school and sports performance if not recognized and treated.

How do you diagnose a concussion?

Diagnosis of concussion is based on history and physical exam findings. In general there are no imaging studies (MRIs or CT scans) that can be used to diagnose a concussion, but in certain circumstances they may be indicated. There are several tests that can be used to assess concussion symptoms, including the ImPACT concussion test. An ImPact concussion test is a concussion evaluation tool that is used to measure an athlete’s cognitive function. This test is frequently done at the high school level, college and professional athletic levels and is used as a baseline (completed prior to an injury and not done in the emergency department) which allows physicians to figure out when an athlete has returned to baseline and is ready for return to sports.

Treatment of concussions?

Treatment of concussion generally involves rest and avoiding activities that may cause a concussion until symptoms have passed. In general, although guidelines continue to change rapidly as more research becomes available, physicians will recommend a period of brain rest and limit physical activity. Brain rest is typically recommended for 5-7 days. What is brain rest? Think about it this way – if your child injured their leg would they walk on it? Of course not – they would rest, maybe use crutches or have a cast/splint. Think about concussions the same way – your child needs to rest their brain. So what does this mean? It means resting, limiting stimulation and particularly avoiding screens – phone, tablets, televisions. This also usually means not going to school/returning immediately to sports and letting teaches know your child’s diagnosis so they can support as symptoms may take several days to weeks depending on severity. In addition, many emergency physicians will recommend close follow up with your child’s pediatrician (if they are comfortable managing a concussion) or with a concussion specialist. These physicians can help guide a safe return to daily activities and athletics.

There is no one concussion treatment that fits everyone, and concussion rehabilitation may vary depending on the severity of the concussion. Treatment may include rest, physical therapy, cognitive rehabilitation, and medication if needed.

Can we prevent concussions?

Prevention of concussion is largely dependent on safe playing practices. Helmets should be worn during contact and collision sports, and rules that minimize head contact should be followed. Concussions can also occur from everyday activities, so it is important for children to wear helmets when biking or skating, and to wear their seatbelts on every car ride.

If concussion is suspected after any injury, it is important to seek medical attention as soon as possible. If a concussion has already occurred, proper management can help speed recovery and prevent further complications from concussion.

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For more information and resources on your baby’s or child’s health, parent tips and tricks, pediatric emergencies, please visit our website or blog. Follow us on Instagram, Facebook and Twitter. You can also visit our website to download free PDF guides and hear our podcasts @momanddoctalk

The information in this blog is not intended to substitute for professional medical advice, diagnosis or treatment. All content is for general information purposes and is the opinion of staff at Blue Emerald Wellness. Please do not delay seeking medical advice or treatment because of something you read in this blog.

Authored by Dr. Christopher Haines

Disclosure: We only recommend products we would use ourselves and all opinions expressed here are our own. This post may contain affiliate links. If you use these links to buy something we may earn a small commission. Read our full privacy policy here.

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