Concussions: the hottest topic right now in football. A huge lawsuit and a lot of targeting penalties can attest to the fact that players, coaches and referees all agree that head injuries are a big deal, and it’s high time we treat them that way. Concussions can happen at the pee-wee level too – or on the monkey bars or the sidewalk outside your house. Do you know what to do if your child hits his head? We talked to Cook Children’s neurologist Howard Kelfer to find out what we need to know about concussions and how to keep our kids safe.
What is a concussion?
Dr. Kelfer says many people don’t even understand what a concussion is. “A lot of people think a concussion means you get knocked out or your lose consciousness – and that’s definitely not true,” he says. According to the CDC, a concussion is “caused by a blow to the head or body that causes the brain to move rapidly inside the skull.” This could be caused by a mild bump on the jungle gym, tripping and falling on the stairs at school or getting bulldozed by a 300-pound lineman – anything that shakes up the brain cells. It can happen in a 2-year-old, a 10-year-old or a teenager.
What are the signs of a concussion?
Dr. Kelfer explains that there are physical signs and cognitive signs. Physical signs include vomiting, dizziness, balance problems, sensitivity to light or noise, headaches and of course a goose egg at the point of impact. Cognitive symptoms include what Dr. Kelfer calls “mental fog” – trouble concentrating, trouble remembering, feeling slow. Parents might see this mental fog manifested in the form of lower grades – and frustration from their kids. “They know that they did better at schoolwork than they do now.” Concussed kids also show emotional changes; “they tend to be irritable or anxious or sad,” Kelfer says.
The symptoms may start right away, or they may be delayed – which makes it even more important for parents and coaches to use caution when an incident occurs that might have induced a concussion.
What should you do if you suspect a concussion?
First and foremost, take your kid out of the game – or playground, or bounce house, or wherever the incident occurred. Kelfer advises parents not to mess around with concussion symptoms. “If in doubt, get them out.”
Taking them out of the activity also precludes the chance for Second Impact Syndrome, or getting a second concussion before the symptoms of the first are resolved. Dr. Kelfer explains that SIS compounds the degree of damage to the brain, with disastrous results.
Once you have removed your child from the situation, decide whether to call 911. “If he’s just feeling a little dizzy and headachy, go home and rest,” Dr. Kelfer explains. “If he’s vomiting, or if he’s not perfectly awake and alert, you need to come to the ER.”
In addition to physical rest after a concussion, your child needs cognitive rest. AP classes and a full academic load are not good for a recovering brain injury. Parents should make arrangements with their child’s school to facilitate his recovery, and at home they should limit screen time and other activities that stress the brain.
When can your child return to physical activity after a concussion?
Dr. Kelfer says symptoms can last for a few days but typically last for a week or two. On rare occasions, you may see symptoms for months after the incident. To prevent SIS, your child should not return to intense physical activity until his symptoms are cleared. Most athletic programs have a rule that a child cannot return without a medical release.
While the doctor can be a good judge of whether your child is ready to return, your child might be the best indicator. Even if his physical symptoms appear to be gone, your child should honestly evaluate his cognitive symptoms – is the mental fog completely gone?
Even after the symptoms have disappeared, returning to physical activity should be a gradual process. The CDC outlines a six-step progression for returning to play:
- Complete physical and cognitive rest. Symptoms should be gone for 24 hours.
- Light aerobic exercise, such as walking or stationary bike.
- Moderate exercise, such as jogging and moderate-intensity weight-lifting.
- Non-contact exercise, including light resistance training and more complex drills.
- Full contact practice.
- Competitive play.
How can kids prevent concussions?
“Don’t play football,” Dr. Kelfer says simply. “No human being should play football.” But here in North Texas, that doesn’t even feel like an option for a lot of families. Thankfully, coaches and trainers are becoming more knowledgeable about concussions. There are new rules being established and new equipment being manufactured all the time to keep kids safer.
Dr. Kelfer also says training and practice can help kids’ bodies prepare for impacts during game-time. Strengthening their neck muscles can prevent their heads from bobbing back and forth. And learning to protect themselves by going full-tilt during practice is much more effective than avoiding contact during practice sessions.
If your child plays football, ice hockey, soccer or girls’ basketball, you should be especially vigilant, as these are the most concussion-prone sports. But even if you can’t prevent a fall from happening, you can make sure your child heals safely.
Published February 2014
