Pediatric Concussion

John is a school football player who has been tackled and is at the bottom of the pile. As the players stand and regroup, they notice he is sitting and appears to be dazed and confused. He is brought to the sidelines where he is evaluated and found to have a concussion.

According to CDC statistics, pediatric concussions account for 500,000 ER visits yearly, 35,000 hospitalizations, and 2,000 deaths. The exact number of sports related concussions is not accurately known because many victims do not come to the ER for evaluation. Some experts speculate that the true incidence of sports related concussions may be close to three million yearly.    

The clinical definition of Concussion is as follows: any injuries resulting from a blow or jolt to the head that disrupts the normal brain function. The disruption may be temporary or permanent. Concussions occur in collision sports such as football, ice hockey, or other contact sports such as basketball or soccer. Non-sports related concussions occur in motor vehicle accidents, bike and skate board accidents and collisions with the ground or other objects. 

The symptoms of a concussion include the following: confusion, disorientation, headache, nausea, vomiting, dizziness or balance problems, double and blurry vision, sensitivity to light or noise, feeling dazed, mentally foggy, short term memory loss, post-traumatic amnesia, trouble concentrating, change in mood, irritation, overly emotional, nervousness, sleeping more than usual, fatigue, and trouble falling asleep.

Whatever severity, all concussions are serious and all athletes with suspected concussions should not return to play until they see a doctor. The physician should confirm the diagnosis of concussion and, if necessary, order tests such as Cat scans or MRI scans of the head to rule out other complicating issues. He may decide to also order neuropsychological testing and other cognitive screens to help decide if and when it will be okay for the athlete to return to play. Premature return to play after a concussion can lead to another concussion and even death in some instances.

An athlete with a history of concussion may be more susceptible to other athletic  injuries than players without a history of concussion. Since no one knows how many concussions are too many before permanent damage occurs, repeated concussions are worrisome, especially if each new one takes longer to resolve or requires less of a blow to cause.

The treatment for a concussion is complete rest from all physical and mental activity. Screen devices such as TV, IPAD, cellphone, and loud music should be stopped or limited, especially if they worsen symptoms. School with all activities including test taking, homework assignments, PE, recess, and other extra-curricular activities should be suspended until symptoms are resolved. Duration of suspension is variable depending on the individual, the severity of the concussion, and history of previous concussions. Any worsening of concussion symptoms, change in neurologic status, including memory loss, disorientation, or behavioral changes should be reported to your doctor.        

All sports activity should be suspended until symptoms have completely resolved at rest. At that time a stepwise return to activity can begin. This plan must be individualized with close monitoring by the school nurse, athletic trainer, and coach.  Close observation of symptoms returning with exertion such as increasing headache, nausea, dizziness, ringing in the ears, or any other recorded previous symptoms may indicate that the concussion is not healed. Having a physician involved to monitor progress is highly recommended.

Professional Pediatrics