Concussions

About Concussions

The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. The brain can move around inside the skull and even bang against it. If the brain does bang against the skull — for example, if a child hits his or her head on the sidewalk — the brain can get bruised, blood vessels can be torn, and the nerves inside the brain can be injured. These injuries can lead to a concussion, which is the temporary loss of brain function.

There are three different types, or grades, of concussions. The severity of a concussion determines the length of time needed before a player can safely return to sports activities:

• Grade 1 concussions involve no loss of consciousness and cause a temporary change in mental state, like confusion, disorientation, and trouble focusing, which resolves within about 15 minutes.
• Grade 2 concussions are similar but the change in mental state lasts longer than 15 minutes.
• Grade 3 concussions include a loss of consciousness, regardless of how long they last.

Head injuries that result in concussions can be caused by car, bike, and motorcycle accidents; falls; assaults; and contact sports (football, ice hockey, volleyball, lacrosse, basketball, wrestling, field hockey, rugby, soccer, softball, baseball, etc.).

Signs and Symptoms of a Concussion

A child with a concussion may lose consciousness, but this doesn't occur in every case. Other signs of a concussion include:

• feeling confused and dazed
• temporary amnesia
• blurred vision
• headache
• slurred speech or saying things that don't make sense
• difficulty concentrating, thinking, or making decisions
• difficulty with coordination or balance (such as being able to catch a ball or other easy tasks)
• vomiting
• trouble remembering things, such as what happened right before or after the injury
• feeling anxious or irritable for no apparent reason

Young kids can have the same concussion symptoms as older kids and adults, but changes in mood and behavior may be more subtle.

Call an ambulance or go to the ER right away if, after a head injury, your child:

• can't be awakened
• has one pupil — the black part of the eye — that's larger than the other
• has convulsions or seizures
• has slurred speech
• seems to be getting more confused, restless, or agitated

Though most kids recover quickly from concussions, some symptoms — including memory loss, headaches, and problems with concentration — may linger for several weeks or months. It's important watch for these symptoms and contact your doctor if they persist.

Diagnosis

If a concussion is suspected, the doctor will ask about how the head injury happened, when, and its symptoms. The doctor also may ask basic questions to gauge your child's consciousness, memory, and concentration ("Who are you?", "Where are you?", "What day is it?").

The doctor will perform a thorough examination of the nervous system, including testing your child's balance, coordination, nerve function, and reflexes. Sometimes a doctor may order a CT scan of the brain (a brain X-ray) or an MRI (a non-X-ray brain image) to rule out bleeding or other serious injury involving the brain.

Treatment

If the concussion is not serious enough to require hospitalization, the doctor will provide instructions on how to take care of your child at home. The doctor may have you wake your child up at least once during the night. If your child cannot be easily awakened, becomes increasingly confused, or has other symptoms (such as continued vomiting), it may mean there is a more serious problem that requires contacting the doctor again.

The doctor will probably recommend that your child take acetaminophen, ibuprofen, or other aspirin-free medications for headaches.

After a concussion, the brain needs time to heal. It's very important for kids to wait until all symptoms of a concussion have cleared up before returning to normal activities. Recovery time will depend on how long the symptoms last. Healthy kids can usually resume their normal activities within a few weeks, but each situation is different. A doctor will monitor your child closely to ensure that recovery is going well.

A child diagnosed with a concussion shouldn't participate in sports or other physical activities until the doctor says that it's safe. Even if your child pleads that he or she feels fine or a competitive coach or school official urges you to go against medical instructions, it's essential to wait until the doctor has given the OK. Even mild concussions require the player to sit out for the remainder of the game. It may take less force to sustain a second or subsequent concussion. And evidence shows that repeated concussions can result in lasting brain damage, even when the injuries occur months or years apart.

If your child was hurt while playing sports, the doctor will advise you when it is OK to return to play. After a Grade 1 concussion, a patient is usually cleared to play once symptoms go away. After a Grade 2 concussion, the individual should not play again that day and should only return after being symptom free for at least a week. After a Grade 3 concussion, a child is typically told to wait for 1 to 2 weeks without symptoms before returning to play.

Preventing Concussions

Childproofing your home will go a long way toward keeping an infant or toddler safe from concussions and other injuries. Babies reach, grasp, roll, sit, and eventually crawl, pull up, "cruise" along furniture, and walk. Toddlers may pull themselves up using table legs; they'll use bureaus and dressers as jungle gyms; they'll reach for whatever they can see.

All of these activities can result in a head injury that leads to a concussion. Be sure your child has a safe place to play and explore, and never leave a baby or toddler unattended.

All kids should wear appropriate headgear and safety equipment when biking, blading, skateboarding, snowboarding or skiing, and playing contact sports.

In vehicles, children younger than 1 year should be placed in rear-facing infant-only seats or convertible child safety seats. Kids older than 1 year who weigh more than 20 pounds can be safely restrained in forward-facing child safety seats. Those weighing between 40 and 80 pounds, usually between 4 and 8 years of age, can use belt-positioning booster seats or combination seats that allow the harnesses to be removed. Older kids should always wear a seat belt.

The time you spend taking these safety precautions — and getting your child into the habit of abiding by your safety rules and regulations — will help keep your child safe and sound!