Concussions in children

What to expect during your child’s concussion evaluation

At the initial evaluation, your child will meet with several members of our team. Your child’s concussion evaluation begins with a comprehensive history and medical exam with a licensed athletic trainer and a physician to confirm concussion diagnosis and evaluate for complications. This comprehensive evaluation can take 1 - 1.5 hours, so please plan for an extended time in the clinic. We will educate you and your child on the typical course of a concussion and the need for physical and mental rest. Together, we will discuss what to expect through the recovery process.

Your child’s team members

Every member of every team is important and has an essential part to play at certain stages of recovery. A multi-disciplinary team can provide multiple perspectives of the student/athlete and can provide multiple sources of data.

Communication and collaboration = TEAMWORK
Teamwork = the safest way to manage a concussion

• Family team: Who from the family will watch, monitor, and track the emotional and sleep/energy symptoms of the concussion and how will the family team communicate with the school and medical teams?
• School team: Who at the school will watch, monitor, and track the academic and emotional effects of the concussion?
• Sports/physical activity team: Who at the school/club will watch, monitor, and track the physical symptoms of the concussion once the medical team has cleared the child to start activity?
• Medical team: How will the medical team get information from all of the other teams?

A baseline concussion test helps improve concussion care and make return-to-play decisions. You can schedule a test yourself at these locations:

• Delafield
• Greenfield
• Mequon

Or call our concussion line at (414) 337-8000.

Return to learn

Return to learn, or RTL, is the important process of getting an injured student back into the classroom. This is an individualized process, as it depends on the injury/symptoms, academic abilities of each patient, and school work load. As the student uses their brain, it may increase symptoms which can interfere with life and learning and may slow recovery. It is important to understand that athletes need to be symptom-free and back to normal to return to sport, however, we cannot wait for that to return students to school - we expect students to have symptoms initially with RTL.

• Some people may need to miss days of school and then gradually increase from partial days to full days.
• Class work expectations usually need to be reduced to help patients recover.
• Athletes should not return to sport until they have returned to full days of school and completing their class work without any adjustments or accommodations.
• Learn more about the free course, Return to Learn, that we designed for educators to help their students return safely to the classroom. 

Return to play

When all four "teams" agree that the student/athlete is 100% recovered and has been able to attend one to two full days of school without adjustments, then the medical team can approve starting the graduated return to play (RTP) protocol.

• The introduction of physical activity is the last test of the brain cells to make sure they are healed and that activity does not "flare" symptoms. This is the final and formal step towards "clearance" and the safest way to guard against a more serious injury.

• If symptoms return during the progression, stop activity immediately and call the Concussion Line at (414) 337-8000.

• Download our recommendations about returning to activity/play after a concussion.

Q: Do kids always lose consciousness when they get a concussion?
A: False: Most concussions do not involve a loss of consciousness (LOC). Nor does LOC indicate a more severe injury.

Q: Are Neuroimaging tests (i.e. CT scan or MRI) needed to diagnose concussions?
A: False. Concussions cannot be detected by neuroimaging tests. Concussions are typically diagnosed by careful examination of the signs and symptoms after the injury. Symptoms during a concussion are thought to be due to an energy crisis in the brain cells (neurons), causing the cells to stop functioning normally. Because of the injury, there is not enough "fuel" (sugar/glucose) for the cells to work efficiently to help you play or think. While a CT scan or MRI may be used after head trauma to look for bleeding or bruising in the brain, a scan will be normal after a concussion. A negative scan does not mean that a concussion did not occur.

Q: Should I place my child in a “dark room” with no stimulation to promote healing?
A: False. We do not recommend dark room or "cocoon" therapy for treatment since it has not been shown to decrease the time of recovery. While it is appropriate at first to avoid visual stimulation - including video games, computers, texting, television and reading - you should not go to the extreme of a dark room to enhance recovery.