How to tell if a child has a concussion

In the past, there has been a temptation for athletes to just “play through the pain,” but as we have learned, concussions are serious injuries and must be treated appropriately to decrease the risk of long-term effects. This is especially true for children, whose developing brains may be morevulnerable to injury.

Unlike the pros, young athletes participating in sports often do not have the benefit of trained medical personnel on the sidelines to look for and evaluate head injuries. Because of this, parents and coaches should be aware of what symptoms to watch for to help determine when a bump on the head may actually be something more serious.

What to watch for

Below are some common signs and symptoms to watch for:

Physical symptoms

• Headache
• Balance problems/dizziness
• Nausea
• Vision problems
• Sensitivity to noise/light
• Increased fatigue
• Trouble falling asleep

Cognitive symptoms

• Difficulty concentrating
• Forgetfulness
• Feeling slowed down

Emotional symptoms

• Moodiness
• Increased irritability
• Anxiety

It is important to know that an athlete does not need to lose consciousness to have sustained a concussion and, in fact, most concussions do not involve a loss of consciousness.

When to worry

If you suspect your child has suffered a concussion, he or she should be removed from play immediately and not be allowed to return until he or she has been evaluated by a trained healthcare professional. Ideally, your child should be evaluated within 24-48 hours after the injury. Your child should be evaluated immediately in the emergency room if he or she has any of the following:Neck pain

• Neck pain
• Numbness/tingling or weakness of extremities
• Persistent vomiting
• Seizure or convulsion
• Increasing irritability or confusion
• Decreasing state of consciousness
• Severe or increasing headache
• Unusual behavior change
• Vision problems

Concussion treatment

When a concussion is diagnosed, it is important to carefully follow treatment recommendations to avoid prolonging symptoms or causing a worse injury. Brain rest, which includes both cognitive and physical rest, is important in concussion recovery. General recommendations for initial concussion treatment include the following:

• Limit visual stimulation: Wear sunglasses or a hat to block sunlight or bright indoor environments. Limit screen use (video games, computers, cellphones, TV, etc.) and reading. These activities require more energy from the brain and can worsen symptoms.
• Limit auditory stimulation: Avoid noisy environments.
• Sleep: Ensure your child is getting at least 8-10 hours of sleep per night and stick to a consistent bedtime schedule. Naps should be limited to 30-40 minutes, 1-2 times per day as not to interfere with regular sleep patterns.
• Diet: Don’t skip meals and maintain adequate hydration, preferably with water.
• Pain control: Over-the-counter acetaminophen (Tylenol) is the preferred medication after the initial injury (during the first 72 hours), although your child’s doctor may recommend others if the symptoms are severe or prolonged. Nonsteroidal anti-inflammatory drugs (such as ibuprofen) are typically safe to use after the first 72 hours.
• Limit physical exertion: Avoid activities that significantly increase heart rate.

Getting back in the game

While rest is important for concussion recovery, exactly how much rest is needed is unknown and can vary depending on the athlete’s symptoms.

In the past, it was commonly recommended that children rest completely from all academic and physical activities until symptoms completely resolved, but new research is showing that too much rest can make symptoms worse. Kids that are out of their normal daily routines and away from school and social activities for long periods of time tend to report more symptoms and take longer to recover compared to kids who gradually start returning to these activities when symptoms start improving (but have not yet completely resolved). Academic accommodations are typically recommended to help kids return to the classroom while they are still recovering.

Light physical activity after a period of rest can also be beneficial if it does not cause an increase in symptoms, but contact activities and activities that put kids at risk for being hit in the head should absolutely be avoided until the athlete has completely recovered. If a child returns to these activities too soon and gets hit in the head again before they have recovered, they are at risk for worsening their injury and prolonging recovery. In rare cases, this can be fatal.

Benefits of baseline testing

If your child does participate in sports, it’s a good idea to get a baseline concussion test done (you can schedule one by calling our Children’s Concussion Line at 414-337–8000). Baseline concussion tests are given to healthy athletes before a concussion happens. After a suspected concussion, the test is taken again and the results are compared to measure the athlete’s brain function. This helps sports medicine specialists diagnose a concussion, determine severity, devise a treatment plan and make return-to-play decisions.

It is important to remember that concussion symptoms and concussion recovery can be different from child to child. However, when treated properly, kids should be expected to make full recoveries.

Kimberly Hornbeck, MD Sports Medicine Specialist Greenfield Clinic

Children’s Wisconsin offers the only Sports Medicine Program in Milwaukee and Wisconsin just for young athletes. Our goal is to make sure your kids are healthy — and can get back to the activities they enjoy — as soon as possible.