10 Signs Your Child’s Concussion Is Serious — and What to Do

If your child suffers a concussion, whether while playing sports or from a fall or other accident, keep a close watch for symptoms of more severe brain trauma.

“Parents should be concerned about a series of things we call red-flag issues,” says neurologistAndrew Russman, DO. “These are symptoms that warrant a prompt evaluation because they could signal something more worrisome than just a concussion.”

Watch for these 10 red-flag symptoms

If you see any of the following symptoms after a concussion, go to an Emergency Department immediately for a medical evaluation:

1. Severe or worsening headache or ringing in the ears
2. Neck pain
3. Vomiting
4. Increasing confusion or dizziness (Some patients exhibit sadness about the injury, unusual or irritable behavior or the inability to recognize people or places.)
5. Fainting, drowsiness, significant decline in alertness, inability to waken from sleep, any prolonged loss of consciousness
6. Seizures
7. Slurred speech
8. Weakness or numbness in arms or legs
9. Clear, watery discharge from the nose or ears, or bloody discharge from the ears
10. Pupils that are unequal in size

Of these, Dr. Russman says, the most common are headache, neck pain, and fogginess or dizziness.

“The basic concern is to know to identify the concussion symptoms and seek medical attention appropriately,” he says. “If there are some of these red flags, an ER evaluation is important.”

How to handle a less serious concussion

Dr. Russman addresses two common misconceptions about concussions.

First, if a child suffers a concussion, he or she does not necessarily need a CT scan, he says.

“Few patients with concussions will benefit from any type of brain imaging in their early evaluation,” he says. “In fact, ERs have a whole list of criteria for requiring a CT scan, so the patient would have to have at least one of the red-flag symptoms.”

Second, you don’t have to keep the child awake if he or she is not showing any of the red-flag symptoms, he says.

“As long as the child has remained awake and alert, there’s no reason that you have to wake them if they fall asleep at a normal time,” he says.

Again, if the child’s condition worsens or he exhibits any of the red-flag symptoms, take him or her immediately to the ER.

What usually happens when a child athlete gets a concussion?

Typically, if your child gets a concussion during an organized athletic event, one or more members of a team of trained medical professionals will examine him or her immediately. This usually starts with a team physician or athletic trainer on the sidelines. A physical therapist, pediatrician or neurologist may examine your child later.

After that initial evaluation, the medical professional will help decide whether the child should go to the office for a follow-up evaluation, to the ER for immediate medical attention, or whether he or she is well enough for parental observation at home.

“They should never return to the sport on the same day they have had the injury,” says Dr. Russman. “Next, they need to go through a graded program of physical recovery under the direction of a licensed healthcare professional.”

The goal for athletes

While most patients may not need an ER evaluation, they all need to carefully follow a set of guidelines that will return them to the classroom first, and then return them to their athletic activities, Dr. Russman says.

“The point person on the sidelines, the team physician and the athletic trainers, as well as the other medical professionals involved, will follow up and continue to evaluate and eventually help the child return to learn and return to play,” he says.

Source: “10 Signs Your Child’s Concussion Is Serious - and What to Do - Health Essentials from Cleveland Clinic.” Health Essentials from Cleveland Clinic. N.p., 31 Aug. 2015. Web. 31 Aug. 2015.

Concussions can occur in all youth sports

By JANE E BRODY

Recent attention to long-term brain damage linked to multiple concussions among professional football players has prompted a much closer look at how children and adolescents who participate in sports can be protected from similar consequences.

And with good reason. The young brain is especially susceptible to concussion, and sports-related concussions account for more than half of all emergency room visits by children ages 8 through 13, according to the National Athletic Trainers’ Association. A child who suffers a concussion is one and a half times more likely to have another, and those who have had two concussions have a threefold greater risk of the same injury happening again.

Many parents wonder if it is wise to let their children participate in sports like football and soccer, in which head injuries are most common. Concerns about concussion have been cited as a reason for a decline in enrollment in Pop Warner, the country’s largest youth football program.

At the same time, misconceptions among parents and coaches abound about the seriousness of concussions and how best to prevent them, especially for players who often think they are invincible and say they feel fine, so they can get back in the game. Studies have found that more than 50 percent of high school athletes and 70 percent of college athletes failed to report concussions they had suffered while playing football.

But first, it is worth noting that almost no sport is free of a concussion hazard, and that participating in sports has “cognitive, physical, emotional and social benefits that outweigh everything,” said Steven P. Broglio, director of the Neurotrauma Research Lab at the University of Michigan and the lead author of the National Athletic Trainers’ Association position statement on how best to deal with concussions among young athletes.

For far too long, concussions have been minimized, with youngsters who have suffered one often going back into the game much sooner than they should, sometimes on the very day they are injured. Experts say that even the language commonly used to describe a hit - like “ding” or “bell ringer” - minimizes the seriousness of the injury and should be abandoned.

Perhaps concussions would command greater respect if they were called by their proper medical term: mild traumatic brain injuries. A concussion is caused by a direct or indirect blow to the head. The brain is jostled against an unyielding skull, temporarily disrupting normal neurological and metabolic functions.

Contrary to popular belief, you don’t have to lose consciousness to have suffered a concussion. Ninety percent of concussions involve no loss of consciousness or only a brief disruption of mental alertness. You don’t even have to hit your head - a whiplash injury can cause one.

Furthermore, the usual five-minute assessment done on the sideline to check an injured athlete’s ability to orient, remember, concentrate and recall words “misses about 40 percent of concussions,” Broglio said in an interview. “A single test is not diagnostic and should not be relied on. Multiple different tests taken together can increase the sensitivity to the mid- to upper 90s.”

However, the time allotted to assess an injured athlete on the sideline is often inadequate to determine whether it is safe for a player to return, Broglio said. One of the most dangerous effects of failing to detect a concussion and allowing time for a young athlete to recover is second-impact syndrome - rapid, catastrophic swelling of the brain that can cause lifelong impairments, coma and even death - should the athlete have another concussion.

A growing number of parents now weigh the risks of concussion when helping their children decide which sport to pursue. The Institute of Medicine and the National Research Council of the National Academy of Sciences reported in 2012 that tackle football players suffered the most concussions among high-school-age athletes, with 11.2 reported among 10,000 “athletic exposures” - the number of practices and games in which an athlete participates. Lacrosse was the next riskiest, with 6.9 concussions per 10,000 athletic exposures although one recent study found ice hockey and wrestling to be more hazardous than lacrosse.

Among girls, soccer is associated with the highest risk - 6.7 concussions per 10,000 athletic exposures, according to the academy study. Although many focus on the hazards of heading the ball, a new study of high school soccer players found that contact with another player was by far the most frequent cause of concussions among female and male players.

The study’s authors, from the University of Colorado School of Public Health, predicted that “banning heading is unlikely to eliminate athlete-athlete contact or the resultant injuries.” They noted that soccer had become a much more physical sport in recent years, resulting in more collisions between players.

Girls’ basketball is not far behind, with 5.6 concussions per 10,000 exposures, a rate twice that of boys’ basketball.

Gymnastics has had a sharp rise in concussions in recent years. As the USA Gymnastics organization pointed out last year, “a concussion can be caused by a hit to the body, not just the head.”

Its statement added, “A gymnast could fall, have a whiplash type movement and sustain a concussion even though they didn’t hit their head.”

The lowest concussion rate is associated with swimming, with only 0.2 such injuries per 10,000 exposures among girls and 0.1 among boys who swim competitively, according to a 2012 study in The American Journal of Sports Medicine.

Every athlete, parent and coach should be familiar with the signs and symptoms of concussion, some of which may show up hours or days after the injury. The athletic trainers’ report includes these:

•Difficulty thinking clearly, concentrating or remembering new information.

•Headache, blurry vision, queasiness or vomiting, dizziness or balance problems or sensitivity to noise or light.

•Irritability, moodiness, sadness or nervousness.

•Excessive sleepiness or difficulty falling asleep or remaining asleep.

Any of these should be reported without delay to a coach, athletic trainer, parent or school nurse. Especially worrisome is a symptom that worsens with time.

All 50 states and the District of Columbia have laws to protect young athletes suspected of having suffered a head injury. Most important, the laws stipulate that no one with even a slight concussion should return to play the day of injury. The athlete should be evaluated and cleared by a health care provider trained to do so before returning.

Source: Brody, Jane E. “Concussions Can Occur in All Youth Sports.” Telegram.com. N.p., 26 Aug. 2015. Web. 26 Aug. 2015.

MIAA teams with ThinkTaylor and INARIA to raise concussion awareness in soccer

By DAN VENTURA

FRANKLIN - The Massachusetts Interscholastic Athletic Association (MIAA) announced a new initiative yesterday, entering into a partnership with former New England Revolution star Taylor Twellman’s foundation, ThinkTaylor, and soccer equipment company INARIA to introduce Concussion Awareness Week.

The initiative is aimed at helping raise awareness and better educate soccer players, parents, coaches and trainers on concussion injuries and proper treatment and will take place at all MIAA member schools hosting boys and girls soccer games during the week of Sept. 21.

Those schools will be encouraged to paint their fields orange, and will be given special balls, wristbands, scarves and information tags for each player’s equipment bags aimed at raising awareness.

“We need concussion awareness, recognition, education,” said Twellman, now the lead soccer analyst for ESPN. “At ThinkTaylor, we call it the care program and its real simple. If we can change three things, the awareness, the recognition and the education, then we’re going to make a difference.”

While this program is soccer-specific, the issue of concussions and traumatic brain injury extends across all sports.

“This is an opportunity and when folks come to the table and ask to participate in a partnership that we assess will make a significant difference, we jump on it,” said MIAA Executive Director Bill Gaine. “Irregardless of that, we have a responsibility as an association to continually reflect upon current standards and expectations vis a vis rules in all sports. We do have in place a sports medical committee and that committee continually are recommending more changes for the benefit of our student athletes. We have a universal issue but this is an opportunity to make a significant positive change and address problems in a particular sport community.

Twellman added, “I don’t care if you’re skateboarding, horseback riding, gymnastics, cheerleading, or playing football. “I get as many phone calls from football athletes as I do from soccer athletes. We’re equipped as a foundation to direct you to the right people, the doctors, to do the right thing. If another state comes to us and says mens and womens ice hockey, we want to do this, we’ll do it.”

Twellman used himself as a perfect example of how education in the area of concussions and traumatic brain injuries has been sorely lacking. He noted that he took and passed more than 70 baseline tests after suffering his concussion on Aug. 30, 2008, but was still unable to resume his career.

“The hardest thing for athletes to understand is, honesty on this injury is the most important thing,” he explained. “If a doctor looks you in the eye and says you’re fine but in your heart and in your head you don’t feel right then you have to speak up. That’s where I think it’s changed from 2008 to 2015. The moment the athlete is honest and says something, I think we have more people around him saying you have to sit out where in 2008, it was suck it up. I don’t think it happens as much but it’s still happening.”

Source: Ventura, Dan. “MIAA Teams with ThinkTaylor and INARIA to Raise Concussion Awareness in Soccer.” N.p., 26 Aug. 2015. Web. 26 Aug. 2015.