Concussion in Children
John W. Gainor, MD, Orthopedics
A concussion is a traumatic brain injury that occurs when the brain strikes the inside of the hard skull with a sudden deceleration (hitting a wall) or acceleration (whiplash). The brain is made up of soft tissue and it is cushioned by blood and spinal fluid. Imagine a cube of ice floating in a glass of water. When you move the glass abruptly the cube hits the inside of the glass. This kind of movement of the brain can cause bruising or even bleeding. In a closed container like the skull this bleeding can compress the brain. Common ways to get a concussion are fights, falls, playground injuries, car or bike crashes. They also can occur in sports such as football, boxing, hockey, soccer, skiing and snowboarding. The symptoms can vary from mild to severe and one does not necessarily lose consciousness. Every year more than 400,000 kids in the US are sent to emergency departments for serious brain injuries.
The symptoms fit into four main categories. Thinking and remembering problems may manifest as not being able to concentrate or remember new information. Kids may also not remember the injury itself (amnesia). The physical could be headache, dizziness, sensitivity to light, balance problems and, in severe cases, nausea and vomiting. Being nervous or anxious or being easily upset are examples of mood changes. Sleep patterns can be affected such as sleeping more than usual or having a hard time getting to sleep.
Young children can have the same symptoms as older children and adults. Very small children may incur an injury that nobody witnessed and cannot describe their symptoms often making it more difficult to diagnose a concussion. They may cry more than usual, be more easily upset than usual (temper tantrums), change the way they play, nurse, eat or sleep. Other clues are lack of interest in their favorite toys, loss of balance and trouble walking.
These symptoms can last from a few minutes to a few weeks after the injury. All concussions cause some disruption to the brain and call for an exam by your child's regular doctor and careful monitoring. Most concussions do not cause lasting damage although we all have heard about football player and boxers who have had multiple concussions resulting in permanent damage. The most well-known concussions occur during sports. Students are playing at higher and higher levels of competition and the risks are elevated. Coaches and trainers should be aware of the symptoms and should keep a possible concussion victim out of play until a medical exam is done. A strict rule is that any player with a suspected concussion is not to play again that same day.
Most people who have a concussion will feel groggy and dazed for at least a little while. They may be shaky or dizzy if they try to walk or do normal activities right away. Many will have a headache that lasts for days. Anyone with these symptoms, and who may be at risk of having suffered a concussion, should be examined right away. The doctor will ask questions that may seem silly. He or she will look in the patient's eyes and check reflexes and balance and perhaps do other tests. In severe cases a CAT scan (a special three-dimensional brain x-ray) may be ordered to determine if there is any bleeding inside the skull that could expand and put pressure on the brain, especially if the patient lost consciousness or is feeling quite sick in the emergency department. If the patient is discharged with a concussion the parents will receive a list of instructions which may include such things as to wake the child once or twice during the night to check their response.
Returning to sports after a concussion depends on an individual medical assessment and follow-up exam. Some experts recommend Cognitive Rest for concussion. During recovery they allow easy reading, music at low volume, short visits with friends, and short periods on video games and computers. Patients should avoid loud music, sending or reading text messages, loud games with flashing lights, using computer for more than 30 minutes or watching action TV.
Concussions can't always be avoided but common sense measures can help reduce the likelihood and effects of accidents. Seat belts and booster seats in cars are now mandatory and wearing the proper headgear for football, skating, snowboarding, skiing, biking and other activities provides protection for both children and adults.
Dr. John Gainor is board-certified in Orthopedic Surgery and received his medical degree from Albany Medical College at Union University. He served in the United States Army Reserve Medical Corp and started his medical career at Sansum Clinic in 1968.