Concussion Education 

What is a concussion?

A concussion is a brain injury that results in a temporary disruption of normal brain function. A concussion occurs when the brain is violently rocked back and forth or twisted inside the skull due to a blow to the head or body. An athlete does not have to lose consciousness (be “knocked out”) to suffer a concussion.

Concussion Facts

  • It is estimated that over 140,000 high school athletes across the United States suffer a concussion each year. (Data from NFHS Injury Surveillance System)
  • Concussions occur most frequently in football, but girls’ lacrosse, girls’ soccer, boys’ lacrosse, wrestling, and girls’ basketball follow closely behind. All athletes are at risk.
  • Concussion symptoms can persist from a few days to several months.
  • Concussions can interfere with school, work, and social life.
  • Athletes should not return to sports while still having symptoms from concussions, because doing so places them at risk for prolonged symptoms and further injury.
  • Concussion symptoms can be subtle, and they are often difficult to recognize; some symptoms appear immediately after the injury, but others may develop over the next several days or weeks.

Signs and symptoms of a concussion may include the following:

  • Headache or a feeling of pressure in the head
  • Temporary loss of consciousness
  • Confusion or feeling as if in a fog
  • Amnesia surrounding the traumatic event
  • Dizziness or “seeing stars”
  • Ringing in the ears
  • Nausea or vomiting
  • Slurred speech
  • Fatigue

Some symptoms of concussions may be immediate or delayed in onset by hours or days after injury:

  • Concentration and memory complaints
  • Irritability and other personality changes
  • Sensitivity to light and noise
  • Sleep disturbances
  • Psychological adjustment problems and depression
  • Disorders of taste and smell 

If you or your child experiences a head injury, even if emergency care isn’t required, see a doctor within one to two days.

The American Academy of Pediatrics recommends that you call your child’s doctor for advice if your child receives anything more than a light bump on the head. If your child remains alert, moves normally and responds to you, the injury is probably mild and usually doesn’t need further testing. In this case, if your child wants to nap, it’s OK to let her sleep. If worrisome signs develop later, seek emergency care.

Seek emergency care for a child who experiences any of the following symptoms after a head injury:

  • Vomiting
  • A headache that gets worse over time
  • Changes in his or her behavior, including irritability or fussiness
  • Changes in his or her physical coordination, including stumbling or clumsiness
  • Confusion or disorientation
  • Slurred speech or other changes in speech
  • Vision or eye disturbances, including pupils that are bigger than normal (dilated pupils) or pupils of unequal sizes
  • Changes in breathing pattern
  • Lasting or recurrent dizziness
  • Blood or fluid discharge from the nose or ears
  • Large bumps or bruises on areas or the head other than the forehead, especially in infants under 12 months of age

Seek emergency care for anyone who experiences a head injury and any of the following symptoms:

  • A loss of consciousness lasting more than a minute
  • Repeated vomiting
  • Seizures
  • Obvious difficulty with mental function or physical coordination
  • Symptoms that worsen over time

Seek emergency care for a child who experiences any of the following symptoms after a head injury:

  • Vomiting
  • A headache that gets worse over time
  • Changes in his or her behavior, including irritability or fussiness
  • Changes in his or her physical coordination, including stumbling or clumsiness
  • Confusion or disorientation
  • Slurred speech or other changes in speech
  • Vision or eye disturbances, including pupils that are bigger than normal (dilated pupils) or pupils of unequal sizes
  • Changes in breathing pattern
  • Lasting or recurrent dizziness
  • Blood or fluid discharge from the nose or ears
  • Large bumps or bruises on areas or the head other than the forehead, especially in infants under 12 months of age

Seek emergency care for anyone who experiences a head injury and any of the following symptoms:

  • A loss of consciousness lasting more than a minute
  • Repeated vomiting
  • Seizures
  • Obvious difficulty with mental function or physical coordination
  • Symptoms that worsen over time

What should you do if you think your child has had a concussion?

If an athlete is suspected of having a concussion, he or she must immediately be removed from play, be it a game or practice. Continuing to participate in physical activity after a concussion can lead to worsening concussion symptoms, increased risk for further injury, and even death. Parents and coaches are not expected to diagnose concussions; that is the job of a medical professional. However, you must be aware of the signs and symptoms of a concussion—and if you are suspicious, then your child must stop playing.

When can an athlete return to play following a concussion?

After suffering a concussion, no athlete should return to play or practice on that same day. Previously, athletes were allowed to return to play if their symptoms resolved within 15 minutes of the injury. However, studies show that the young brain does not recover quickly enough for an athlete to return to activity in such a short time.

Concerns over athletes returning to play too quickly have led state lawmakers in both Oregon and Washington to pass laws stating that no player shall return to play following a concussion on that same day, and that the athlete must be cleared by an appropriate healthcare professional before he or she is allowed to return to play in games or practices. The laws also mandate that coaches receive education on recognizing the signs and symptoms of concussion.

Once an athlete no longer has symptoms of a concussion and is cleared to return to play by a healthcare professional knowledgeable in the care of sports concussions, he or she should proceed with activity in a stepwise fashion to allow the brain to readjust to exertion. On average, the athlete will complete a new step each day. The typical schedule for returning to play should proceed as outlined below, following medical clearance:

  • Step 1: Light exercise, including walking or riding an exercise bike; no weight-lifting.
  • Step 2: Running in the gym or on the field; no helmet or other equipment.
  • Step 3: Non-contact training drills in full equipment; weight-training can begin.
  • Step 4: Full contact practice or training.
  • Step 5: Gameplay.

If symptoms occur at any step, the athlete should cease activity and be re-evaluated by his or her healthcare provider.

How can a concussion affect schoolwork?

Following a concussion, many athletes will have difficulty in school. These problems can last from days to months and often involve difficulties with short- and long-term memory, concentration, and organization.

In many cases, it is best to temporarily lessen the athlete’s class load after the injury. This may include staying home from school for a few days, followed by a lightened schedule for a few days, or longer, if necessary. Decreasing the stress on the brain immediately after a concussion can mitigate symptoms and shorten recovery time.

What can I do?

  • Both you and your child should learn to recognize the signs and symptoms of concussions as listed above.
  • Teach your child to alert the coaching staff if he or she experiences such symptoms.
  • Emphasize to administrators, coaches, teachers, and other parents your concerns and expectations about concussions and safe play.
  • Teach your child to tell the coaching staff if he or she suspects that a teammate has a concussion.
  • Monitor sports equipment for safety, fit, and maintenance.
  • Ask teachers to monitor any decrease in grades or changes in behavior, which could indicate a concussion.
  • Report concussions that occurred during the school year to appropriate school staff. This will help in monitoring injured athletes as they move to the next season’s sports.

Other Frequently Asked Questions

Why is it so important that an athlete not return to play until they have completely recovered from a concussion? 
Athletes who are not fully recovered from an initial concussion are significantly vulnerable for recurrent, cumulative, and even catastrophic consequences of a second concussive injury. Such difficulties are avoided if the athlete is allowed time to recover from the concussion and return-to-play decisions are carefully made. No athlete should return-to-a sport or to other activities that place them at risk if symptoms of concussion are present and recovery is ongoing.

Is a “CAT scan” or MRI needed to diagnose a concussion? 
Diagnostic testing, which includes CT (“CAT”) and MRI scans, are rarely needed following a concussion. While these are helpful in identifying life-threatening brain injuries (e.g., skull fracture, bleeding, swelling), they are not normally used in these cases, even for athletes who have sustained severe concussions. A concussion is diagnosed based upon the athlete’s recounting of the injury and the healthcare provider’s physical examination.

What is the best treatment to help my child recover from a concussion more quickly? 
The best treatment for a concussion is rest. There are no medications that can speed the recovery from a concussion. Exposure to loud noises, bright lights, computers, video games, television, and phones (including text messaging) all may worsen the symptoms of a concussion. You should allow your child to rest as much as possible in the days following a concussion. As the symptoms lessen, you can allow increased use of computers, phones, video games, etc., but use must be decreased if symptoms worsen.

How long do the symptoms of a concussion usually last? 
The symptoms of a concussion will usually go away within one week of the initial injury. You should anticipate that your child will likely be out of sports for about two weeks following a concussion. However, in some cases symptoms may last for several weeks, or even months. Symptoms such as headaches, memory problems, poor concentration, and mood changes can interfere with school, work, and social interactions. The potential for such long-term symptoms underscores the need for careful management of all concussions.

How many concussions can an athlete have before he or she should stop playing sports? 
There is no “magic number” of concussions that determines when an athlete should give up playing contact or collision sports. The circumstances surrounding each injury, such as how the injury happened and duration of symptoms following the concussion, are very important and must be considered when assessing an athlete’s risk of further and potentially more serious concussions. The decision to “retire” from sports is best reached following a complete evaluation by your child’s primary care provider and a consultation with a physician or neuropsychologist who specializes in treating sports-related concussions.

I’ve read recently that concussions may cause long-term brain damage in professional football players. Is this a risk for high school athletes who have had a concussion? 
The issue of “chronic encephalopathy” in several former NFL players has received a great deal of media attention lately. Very little is known about what may be causing dramatic abnormalities in the brains of these unfortunate retired football players. Currently, we have very little knowledge of the long-term effects of concussions which happen during high school athletics.

In the cases of the retired NFL players, it appears that most had long careers in the NFL after playing in high school and college. In most cases, they played football for over 20 years and suffered multiple concussions in addition to hundreds of other blows to their heads. Alcohol and steroid use may also be contributing factors in some cases. Obviously, the average high school athlete does not come close to suffering the total number or shear force of head trauma seen by professional football players. However, the fact that we know very little about the long-term effects of concussions in young athletes is further reason to manage each concussion very carefully.

Getting Better: Tips for Children

Parents and caregivers of children who have had a concussion can help them recover by taking an active role in their recovery:

  • Have your child get plenty of rest. Keep a regular sleep schedule, including no late nights and no sleepovers.
  • Make sure your child avoids high-risk/high-speed activities, such as riding a bicycle, playing sports, climbing playground equipment, and riding on roller coasters or other rides that could deliver another bump, blow, or jolt to the head or body. Children should not return to these types of activities until healthcare professionals say they are well enough to do so.
  • Give your child only those drugs that are approved by the pediatrician or family physician.
  • Talk with your child’s healthcare professional about when your child should return to school and other activities and how you can help your child deal with potential challenges. For example, your child may need to spend fewer hours at school, rest often, or require more time to take tests.
  • Share information about concussions with your child’s siblings, teachers, counselors, babysitters, coaches, and others who interact with the child to help them understand what has happened and how to meet your child’s needs.

Help Prevent Long-Term Problems

If you already had a medical condition at the time of your concussion (such as chronic headaches), it may take longer for you to recover from the concussion. Anxiety and depression may also make it harder to adjust to the symptoms of a concussion. While you are healing, you should be very careful to avoid doing anything that could cause a bump, blow, or jolt to the head or body. On rare occasions, receiving another concussion before the brain has healed can result in brain swelling, permanent brain damage, and even death, particularly among children and teens.

After you have recovered from your concussion, you should protect yourself from having another one. People who have had repeated concussions may have serious long-term problems, including chronic difficulty with concentration, memory, headache, and occasionally, physical skills, such as keeping one’s balance.

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