November 21, 2012
Signs and Symptoms of Concussion from the Centers for Disease Control and Prevention Heads Up Toolkit Parent Handout
Signs Observed by Parents:
-Appears dazed or stunned
-Is confused about assignments or position
-Forgets an instruction
-Is unsure of game, score or opponent
-Answers questions slowly
-Loses consciousness (even briefly)
-Shows behavior or personality changes
-Can’t recall events prior to hit or fall
-Can’t recall events after hit or fall
Symptoms Reported by Athlete:
-Headache or "pressure" in head
-Nausea or vomiting
-Balance problems or dizziness
-Double or blurry vision
-Sensitivity to light
-Sensitivity to noise
-Feeling sluggish, hazy, foggy or groggy
-Concentration or memory problems
-Does not "feel right"
As high school football players gear up for post-season competition, parents, coaches and young athletes are focused on playing smart and aggressively to beat out their opponents. On the day of competition, many of these teams may be faced with a star athlete becoming injured and having to make the crucial call: Keep him in or take him out? In the past, getting back in the game after a “ding” or “getting your bell rung” and “playing it out” was commonplace, expected and a sign of toughness. Now, returning a young athlete to play after a head injury is not only dangerous and strongly discouraged by professional societies such as the American College of Sports Medicine and the American Academy of Pediatrics, but in some states, like Washington, it is also illegal. Any parent whose child plays football or other high-risk sports like soccer, lacrosse and ice hockey, or any sport in which a child is at risk for a head injury, should absolutely be concerned about concussions.
A concussion is caused by an impact injury to the brain, resulting in symptoms such as headache, irritability and other changes in behavior (see sidebar, "Signs and Symptoms of Concussion from the Centers for Disease Control and Prevention"). Loss of consciousness is not necessary for an athlete to have a concussion; in fact, loss of consciousness is uncommon. While some athletes who have suffered a concussion will experience symptoms immediately, others may not notice symptoms for days and possibly even weeks after the injury.
The severity of a concussion is affected by past history of concussion (those athletes who have had a concussion in the past are at increased risk for both a repeated and more severe concussion), neck strength, the magnitude and location of the impact and whether an athlete has experienced a prolonged loss of consciousness (longer than one minute). Young athletes, especially females, are at higher risk of concussion, and children and teens also take longer to recover than adults.
Any athlete who has experienced a concussion should be removed from same-day play and be evaluated by a physician. While some athletes who "feel fine" after a brief period of disorientation or confusion or other sign suggesting a concussion may want to get back in the game, the risk is never worth it. An athlete who experiences a "second blow" while still symptomatic from a previous concussion is at increased risk for a prolonged recovery and, in some cases, even permanent brain damage or death. As many experts advise, "When in doubt, keep them out."
Other long-term effects of concussions are mostly unknown. Most athletes seem to recover fully without permanent effects. However, some studies have found that athletes with two or more concussions perform poorly in school and have information-processing delays. Some athletes with a history of repeated concussions report changes in the way they think, feel and communicate with others. They also have experienced changes in memory, personality and cognitive functioning. Depression and inability to concentrate are common. An autopsy of an 18-year-old multisport athlete who had suffered multiple concussions playing football found evidence of chronic traumatic encephalopathy, severe brain damage previously found only in the autopsies of a number of professional football players and boxers.
A physician will carefully evaluate an individual who has suffered a head injury for continued symptoms. An athlete is safe to resume exercise when he or she experiences no symptoms at baseline, is on no medications to control symptoms and has a normal physical exam. The return to exercise will occur in a graded fashion, typically taking seven to 10 days for a complete recovery (see sidebar, "Recommended Stepwise Return to Play from the American Academy of Pediatrics"). Some athletes, however, may experience symptoms for weeks to months. During the time of recovery, athletes should rest both physically and cognitively. The American Academy of Pediatrics recommends that while a child is symptomatic, he or she should not attend school, watch television, play video games, read or otherwise engage in cognitively demanding activities. Upon return to school, a recovering child may require a shortened school day, decreased workload, more time for tests and sufficient time to make up school work. The pediatrician can help to explain to school officials the importance of this cognitive rest.
While concussions cannot be entirely prevented, coaches, parents and athletes can take several steps to decrease risk. This includes:
- Wearing appropriately fitting protective equipment. While wearing a helmet does not prevent concussions, the improper use and fit of a helmet may increase risk.
- Enforcing the rules. Athletes should never get away with spearing, head-to-head contact or leading with the head.
- Emphasizing good technique.
- Reporting signs of concussion early. Everyone involved in youth sports should be vigilant in the early identification and treatment of head injuries in young athletes.
In the midst of the excitement and energy generated from competitive sports, youth athletes and their parents and coaches must not overlook the importance of prevention, early identification and treatment of concussions. More information is available from the CDC’s Heads Up campaign.
The scientific understanding of concussions in youth athletes is constantly evolving. The statistics and information contained within this blog are from two excellent publications, which represent the most recent guidelines from the American Academy of Pediatrics and the American College of Sports Medicine:
Halstead, M.E., Walter, M.D, and The Council On Sports Medicine and Fitness (2010). Clinical report—sport-related concussion in children and adolescents. Pediatrics, 126, 3, 597-615. Available for free at: http://pediatrics.aappublications.org/content/126/3/597.full
Herring, S.A. et al. (2011). Concussion (mild traumatic brain injury) and the team physician: A consensus statement—2011 update. Medicine & Science in Sports & Exercise, 43, 12, 2412-2422. Available for free at: http://journals.lww.com/acsm-msse/Fulltext/2011/12000/Concussion__Mild_Traumatic_Brain_Injury__and_the.24.aspx
By Natalie Digate Muth
Natalie Digate Muth, MD, MPH, RD, FAAPNatalie Digate Muth, MD, MPH, RD, FAAP is the Healthcare Solutions Director for the American Council on Exercise, a board-certified pediatrician and Fellow of the American Academy of Pediatrics, a Diplomat of the American Board of Obesity Medicine, registered dietitian and board-certified specialist in sports dietetics, and ACE-certified health coach. She is the author of "Eat Your Vegetables" and Other Mistakes Parents Make: Redefining How to Raise Healthy Eaters" and the upcoming textbook "Sports Nutrition for Health Professionals". She has been ACE certified since 1998.