Concussions in Kids

It’s a knockout!!! Or does it need to be???

As we head back into contact winter sports, such as AFL, Rugby Union and Rugby League, the hot topic of concussion will again feature in the news. As professional players continue to come forward demonstrating the long term effects of cumulative head trauma and other current players been told to retire, what exactly is the risk to children playing sport and what should we, as caregivers, be looking out for?

Firstly, what is concussion? Concussion is a type of traumatic brain injury resulting in a short-term loss of normal brain function in response to a head injury. Common symptoms are headache, dizziness, nausea, vomiting and impaired memory. Repeated, subsequent concussions can lead to longer-term health impacts, particularly if another head injury is sustained before a full recovery is made from the initial insult.

Younger players, i.e. children, are at a greater risk of concussion due to the immaturity of the cells in a child’s brain. For a given force, a child’s nerve cells in the brain are more likely to be torn apart and damaged than in adults. Contrary to popular belief that concussion means you have been ‘knocked out’, concussion has a wide range of presentations and is caused by either a direct or indirect blow to the head – you do not need to be knocked unconscious to have symptoms or concussion or to incur damage to brain cells. An example of a direct blow would be if a child is tackled and as they fall, they hit their head on the ground or a cricket ball hits them in the head. An indirect blow would involve sustaining an impact like falling off their bike but not hitting their head on any object at all.

Education of signs and symptoms is key. Coaching staff, support staff, teachers, officials and parents need to know what to look for to ensure concussion is recognized early and is fully resolved before return to play. Symptoms do not always show straight away and can develop up to 72 hours post injury. More serious symptoms that would warrant a trip to the Emergency department include the following:

• Loss of consciousness
• Severe headache, including a headache that gets worse
• Blurred vision
• Trouble walking
• Confusion and saying things that don’t make sense
• Slurred speech
• Unresponsiveness (you’re unable to wake your child)

However, more subtle symptoms may include:

• Lack of concentration
• Difficulty sleeping
• Increased frustration or irritability
• Memory loss

More subtle symptoms would warrant a trip to the GP or Sports Doctor and would need to be monitored for resolution prior to returning to sport.

Treatment for concussion includes the following:

Physical rest

o No physical e.g. school PE or sports until the symptoms have fully resolved. Physical activity should be limited to basic day-to-day activities to reduce the stress on the brain and decreases the likelihood of the child sustaining another brain injury during the recovery period. Once the symptoms are resolved the child should follow a graduated return to sport/play, working their way back to pre-injury activity levels.

Mental Rest

o This means avoiding any cognitive activity ie thinking, that could make the symptoms worse eg watching TV, using a computer, doing schoolwork, reading, playing video games etc. These activities can be re-introduced and gradually increased if they don’t exacerbate symptoms.

Eating well and staying well-hydrated avoiding caffeinated beverages.

In summary, it is important to be educated in the signs and symptoms of concussion, especially when working with children in contact sports. Early recognition and good medical follow-up can aid in avoiding a second injury whilst the brain is healing.

References:

Kemp, J.L., Newton, J.D., White, P.E., & Finch, C.F. (2016). Implementation of concussion guidelines in community Australian Football and Rugby League – The experience and challenges faced by coaches and sports trainers. Journal of Science and Medicine in Sport, 19, 305-310

Concussions. Reviewed by Ben-Joseph, E.P. and Maughans, T.A. , March 2015

 http://kidshealth.org/en/parents/concussions.html

Why are kids at greater risk of concussion than adults? Cantu, R.
http://www.brainline.org/content/multimedia.php?id=9017



Concussion. Centers for disease Control and Prevention
https://www.nlm.nih.gov/medlineplus/concussion.html