Concussions

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

Beautiful weather has arrived; kids are out riding bikes, playing sports, jumping on the trampoline, skateboarding and multiple other activities. So lets talk about concussions, also called mild traumatic brain injuries. If your child falls on the playground or falls off a bike or falls on a sports field their brain, which is essentially soft tissue surrounded by spinal fluid, can bang against their bony skull causing injury.

If your child has a head injury you should watch them closely for any signs of a concussion. There can be behavioral changes such as increased crankiness, drowsiness, and trouble falling asleep or sleeping more than usual. Mental/cognitive changes include slowed reaction times, difficulty concentrating, difficulty remembering, confusion, and/or impaired learning. They may complain that bright lights or loud noises bother them. The physical symptoms include headache, nausea, vomiting, dizziness, any loss of consciousness, and impaired coordination.

Symptoms can occur within hours to days of the event. They usually do resolve within 1 to 4 weeks.

The important aspect in all this is to have your child checked by their pediatrician when they have had a direct or indirect hit to the head. MRI or CT scans are most often normal.  Your child’s pediatrician will do a thorough neurological exam and discuss the follow-up your child will need.

The first step after a concussion is physical rest and mental rest accompanies this. Your child should avoid any thinking activity that could make symptoms worse – this includes using a computer, a cell phone, watching TV, doing homework or playing video games. Teens should not drive or participate in any activity that requires quick decisions and actions.

Most children can return to school and normal activity within a few weeks, but this is very individual. You want your child to be healed completely before doing anything that could cause a second concussion. Talk to the teachers, counselors and the school nurse about your child and their symptoms. They may need a graduated return to learning protocol. This includes cognitive rest with slowly increasing cognitive tasks, and slowly increasing school attendance, limiting tests to no more than one a day, and limiting homework assignments to 15 to 20 minute blocks.

Once your child is back to school with full function, then the return to play for sports can be initiated.

Return to play is a six step plan that begins with no activity until symptoms subside and then slowly increasing activity without any body contact or jarring movements, weight lifting or resistance training, until the last stage when they can return to play their sport fully. The six-step plan applies to children over age 10. Your pediatrician will handle the return to school and play individually for children under age 10.

During all this, if your child has a headache that increases in severity over a brief period of time, becomes increasingly confused, lethargic or has frequent vomiting, you need to call your pediatrician or go to a pediatric ER as the symptoms could indicate a serious problem.  

As with any health issue prevention it’s best to remember sports specific safety gear for your child.