Children and Concussions
Many children are active and on the go – participating in a wide variety of sports and activities. It’s important for caregivers to know the best way to keep kids safe while taking part in physical activities. Every year, more than 400,000 kids are sent to the emergency department for serious brain injuries. Injuries from car crashes, playgrounds and sports are the most common ways that kids get concussions.
Concussions and Brain Injury
The brain, made up of soft tissue, is cushioned by blood and spinal fluid. When someone gets a blow to the head or hits something very hard, the brain shifts inside the skull and can knock against the bony surface.
“A concussion is defined as a type of traumatic brain injury,” says John Hackett, MD, Medical Director and Primary Care Physician at Newton-Wellesley Family Medicine and Medical Director and School Physician for Waltham Public Schools. “The injury disrupts the normal function of the brain and can range from mild to severe in presentation. Any bump, blow or jolt to the head or body can be the cause.”
A concussion may only last for a short time or they can continue for days or weeks. “There is no single sign or symptom or group of signs or symptoms that defines a concussion,” says Dr. Hackett. “Each concussion presents differently and is dependent upon the age of the child, severity of impact, other medical history and issues that already may exist in a particular child.”
Experts at Newton-Wellesley care for many children with the signs of a concussion. “We see and treat children for concussions in the Pediatric Emergency Department at Newton-Wellesley,” says Mary Chris Bailey, MD, Chief of Pediatric Emergency Medicine at Newton-Wellesley. “I encourage parents to learn and understand the various symptoms of a concussion so they know the steps to take if they suspect one.”
A Variety of Symptoms
Symptoms vary and some can present anywhere from immediately after the concussion to even hours to days after the event. Possible symptoms include:
- Physical – Nausea, vomiting, headaches, sleep problems, dizziness/ balance problems, light/noise sensitivity, feeling tired all the time, double/blurry vision
- Thinking – Trouble remembering and paying attention, slower thinking and giving answers, looking dazed, grade issues at school, reading problems
- Behavior/Personality – Excessive irritability, sadness or moodiness, different personality around other people, easily frustrated, more risky/impulsive, wants to be alone more
“The severity of these symptoms should dictate the caregivers’ response,” says Dr. Bailey. “For severe symptoms or prolonged symptoms, they should seek immediate medical care. For minor symptoms, the most important consideration is when the child can return to sports or other activities that put them at risk for more severe injury a second time.”
She advises consulting the child’s pediatrician to discuss minor symptoms and determining next steps.
For more severe symptoms, caregivers should bring children to the emergency department, where they will have a complete history and physical examination including a detailed neurologic exam. If the child’s symptoms are minor and gradually resolving and their neurologic exam is normal, they will be sent home with recommendations for return to activity as well as brain rest such as decreased TV and computer time. If the symptoms are more severe or prolonged, they will likely need a head CT scan to determine what happens next.
Recurrent Head Injuries
“Recurrent head injuries have been shown to lead to long-term learning and memory problems,” says Dr. Bailey. “Through our collaboration with Massachusetts General Hospital, we are able to refer children who have had a more severe concussion or multiple concussions to the Massachusetts General Hospital Pediatric Trauma Clinic. At the Clinic the child is evaluated for any neuropsychologic deficits that are a result of the injury. The team then makes recommendations to the school and the family on how to help the child compensate for the deficits.”
Since getting more than one concussion or having a severe concussion can lead to serious problems, it is important for parents and caregivers to understand how to prevent them from happening.
“Recurrent concussions following an initial concussion can result in a very serious condition called Second Impact Syndrome,” says Dr. Hackett. “This rare condition results in rapid and severe brain swelling with catastrophic results when the brain is not allowed to heal properly after the concussion. Second Impact Syndrome can occur hours, days, even weeks after the initial concussion. Appropriate medical follow up to ensure healing of the initial concussion is very important.”
Recurrent concussions over many years have shown that each later concussion likely prolongs recovery at the next episode. Ongoing research is being conducted to study the potential longterm effects of concussions. Even though many concussions may resolve in a matter of a few weeks; there are also many that don’t. There is not a single test to decide when a child has recuperated fully. Each concussion needs be handled on a case-by-case basis.
“We are uncertain if the number of concussions is on the rise or if parents, schools, sports organizations and society are becoming more aware of the problem,” adds Dr. Hackett. “With the increased education of all parties involved, everyone is doing a better job of identifying concussions that previously went under diagnosed or reported.”
Prevention comes with safety awareness and good education for both parents and children. Communication with your child and their coaches during sports seasons and appropriate parental involvement will also help.
“One of the best ways to avoid concussions is to understand what the risks are for a given sport,” adds Dr. Bailey. “For example there has been a reduction in head injury in football by avoiding certain types of tackling. In soccer heading the ball is not recommended for younger children. It is also important to make sure that appropriate protective head gear is used for a given activity. The most obvious example is the use of bicycle helmets at all times when riding a bike, skateboard or inline skating. Pre-sport conditioning is also important to prevent injury. Equipment for a given sport should fit properly and be in good condition.”
Dr. Hackett explains that the guidelines generally include no sports or practice at all until the child has a week of no symptoms. The health care provider will then clear the child for a slow increase or graduated return to sports before resuming game activities. Usually at high schools, the athletic trainers assist with this graduated play protocol.
“Many of our high school athletes may be evaluated by the school’s certified athletic trainer and given specific instruction,” he adds. “A recent Massachusetts law now requires all public high schools to have a concussion policy in place to help educate the coaches, players and parents as well as a guide policy for evaluation after a concussion and return to play.”
For youth sports-related concussions and non-sports related accidents, each parent should contact their child’s primary care provider to review the symptoms and events. The provider will help decide when a visit is needed and discuss a further specialty referral if required. “We want to educate parents, caregivers and children about concussions and ways to prevent them,” says Dr. Hackett.
“We want people to understand the resources available here at Newton-Wellesley to treat these injuries and help children continue to participate in healthy and fun physical activities.”
Mary Christine Bailey, MD
Chief of Pediatric Emergency Medicine, Newton-Wellesley Hospital
Dr. Bailey is board certified in pediatric emergency medicine. She received her medical degree and completed her internship and residency at Oregon Health Sciences University. She completed her fellowship in pediatric emergency medicine at Boston Medical Center. Dr. Bailey has served as the trauma research coordinator for Children’s Hospital and has presented research on trauma in children at both the pediatric and emergency medicine national conferences.
John Hackett, MD
Medical Director and Primary Care Physician at Newton-Wellesley Family Medicine and Medical Director and School Physician for Waltham Public Schools
Dr. Hackett is board certified in family medicine. He received his medical degree from Boston University School of Medicine and completed his residency at the University of Massachusetts Memorial Medical Center. Dr. Hackett has also served as the team physician for Waltham High School Football for the past 13 years.
For more information about Newton-Wellesley Hospital, please visit www.nwh.org or call CareFinder at 1-866-NWH-DOCS (694-3627) .
Pediatric Emergency Department at Newton-Wellesley Hospital
To care for children in a comfortable environment – close to home – Newton-Wellesley provides dedicated pediatric emergency services in a community hospital setting. Through a collaboration with MassGeneral Hospital for Children, the Hospital offers advanced services in a separate area within the Emergency Department (ED) designated for pediatric patients.
“Our Pediatric Emergency Department is staffed by full-time, pediatric-dedicated physicians with additional training and experience in pediatric emergency medicine,” says Mary Christine Bailey, MD, Chief of Pediatric Emergency Medicine at Newton-Wellesley. “We’ve gone to great lengths to create a high-quality, child-friendly facility so families feel calm, safe and secure when they have to make a trip to our Emergency Department.”
The Pediatric Emergency Department has one of the highest patient volumes of all pediatric emergency departments in the state of Massachusetts and is equipped to provide the highest level of medical care for children. To accommodate the growing pediatric population, the Hospital’s partnership with MassGeneral Hospital for Children allows specialists to be available for treatment, consultation and referral whenever necessary. For critical care situations, the Hospital has established a unique telemedicine link that connects physicians via video to pediatric intensive care specialists at MassGeneral Hospital for Children.