Concussions. Lots of press lately and it’s scary. If you are paying just slight attention to the news, you might never put your son in pads on the football field or perhaps your cheering is more subdued watching football on the weekends. But what if your child isn’t a football player? Well, guess what? Bike riding is a child’s number one risk for incurring a concussion. Yep — it’s almost double the rate of concussions incurred playing football for both kids under 14 and over 14. Yeah, yeah, yeah … I know. More kids ride their bikes than play football. True. That also shows how you have to use your brain, since we’re talking about brain health today, when looking at stats, knowing how to recognize a concussion and when to seek medical help. Concussions can happen anywhere. Today’s information will help you come out of the fear and be empowered with knowledge.
Let’s make one thing clear, obviously I am not an expert. The information I relied on for this piece came from two experts, well respected in their field: Dr. Jason Hubbard, of Howell Allen Clinic, and Dr. Colleen Vanderkolk, who practices at Saint Thomas Health.
What was interesting, enlightening and good to hear is this: concussions are a part of life. We heal from concussions. There is no helmet, mouth guard or device that will prevent concussions. And we are handling concussions so much better today that we, our kids and our athletes will hopefully not have the more chronic conditions and lethal outcomes now recognized from improper diagnosis and follow through. In a nutshell, we are safer today than just even 10 years ago because of all the recognition and research on concussions. But, you need to take concussions seriously and properly take care of yourself and loved ones using all the knowledge we now have on concussions.
With all the information available, consider today’s facts a basic overview. These are things you need to know, but far more information exists and we have links for more information at the bottom of today’s article. Let’s start with a suspected concussion and what to do:
So, your child hits their head in a game and you are concerned about a concussion. What do you and/or their coach look for (this applies to a suspected concussion for your spouse, friend, etc., as well)?
- loss of consciousness (this means 100% to assume a concussion, even if loss of consciousness is for a second. Only 10% of people with concussions will lose consciousness, so refer to this whole list.)
- not acting quite “right” — you know your child better than anyone
- there are other signs to look for as you observe your child over time. The CDC lists them here.
You suspect a concussion. What do you do?
- Ask about what just happened to them. Many times amnesia will be present, meaning they may not remember what just happened before or after a hit or fall. Maybe they don’t remember what they had for breakfast. Ask various questions.
- See if they are confused. Ask what day it is or what the score is.
- Give them three words to remember, for example: girl, dog, green. Can they repeat them back? Good, then go on to other things that require concentration like counting backwards by 3s from 100 (if an older child, count backwards by 7s; if a young child, just count backwards). What are the days of the week, backwards? What is your phone number, backwards? Then go back to those three words — what are they? If they can’t remember, there is a strong probability of concussion.
- Pass all that? Then run the sidelines. Are they more exerted than they should be? Do wind sprints; a concussion headache will get worse with exercise. Ask them how they feel.
- If you, for any reason, suspect a concussion, you must pull your child from the game. A first concussion is one they will recover fully from. But that second concussion, one which occurs when the first hasn’t healed? That’s dangerous and to be altogether avoided.
- Seek medical attention.
Recognizing concussions is far better today than it used to be, which is one reason that more concussions are diagnosed. But why is it hard to diagnose them anyway? Well, you can have a concussion and not have it show up on an MRI or CT scan as it takes a pretty traumatic brain injury to appear this way. To diagnosis a more mild concussion, which still needs to be taken seriously, takes more intentional questioning as well as figuring out what, cognitively, you should be able to demonstrate. The only way to precisely know what the cognitive baseline is, the one to which you need to compare after a suspected concussion, is to actually have a baseline test done prior to the injury.
Baseline testing is a relatively new test that many high school athletes who participate in a contact sport are required to take. This test tracks how quickly the subject can perform tests and how accurate their answers are. This way, if a concussion is sustained, there is a test that can be taken to see when brain activity is back to the individual’s baseline — their normal. Everyone has a different normal, which is why individual testing is needed.
There is no standard for how long it takes to recover from a concussion. Each person is different and each concussion is different. What is standard knowledge today is understanding that a concussion must be fully recovered from before the patient can return to play and many times work/school. Your brain needs to rest, and often that can even include no screen time and a calm environment. Your doctor will help you determine when you/your child are healed, based on progression and ideally based off of baseline testing.
What if your child has not had baseline testing offered through their school or they are not a school athlete and you want them to have baseline testing — where do you go? Start by asking your pediatrician. Some offer this through their practice. After that, ask your doctor or even your local school for a recommendation. For example, here in Nashville, Dr. Hubbard offers free baseline testing at the Howell Allen Clinic for groups. They believe passionately in the tool of the baseline test, so they want it accessible. So, ask around and find out more information in your area on where you can get baseline testing for your child.
Baseline testing works best in a controlled environment. Think of a team all kinda joking around taking the test in the room together. The test results won’t be as accurate as you need them to be. Discuss the importance of the test with your child or team and the demeanor needed for their own future safety. If you are going to the trouble to take the test, make sure it’s as accurate as possible.
One more thing: baseline testing right now works best for high school-age children and older. It can be effective for 11- to 13-year-olds as well, but any younger it is not effective. That said, with all the attention on concussions, new baseline tests geared toward younger kids are in the works. Without a baseline line test, doctors will look to grades and standardized testing to get a more general idea of where your child should test.
What about brain swelling in kids? Why does that happen? It’s a good question without an answer, but it goes back to the second concussion before the first is healed. It’s called Second Impact Syndrome and it only happens in kids and adolescents. Once you have one concussion, it does not take a large impact to create this Second Impact Syndrome. The brain swells and there is tremendous pressure which impedes blood flow to the brain. This is what happened in the case of Zackery Lystedt from Washington State that brought childhood concussions to the forefront of our nation’s attention. The takeaway, again, is you must let your first concussion heal completely. Do not re-enter any game with a suspected concussion. By the way, this is now law in most states. In my home state, Tennessee, the law protecting student athletes with suspected concussions passed just this year with three main parts, which are very similar state-to-state:
- To inform and educate coaches, youth athletes and their parents and require them to sign a concussion information form before competing.
- To require removal of a youth athlete who appears to have suffered a concussion from play or practice at the time of the suspected concussion.
- To require a youth athlete to be cleared by a licensed health-care professional before returning to play or practice.
For more information on individual state concussion laws, see: www.cdc.gov.
Also, for anyone who has a concussion which has not fully healed, you are at much greater risk of receiving another concussion.
By letting concussions heal before you are back in the game, the goal is to eliminate the issues that you hear about mainly with professional athletes. Think about it: if you break your ankle and don’t let it heal properly before using it, you will end up with bigger problems down the road that are irreversible. Let it heal. The same is true for your brain. And, to reiterate, it may take days, weeks or months to heal. Each concussion and person are different.
The good news
Concussions are recognizable and able to be treated. The key is to be aware when you have one and realize when you are over it. Recognize it. Be observant. Seek medical care. With proper care and proper healing, most will not have long-term problems.
Thank you again to Dr. Jason Hubbard, of Howell Allen and Dr. Colleen Vanderkolk for today’s information. They are both passionate about this issue and they are both well-respected for their expertise in the field of neurology. If you have any questions, you can call their offices or find a neurologist near you.
This past week
To keep this current, this is why so many people are upset over what happened this past weekend in the University of Michigan football game. Knowing about concussions is standard for coaches today, from the Pee Wee football league to YMCA soccer to the other end of the spectrum, which is college and pro sports. As parents, you need to be empowered with this information because if you don’t think a situation is right, you need to step in. Getting a second impact is simply not tolerable with the information we have today. For more on the Michigan game, via CBS sports, see: cbssports.com
For a more in depth look at concussions, that is still easy to follow and pertinent to more than one specific sport, this pdf by the CDC is quite good: cdc.gov.
This Frontline report was also quite informative: pbs.org