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What should parents know about concussions?
Q: During a soccer game, my 9-year-old collided with another player and got a concussion. What should parents and coaches know about concussions? When is it safe for the child to play again?
A: Joshua, now that more and more children are playing competitive sports, concussions have become all too common. It’s estimated that each year more than 300,000 child athletes suffer concussions. They are more common in certain sports: football, rugby, ice hockey, soccer, wrestling, basketball, field hockey, baseball, softball and volleyball.

A concussion is when a blow or jolt to the head causes a mild injury to the brain. It may or may not involve loss of consciousness. The immediate signs of a concussion can include loss of coordination, slowed movements, vacant stare, confusion, memory disturbance, increased emotionality, headache, dizziness, vomiting and loss of consciousness. Most children recover fully from a single, uncomplicated concussion, but recovery can take days, weeks or longer.

During the recovery period, children may have symptoms such as headaches, low energy, sleep disturbances, dizziness, balance problems, nausea, vision changes, ringing in the ears, sensitivity to light/noise, irritability, increased emotionality, depression, anxiety, slowed thinking, poor concentration and trouble with learning and memory.

Concussions can cause short- and long-term neurological damage, especially when they are severe and repeated. Children who suffer a concussion while recovering from another concussion are at risk of “second impact syndrome,” a rapidly developing swelling of the brain, which can be fatal.

Because of the seriousness of the injury, it’s crucial that children receive the proper medical evaluation and care after a concussion. They should not return to the sport until they have fully recovered. Here’s a summary of the recent recommendations from the American Academy of Pediatrics:

1. After the concussion the child needs a physical and neurological exam to make sure there is no medical emergency (e.g., spinal fracture, skull fracture, bleeding in brain). If there are any signs of concern, call 911 and have the child taken to the emergency room for full medical evaluation, which may involve X-rays or CT scans of the head. Many experts recommend a head CT scan if the child has lost consciousness for more than a few seconds, shows dramatic worsening of headache, seizures, numbness or weakness of a body part, repeated vomiting, clear fluid from the nose or blood from the ears, or significant worsening of mental status or other symptoms.

2. If there is a bump or swelling on the head, apply ice. If there is bleeding of the face or scalp, apply a clean gauze and pressure.

3. Some experts say it may be safe to let children with the mildest concussion—no loss of consciousness and no lasting symptoms after 15 to 20 minutes—return to play after 20 minutes. Others say that it’s safest to follow the adage, “When in doubt, sit them out” and not allow the child to return to play on the day of the injury.

4. Contact your child’s doctor immediately to explain the injury and ask what to do. It’s important to observe your child carefully for 24 to 48 hours. Even if he appears well, most doctors recommend that you check periodically through the night to make sure there are no danger signs: inability to be awakened, different sized pupils, slurred speech, increasing confusion or agitation, repeated vomiting or seizures. Over the next few days, continue to observe him for danger signs such as increasing headache, weakness, numbness or loss of coordination. If there are any danger signs, contact your doctor or 911 immediately.

5. If your child has difficulty concentrating during the recovery period, he might need some special accommodations in school.

6. Most children will recover fully after a concussion. But if your child has not completely recovered within one to two weeks, he should see a specialist for further evaluation and treatment.

7. Your child should not return to play until his neurological exam is normal and there are no signs or symptoms of the brain injury, either at rest or during exertion. He should return gradually, beginning with shorter periods of light activity (walking, stationary bike) and increasing to non-contact sport-specific activities (running and kicking for soccer) followed by full-contact practice and games after medical clearance.

8. Try to prevent concussions by having your child wear appropriate safety gear and helmets for biking, in-line skating, skateboarding, snowboarding, skiing, football, baseball and lacrosse.

For more information, see the centres for Disease Control and Prevention concussion fact booklet at www.cdc.gov/ncipc/tbi.

Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician