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Pediatrics at HSS

Concussions: What Every Parent Should Know

Concussions: What Every Parent Needs to Know

child with father on soccer field

A lot of news coverage over the past few years has led to an increased awareness of concussions. It’s a concern for many parents, especially if a teenager engages in a rigorous contact sport.

A concussion results from a force or impact causing an injury to the brain. While athletes playing football or hockey may be at higher risk, anyone can get a concussion, even young children, according to Dr. Teena Shetty, a neurologist and program director of the Concussion Program at Hospital for Special Surgery.

Falls, bumps and other accidents can cause a concussion, and it doesn’t have to be a direct blow to the head. Symptoms vary from person to person, so some kids may not know they have a concussion, and their parents may not realize it either. Because of the wide range of symptoms, people often go undiagnosed and untreated, according to Dr. Shetty.

The possibility that one’s child has suffered a concussion is a scary thought. But with a prompt diagnosis, the proper care and adequate rest, the prognosis for a full recovery is excellent.

Concussion Symptoms

How do you know if a child or teen has sustained a concussion? Dr. Shetty says the injury affects people differently, but parents should look out for any of the following signs:

  • headache
  • fatigue
  • nausea
  • memory problems
  • confusion
  • dizziness
  • blurred vision
  • sensitivity to light and noise
  • unsteadiness
  • anxiety
  • irritability

The severity of a brain injury can range from mild to severe. Most people do not need to go to the emergency room. However, a parent should bring a child or teen to the ER if he or she experiences the following:

  • a serious neck injury
  • a loss of consciousness, or level of consciousness that deteriorates over time
  • repeated vomiting
  • inability to recognize people or places
  • profound confusion
  • numbness or tingling in the arms or legs
  • symptoms that worsen dramatically in a short period of time

If Concussion is Suspected

If a parent believes a child may have a concussion, it’s advisable to see a doctor within a few days of the injury, even if emergency care is not required.

If a concussion is suspected while playing a sport, it’s important for the child to leave the field or court immediately, Dr. Shetty says. Young athletes who experience a head injury should be evaluated by a health care professional trained in diagnosing and managing concussions. They should not return to a sport until they have fully recovered and their doctor has given them the green light to play.

With the right treatment, almost all concussions will heal over time, according to Dr. Shetty. The biggest mistake that coaches and parents make is allowing the player return to an activity too soon.

To shed more light on concussions, Dr. Shetty answered the following questions:

Q: Have there been advances in our understanding of concussion over the past several years?

There have been leaps and bounds in the concussion field over the last two decades. Prior to this, people did not appreciate the risks of concussion and multiple concussions. People also did not realize that someone can sustain a concussion even with just a small bump to the head. Although we have learned a lot about concussions recently, there is still a great deal to be done to clarify how the injury evolves and affects the brain and to identify a definitive test for an accurate diagnosis.

Regarding concussions, the most important discovery will hopefully come in the next 5-10 years, when researchers are able to discover or invent a definitive test to help diagnose concussions, such as a blood biomarker or specific imaging tests. This will revolutionize concussion care and will allow physicians to rely on evidence-based measures rather than subjective symptom assessments. This could also allow the diagnosis to take place almost immediately on the sidelines of a game, giving a more accurate picture of the injury sustained by an athlete.

Q: What happens if a concussion goes undiagnosed and untreated?

If a concussion goes undiagnosed and untreated, the immediate consequence is that you are at a much higher risk for sustaining another injury, even with much less force. In terms of long-term outcomes, not following concussion guidelines after an injury can lead to persistent symptoms and eventual post-concussive syndrome, in which symptoms last for weeks, months or even years after the initial injury.

We’ve seen many patients who either do not receive the necessary diagnosis/care at the time of the injury or do not adhere to concussion recommendations. These patients have symptoms that persist and cause a decrease in quality of life, making their jobs or school difficult to impossible. They have headaches that can last for months or years, and many of these individuals need to take time off from school or work months after the concussion in an attempt to treat the symptoms that they did not address at the time of the injury.

Q: Do kids generally speak up after a head injury that doesn't cause major symptoms right away, or do they tend to try to ignore it?

I think the rate of reporting these injuries has risen tremendously over the last few years, especially as awareness increases, but I feel that a child's willingness to report an issue depends a great deal on their environment. If a child feels comfortable and safe reporting an injury to a coach or parent, then they are much more likely to do so. However, there still remains a stigma in some sport cultures to be "tough" and just "power through" an injury, which continues to steer kids away from reporting headaches or dizziness after an impact to their head.

Q: What happens if a young athlete returns to a sport too soon after a concussion?

Before you are fully healed, your brain is very vulnerable and susceptible to subsequent injury; even a small impact or overexertion in the period that follows soon after the head injury can cause repercussions. This can lead to long-term symptoms and will prolong recovery.

Q: What is the best way to prevent a concussion?

The best way to prevent a concussion is to play contact sports safely and to avoid high risk activities. Research is not definitive as to the degree of safety that technologies, for example, helmets, and even headbands, offer. There may be a role for neck strengthening as well.

Q: What kind of concussion research is being conducted in at HSS?

We have many research projects going on in the HSS Neurology Department and a number of scientific grants. One project is investigating the utility of specific MRI sequences in tracking changes in the brain after injury and throughout the recovery period.

We are also testing the validity of certain neuropsychological assessments looking at recovery from a concussion. Another study aims to find and validate a blood biomarker – a substance released in the blood when an individual sustains a concussion.

Another study is using a new technology, called a Brain Network Algorithm test, to measure the electrical impulses from the brain and the response time in individuals with a concussion.

HSS researchers are also looking into specific activities that may serve as barriers to recovery for a concussion patient to develop evidence-based guidelines for recovery.

Q: Is enough being done to educate parents, coaches and young athletes about concussion?

There has been a surge in recent years to educate parents and coaches about the risk of concussions. There has also been a focus on targeting athletic trainers at schools so that they can spot the symptoms of a concussion or a common mechanism of injury, take players out of the game, and refer them to the proper physicians for long-term care.

However, more could always be done to educate coaches, parents, and the athletes themselves. All coaches should be trained in spotting a concussion, or possible concussion, so that athletes are always taken out of the game appropriately to reduce the risk of further injury.

Also, there’s a large number of individuals who sustain a concussion not playing sports, and they also need to be aware of the signs and symptoms so that they seek appropriate medical care. The greater the awareness and education, the more we will be able to change the athletic atmosphere and completely remove the stigma around concussions so that all athletes, and individuals, receive the care they need.