As experts in pediatric care, concussions are of enormous concern to us.
The American Academy of Pediatrics has reported that emergency room visits for concussions in children ages 8 to 13 years old has doubled, and concussions have risen 200 percent among teens ages 14 to 19 in the last decade.
At ANA, we are most alarmed by the increase in the number of concussions, multiple concussions, and especially second-impact syndrome. Equally disturbing is the fact that proper management of concussions continues to be problematic, although it has been estimated that up to 3.8 million recreation and sports related concussions occur annually in the United States. Concussions represent 9% of all high school athletic injuries. Concussion statistic for grade school and middle school aged athletes is underreported.
Symptoms of a Concussion
Symptoms of a concussion usually reflect a functional disturbance to the brain and may include physical (e.g., headaches, nausea), cognitive (e.g., difficulty with concentration or memory), emotional (e.g. irritability, sadness), and ‘maintenance’ (e.g. sleep disturbances, changes in appetite or energy levels) symptoms.
Symptoms may not occur until several hours after the episode and many young athletes may not be forthcoming with their symptoms, for fear of activity restrictions. 90% of most diagnosed concussions do not involve a loss of consciousness. An unconscious athlete or one who regains consciousness quickly may be evaluated further on the sidelines.
Symptoms of a concussion may include:
- Nausea or vomiting
- Dizziness or balance problems
- Double or blurry vision
- Sensitivity to light
- Sensitivity to noise
- Feeling dazed or stunned
- Feeling mentally “foggy”
- Trouble concentrating
- Trouble remembering
- Confused or forgetful about recent events
- Slow to answer questions
- Changes in mood—irritable, sad, emotional, nervous
- Sleeping more or less than usual
- Trouble falling asleep
The seriousness of a concussion dictates what kind of treatment you should seek. Most people with concussions recover fully with appropriate treatment. Make sure there are qualified personnel at sporting events who know how to evaluate participants for concussions. These experts have a variety of tools to determine the presence of concussions on the spot. Since a concussion can be serious, safeguarding yourself is important.
There are three grades of concussions: Grade 1 is characterized by transient symptoms and Grade 3 is the most serious and requires immediate medical attention.
- Symptoms of Grade 1 concussions tend to resolve themselves. The best way to treat a Grade 1 concussion is by simply resting and not rushing back into the activity which caused it. However, it is recommended for people who suffer from multiple Grade 1 concussions to receive additional medical evaluation. If a vision problem occurs, or any other concerning symptom, you should consult a physician immediately.
- For Grade 2 concussions, should there be headache pain once the effects have lingered past a half hour, aspirin or ibuprofen can be taken. However, if the condition worsens over time, medical attention is required immediately. Twenty-four hour close observation by a family member or medical staff is required to make sure that additional symptoms don’t develop or current conditions don’t get worse.
- Similarly to a Grade 2 concussion, observation is essential in assessing a Grade 3 concussion. However, in the case of a Grade 3 concussion, immediate medical attention is required. Should the symptoms worsen in any manner (i.e. more frequent headaches, slurred speech, decreased motor skills, etc.) further medical attention will be required. It is important to look for any possible signs of brain damage, e.g. differing pupil sizes, and problems with vision and eye coordination.
Once a serious injury has been ruled out, the two main components of concussion management include:
- Resting of the Brain – Complete rest of the brain following any level of concussion could help avoid later problems. Complete rest, up to 10 days or even longer, entails not only ceasing physical/sports activities, but also cognitive rest, which means no television, computer, texting, etc.
- Return to Activity – Any return to activity should depend on being symptom-free. It should be a step-by-step process, with any exercise gradually increased. This gradual return to activity should be followed by medical clearance before any return to play. The schedule of returning to activity should be individualized, and take into account the person’s concussion history as well.
Seeking Medical Attention for Concussions
If you suspect someone under your care may have a concussion, it is important to keep a close eye on the individual and call a medical professional if you notice any concerning symptoms. If you are unsure whether or not to call a medical professional, it is important to be on the safe side and call due to the dangerous nature of concussions.
As neurosurgeons, one of our central roles is the evaluation and treatment of mild and severe traumatic brain injuries. This brings the patient population and concussions to the forefront of our practice at ANA. Please call our office immediately if someone under your care needs medical attention for a concussion and we will work with you to ensure the individual receives the care he or she needs.