Concussions (Care of the Young Athlete)

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A concussion is any injury to the brain that
disrupts normal brain function on a temporary or permanent basis. Concussions
are typically caused by a blow or jolt to the head.

When do concussions occur?

Concussions can happen in any sport but more
often occur in collision sports, such as football, rugby, or ice hockey. They
also are common in contact sports that don’t require helmets, such as
soccer, basketball, wrestling, and lacrosse. However, a concussion can also
occur from a collision with the ground; a wall; a goalpost; or a ball that has
been thrown, hit, or kicked. Many concussions also occur outside organized
sports. For example, a child riding a bike or skateboard can fall down and bump
his head on the street or an obstacle.

Symptoms

The symptoms of a concussion range from subtle
to obvious and usually happen right after the injury but may take hours to days
to show up. Athletes who have had concussions may report feeling normal before
their brain has fully recovered. With most concussions, the player is
not knocked out or unconscious.

Symptoms of a concussion include the following:

  • Headache

  • 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

  • Drowsiness

  • Sleeping more or less than usual

  • Trouble falling asleep

What to do if you suspect a concussion

All concussions are serious, and all athletes
with suspected concussions should not return to play until they
see a doctor.
A doctor can confirm the diagnosis of
concussion; determine the need for any specialized tests, such as computed
tomography (CT) scan, magnetic resonance imaging (MRI), or neuropsychological
tests; and decide if it is OK for the athlete to return to play. Prematurely
returning to play after a concussion can lead to another concussion or even
death. An athlete with a history of concussion may be more susceptible to
another injury than an athlete with no history of concussion.

No one knows how many concussions are too many
before permanent damage occurs. Repeated concussions are particularly worrisome,
especially if each one takes longer to resolve or if a repeat concussion occurs
from a light blow. The doctor needs to know about all prior concussions,
including those that occurred outside of a sports setting, in order to make
proper recommendations regarding return to play and future sports
participation.

Treatment

The best treatment for a concussion is complete
rest from all physical and mental activity. Children should be monitored often,
but there is no need for wake-up checks during sleep. Loud music, computer, and
TV should be limited or stopped if they increase the symptoms. School attendance
and work may need to be modified, with tests and projects postponed. Students
need to be excused from gym class or recess activities. Any worsening of
concussion symptoms or changes in behavior (eg, agitation, grogginess,
disorientation) should be immediately reported to your doctor.

Returning to physical activity

Recovery time from concussion is variable based
on the individual, the severity of the concussion, and the history of prior
concussions. An athlete may feel better and want to return to play before their
brain has completely recovered. Given the uncertain and unpredictable time frame
for recovery, all sports activity should be suspended until symptoms have
completely resolved at rest. At this point, a stepwise return to physical
activity can begin if the athlete’s doctor says it’s OK. The
stepwise plan should be progressive and individualized. Having an athletic
trainer involved in monitoring this plan can be very helpful. It is important to
pay close attention to worsening symptoms (like increasing headache, nausea, or
dizziness). Any concussion-related symptoms that return with exertion are a
clear indicator that the concussion has not healed. Final clearance to return to
full activity should also be at the direction of a physician.

Prevention

Not all concussions can be prevented, but some
may be avoided. Helmets should be worn for any riding activities (like
horseback, all terrain vehicle [ATV], motorbike, bike, skateboard, or snowboard)
or contact sports (like football, hockey, or lacrosse). Helmets should fit
appropriately and be in good condition. Athletes should be taught safe playing
techniques and to follow the rules of the game. Most importantly, every athlete
needs to know how crucial it is to let their coach, athletic trainer, or parent
know if they have hit their head or have symptoms of a head injury—even
if it means stopping play. Never ignore a head injury, no matter how minor.

“When in Doubt, Sit Them Out!”

For more information

Centers for Disease Control and Prevention
(Concussion in Youth Sports) www.cdc.gov/concussion/HeadsUp/youth.html

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by the American Academy of Pediatrics (AAP). The AAP is not responsible for the
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