Ask Dr. Doug: Play It Safe with Concussions
Q: My son plays soccer, and I worry all the time about concussions. I understand that there are some new guidelines on childhood concussions from the American Academy of Pediatrics. What do I need to know about these?
A: I worry about concussions, too. Concussions are common, with around 2 million children and teens receiving treatment for one each year. That number is probably too low, since many may not seek medical attention. As you might have guessed, contact sports carry the highest risk, with boys’ tackle football leading the pack, followed by girls’ soccer.
It’s important to realize you don’t have to be “knocked out” to have a concussion. Sometimes seemingly mild injuries or falls can also result in problems. Think of a concussion as any forceful injury that disrupts normal brain function. It often comes on quickly, and usually resolves with time.
Symptoms are varied and may include headache, dizziness, difficulty concentrating, nausea, light or noise sensitivity, feeling mentally foggy, feeling more irritable, or developing sleep problems. Most sports sports-related concussions are better within a few weeks to a month, but some may last longer.
What should you do if your son heads a ball hard and you’re worried about a concussion? First, he needs to be off the field and out of the game. Many sports have access to a team physician or trainer who can help appropriately manage next steps, but remember “when in doubt, take them out.”
You should then see your pediatrician as soon as possible for an evaluation, which should include using a validated screening tool to follow symptoms. Then we’ll come up with plan on how to manage things while he gets back on track.
One of the main takeaways from the updated recommendations is that gradual return to regular activities after a few days of rest is better than complete physical and mental rest until symptoms are gone. Symptoms should be our guide – after a few days rest, if reading makes a headache or nausea worse, that’s the brain saying it needs more time to heal. Once he’s back to regular non-sports activities (including school), then we can go through the return to play steps. That means a gradual approach to full play, from light aerobic exercise to non-contact drills to contact practice and finally a return to full play, seeing how he feels along the way.
Sometimes concussions are more complicated and don’t follow this pattern of gradual resolution. If that happens, we may need to involve specialists or get other testing to clarify things, such as a neuropsychological evaluation.
Interestingly, newer research has raised the possibility that repeated “subconcussive” hits over time may be worse for long long-term brain damage than one or two concussions. It’s sort of like potholes – the big ones that blow out your tire obviously aren’t good, but the small ones that cause little knocks can cause damage that builds up, even if they don’t seem that bad at the time.
The preteen brain is growing rapidly and is particularly vulnerable to trauma. Are we unintentionally causing long-term damage to our kids’ brains by letting them play contact sports too early? More research needs to be done before we have that answer. In the meantime, please play it safe when it comes to concussions.