How can I tell if my child may have a concussion?

Q: My son has been having headaches and difficulty concentrating at school. His teacher thinks he may have a concussion. What do I need to know about this?

A: Concussion is a type of traumatic brain injury (TBI) caused by a blow to the head. It can also be the result of a hit to the body that jolts the head, and causes the brain to moving quickly back and forth inside the skull. There can be direct injury to the brain as it slams against the skull.

Concussion is defined by 5 major features: 1) it is caused by a direct blow to the head or body; 2) it results in the rapid onset of shortterm neurologic impairment that resolves spontaneously; 3) it may result in brain injury at the cellular level, but the acute symptoms reflect a functional disturbance more than a structural injury; 4) it may or may not involve loss of consciousness; and 5) there is typically no abnormality on a CT scan or MRI.

While most children and teens with concussion feel better within a couple of weeks, some will continue to have symptoms for months, or longer. Continuing to play impact sports while having concussion symptoms increases

the chance of having a second concussion. A repeat concussion can be very serious, especially if it occurs while the brain is still healing from the first one. The symptoms can return with increased intensity and may last longer than the usual two to three weeks. In some extreme cases, symptoms may never go away, permanently impacting a child’s quality of learning and life.

Immediately after a head injury, your child or teen may appear dazed. They may be unsteady on their feet, unable to find words, and looking around with a dazed look in their eyes. They may answer questions slowly and move clumsily. If this occurs during a game, they may appear confused about their position or unsure of the score. In some cases, the child may briefly lose consciousness. It is important to ask about all of these symptoms if you did not witness the injury yourself.

One important thing when assessing a child for concussion is a clear idea of what their baseline neurologic and cognitive status was. There is an assessment that can be done by medical professional pre-season as a baseline. It is called the SCAT-3, which stands for Sport Concussion Assessment Tool. The SCAT-3 is a standardized tool for evaluating injured athletes for concussion and can be used in athletes 13 years and older. Pre-season baseline testing with the SCAT-3 can be helpful for interpreting post-injury test scores.

Some time after the injury, the child might show mood, behavior or personality changes. Talking specifically about the injury may reveal that he/she cannot recall events prior to or after a hit. When asked, children have acknowledged symptoms, such as pressure in their head, nausea, balance problems, dizziness or blurry vision. Another sign to investigate is if your child becomes bothered by light or noise if that wasn’t a problem before.

Other general, somewhat vague, symptoms that can result from concussion include confusion, difficulty concentrating, memory problems, not “feeling right” or “feeling down.” These symptoms together are sometimes called Post-Concussion Syndrome (PCS). Most literature defines it as at least three of the following: headache, dizziness, fatigue, irritability, impaired memory and concentration, insomnia, and lowered tolerance for noise and light. Confusion exists in the literature, with some authors defining it as symptoms of at least three months’ duration, while others define it as symptoms appearing within the first week.

Which sports carry the highest risk of concussion for kids? Football, followed by girls’ soccer and boys’ lacrosse are the top three. After that, boys soccer, girls basketball, wrestling, girls lacrosse, softball, boys basketball, volleyball and baseball. It’s important to keep in mind that football is not the only culprit and that girls playing sports may also get concussions.

Some children and teens think concussions aren’t serious or worry that if they report a concussion they will lose their position on the team. Talk with your children about concussion. Remind them that it’s better to miss one game than the whole season. Recognition and education are paramount because, although proper equipment, sport technique and adherence to rules of the sport may decrease the incidence or severity of concussions, nothing has been shown to prevent them. There are excellent resources for parents, teachers and coaches at www.cdc.gov/ Concussion.