The 13-year-old girl timed her jump perfectly to head the soccer ball to her teammate. Dazed, she tried to stay in the game. Her coach assisted her to the bench. For a week, she experienced a persistent headache and had difficulty focusing on her schoolwork.
My granddaughter had sustained a concussion.
A concussion occurs when sudden deceleration or rotation causes soft, brain tissue to slam against the rigid inner wall of the skull. A blow to the head or neck is not necessary. Impact to other parts of the body may be transmitted to the brain, resulting in a concussion.
An estimated 4 million sports and recreation-related concussions occur in the United States each year. Concussions account for almost 10 percent of injuries among high school athletes. There is insufficient data relating to younger athletes in whom concussions are often overlooked and seldom reported.
Children may be more susceptible to concussion because of relatively bigger heads and less developed neck muscles. In similar sports, girls have a higher risk of concussion than boys. Football and ice hockey pose the greatest risk for boys, soccer and basketball for girls.
A concussion launches a complex disruption of brain function that results in reduced energy for mental processes. During the recovery period, a recently concussed brain is vulnerable to the "second impact syndrome," a much more severe injury should a second blow to the head occur.
Concussions may cause a variety of symptoms. Loss of consciousness occurs in less than 10 percent. Dizziness, headache, short term amnesia, unsteady gait, and nausea may occur. Difficulty concentrating, mood change, and insomnia may follow and persist for days to weeks.
Concussions must be evaluated promptly by a health care professional familiar with this type of injury. Unfortunately, many practices and games involving children are not monitored by trained personnel. Children may be erroneously told to "tough it out" after a blow to the head.
Transfer to an emergency room is essential in the event of unconsciousness, seizure, persistent vomiting, worsening headache, drowsiness, or altered mental status following a blow to the head. Concussions infrequently lead to changes in brain imagining such as CT and MRI scans. A child with lesser symptoms should be monitored closely for several hours to assure that symptoms do not worsen.
Following a concussion of any degree, a child should not return to the contest. Physical inactivity and cognitive rest are important to recovery. Cognitive rest may entail a break in school and any other activity, including video games, that requires concentration. Usually symptoms will resolve in 7 to 10 days; although sometimes weeks will be required.
Uncertainty surrounds possible long term consequences of repeated blows to the head in children.
"Concussions and Our Kids" by Robert Cantu and Mark Hyman is a valuable source of information for parents, coaches, and officials. Among the authors' recommendations are:
• No tackle football or heading in soccer before age 14.
• Decrease contact drills in football in pre-season and during season.
• Require chin-straps on helmets and ban head-first slides in youth baseball.
• Require helmets in field hockey and girls' lacrosse.
• Hold coaches and officials to higher standards in prevention and management of injuries, especially to the head.
A more clinical account is presented in "Sports-related Concussion in Children," a medical article by Mark Halsted, accessed on-line at www.pediatrics.aapublications.org/content/126/3/597. This article will be most useful for those overseeing safety of young athletes.
Coaching in proper techniques for each sport will decrease concussions, as will properly fitted equipment. Most importantly, each game and practice of sports involving contact should be monitored by an adult familiar with head injuries, their assessment and immediate treatment.
Contact Clif Cleaveland at firstname.lastname@example.org.