Concussion in Children

by Alan Shahtaji, DO

A concussion is an injury to the brain that can result from direct trauma to the head or indirect injury (i.e. whiplash). This is a transient process and no structural damage is seen on imaging, such as a CAT scan or MRI of the brain. A concussed child most often complains of a headache but can have a variety of symptoms, including irritability, nausea, balance problems, sensitivity to light, difficulty concentrating and feeling in a “fog” or just not feeling right. There may be a phenomenon called Second Impact Syndrome which can cause immediate swelling of the brain if a first concussion/head injury is not recognized and a second blow occurs. This rare entity is usually catastrophic and one reason we are so emphatic about no same day return to play.

If there is ANY concern about a head injury during a game, the athlete should be pulled out and properly evaluated. The athlete’s awareness, concentration, memory, balance and eye movements may be tested in addition to asking about symptoms. Several professional organizations have promoted the mantra, “when in doubt, sit it out” which also reflects in-game management of possible concussions. Symptoms do not always develop right away and sometimes can develop several hours later.

We are constantly learning more about concussions but the present thinking is that a force disrupts the connections inside the brain. This disruption results in a release of different chemicals that normally are stored inside the nerves. In order to heal the brain, an energy surplus is required which is so difficult since we use the brain for everything we do (i.e. reading, listening, concentrating, exercise, etc…)

Adults usually get better within 7-10 days but kids often take a bit longer (around 2-3 weeks) to recover from a concussion. Each concussion acts very differently so the recovery is variable.

The initial treatment is so very simple yet incredibly hard to follow: mental and physical rest. This means no TV, computer, texting, Facebook, Instagram, twitter and the other social media apps that are so commonplace. In addition, minimizing physical activity is important since raising the heart rate can make the symptoms worse and potentially delay recovery. The absolute rest period varies in duration.

There is an abundance of information regarding concussion diagnosis, management and recovery. Unfortunately, about 10% of concussed patients may develop post-concussion syndrome, which is a prolonged recovery that can sometimes last months to years. This is addressed in the following links:

http://health.ucsd.edu/specialties/surgery/ortho/areas-expertise/sports-medicine/concussion/Pages/default.aspx

http://www.cdc.gov/concussion/index.html

http://www.cdc.gov/concussion/sports/index.html

The brain is the most important organ of our body and its development influences all aspects of the maturing pediatric patient. If there is ANY doubt about a possible concussion, remove the athlete from competition and arrange for follow-up with their primary care doctor, either a pediatrician or family medicine physician (MD/DO). Some cases may require seeing a concussion specialist if the recovery is prolonged or when dealing with “return to play” for sports.

Baseline neuropsychological tests can be done prior to a sports season, so that there are objective criteria to compare when evaluating a concussed athlete. This testing is available at the UCSD Concussion clinic, and may also be offered by local high school athletic departments.

Shahtaji Alan Shahtaji, DO CAQ-SM, is a board-certified family and sports medicine doctor at the University of California at San Diego. Dr. Shahtaji has a special interest and fellowship training in sports medicine. He is a team physician for the US Soccer Federation and recently traveled to Brazil with the Women’s National Team.  Dr. Shahtaji is experienced in the care of concussions and non-operative orthopedic problems and has strong interest in sports medicine, exercise, nutrition and preventive care. He is the head physician for the UCSD Concussion Clinic, which is a multidisciplinary clinic providing comprehensive concussion care to athletes of all ages.  He is available to see our patients for either baseline neuro-psychological testing (ImPACT testing), or for expert management of concussion.

 

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