In March 2013, for the first time since 1997, the American Academy of Neurology (AAN) issued new guidelines for management of concussion. Given that three of my son’s soccer teammates sustained concussions just this fall, either from heading balls or from colliding with other players, I am glad to see more attention being given to this issue.
Concussion is a brain injury that alters brain function. It is most often the result of a blow or forceful jolt to the head. Symptoms can be either obvious or very subtle, which can sometimes make diagnosis difficult. A concussion can occur during a head injury even if the injured person does not lose consciousness or have any abnormalities big enough to show up on CT scan or MRI.
The following is a list of worrisome concussion symptoms from the American Academy of Pediatrics:
Most common causes of concussion in children are sports-related, and most in collision sports such as football and rugby, followed closely by soccer and hockey. Soccer and basketball account for the most sports-related concussions in girls. Bike riding without a helmet is also risky. A simple fall and bump of the head on a sidewalk can cause a concussion.
These recommendations probably don’t mean any big changes, except for re-emphasizing that—when it comes to head injuries in children—it is better to err on the side of caution.
So, if your child sustains a significant blow to the head, even if they seem fine and did not pass out, the safest route is to pull them from their activity and observe them for at least 24 hours. If there are any concerns for possible concussion, they should be seen by a licensed health care provider before returning to activity.
As one of the co-authors of the new guidelines put it, “If in doubt, sit it out.” For many, this won’t necessarily mean complete rest. If the child is symptom free at rest, they can participate in activities if they don’t cause symptoms such as headache or dizziness. And the activity itself must not carry a risk of concussion. For example, a soccer player could probably do some running and footwork drills if they feel well enough, but shouldn’t scrimmage or play a game for 10 to 14 days if there is a concern about concussion.
This is an important point. Many people who have sustained a concussion say later on that they weren’t able to assess their condition accurately just after the injury. That is, they didn’t recognize that something was wrong with them, or the fact that they didn’t feel like themselves.
If you have any concerns, you should discuss this with your child’s doctor before the child returns to activities.
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