More Than a Bump on a Head

Kids today play hard. From pickup games to organized sports, children are playing more aggressively and at younger ages than previous generations. With increased participation and younger ages comes a higher risk of injury particularly to the developing brain. The scenarios for injury are endless but the concerns are always the same: is my child’s brain ok? When is it safe to return to sports? Should I call the doctor?

Most children love to play sports and there are many reasons to encourage our children to participate from overall fitness to the many benefits of learning to be part of a team. However sports can be dangerous to children due to their developing bodies and immature coordination. Children also grow at different rates and can be injured by other kids their age who are taller or heavier. This is one of the factors driving the debate over the appropriate age for children to start contact sports which many sports experts and pediatricians feel is currently too young.

Head injury is one of the more serious of sports-related injuries and sports is actually classified by their potential for brain injury. The highest risk sports are the contact sports such as basketball, field hockey, tackle football, ice hockey, lacrosse, martial arts, rugby, ski jumping, soccer, and wrestling. Moderate risk sports have limited collision risk and include baseball, bicycling, cheerleading, white water canoeing, fencing, floor hockey, flag football, gymnastics, horseback riding, skating, skiing, skateboarding, snowboarding. Low risk sports have minimal contact such as archery, weight lifting, bowling, rowing, dancing, golf, walking, sailing, swimming, tennis and curling.

Head injury can cause external injuries to the scalp or skull as well as internal injuries to the brain such as bruises, bleeding, and concussions. Any internal brain injury can be serious but concussions are the most common and can be the least obvious. A concussion occurs when the brain is shaken causing a temporary disruption in how the different nerves talk to each other, similar to a power surge at home. Symptoms vary and often include seeing stars, being dazed, blurred vision, nausea and occasionally amnesia. With more serious concussions, headache, vomiting, balance problems and changing levels of consciousness may occur. Contrary to popular belief, it is possible to have a concussion without loosing consciousness and even minor head injury can cause concussions.

It is crucial that all children with head injury get observed closely for the development of symptoms, and even more crucial that athletes not return to play until their clinical status is clear. Asking a child to "shake it off" in the setting of a head injury is a set up for disaster if that child gets hit in the head again. Multiple concussions during a given game, season or life-time put a person at risk for long-term problems with thinking and memory. One concussion followed closely by another increases a person's chance for a more catastrophic injury, including coma and death.

Return to play guidelines are utilize concussion severity grading systems and are designed to allow for maximum safety. The American Academy of Neurology's concussion grading scale is one of the most widely used and classifies concussions into 3 grades. Grade 1 is a concussion with no loss of consciousness and symptoms occurring for less than 15 minutes. Grade 2 is a concussion with no loss of consciousness and symptoms lasting more than 15 minutes. Grade 3 is any concussion with any loss of consciousness. Young athletes with head injury and symptoms of a concussion need to be evaluated on the field as well as by a physician after the game. Kids with a grade 1 concussion require only close observation at home while athletes with symptoms of a grade 2 or 3 concussion should be taken to the nearest emergency room as those kids usually require prolonged observation or special imaging studies such as a head cat scan. A child should be evaluated again by their doctor or a pediatric neurologist before resuming team activities. You can find more information at www.aan.com (American Academy of Neurology), www.safekids.org (National Safe Kids Campaign) and www.aap.org (American Academy of Pediatrics).

After a head injury, an athlete should be removed from play immediately and kept out of sports for at least one week. Sometimes an athlete’s season will need to be terminated either due to the severity of a concussion or due to how many prior concussions the athlete has suffered.

It is easy to get caught up in our children's excitement for the sports they love and allow them to return to play too soon after a head injury, especially if they seem "fine". Ultimately, it is better to be out of play for a week, a month, or even a season then to be benched for a lifetime.

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