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Concussions: Why It Is Important To Know About Concussions In Children.

09/09/2021

by Jai Sappal
Concussions: Why it is important to know about Concussions in Children.

Children get hurt. They bump their heads or get a bruise from something silly they might have been doing. It’s normal and expected. However, as parents/caretakers it’s also important to recognise when something is just a small knock to the head or when it’s something that may warrant further investigation. This article is meant to be a quick tool to see if your child might be experiencing a concussion and to provide you with some information on how you can manage the situation as well as what some of the research says


What are Concussions?

A concussion is a form of mild traumatic brain injury (mTBI) and are a result of a force acted on the head leading to a negative change in the way the person feels or functions (1). Put simply, it’s like a bruise but in your brain (and like any bruise, it needs a bit of TLC). It is also very common in children and is commonly seen in a variety of sports related injuries. Concussions are so common that they can make up to 10% of injuries in the general population, which comes down to millions of people!(1) In children, it is in organised sports (the most common being soccer) where it is more prevalent. Concussions aren’t exclusive to sport – they can happen in motor vehicle accidents, at school, at home, etc. (3). It’s a head injury and shouldn’t be taken lightly but it’s also not the end of the world if it does happen. This article shouldn’t deter you or your children from having fun and participating in sports. The goal of this article is to inform you on how to recognise and immediate manage concussions if they do happen.

 

What do I look for?

Some symptoms of concussions in children include:

  • Headaches
  • Dizziness
  • Nausea
  • Double vision
  • Lethargy or extreme fatigue
  • Confusion
  • Forgetfulness
  • Spinning-like sensation (the room feels like it’s spinning)

These symptoms are not a limited list. If your child is enrolled in an organised sport a good resource is the SCATS link here:

https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097492childscat5.full.pdf

This document has a list of symptoms and signs to watch out for and can help you decide if your child has a concussion and needs medical treatment.

 

What are the long-term effects if left untreated?

Now this next bit does sound scary, however, it’s important to recognise and treat a potential concussion rather than just ignore it and continue to play (this goes for adult athletes in particular. We all know you want to soldier on and help win the game but at the end of the day it’s your brain and your life that you should be taking care of). With that in mind, let’s dive into the research:

A previous traumatic brain injury is predictive of future “risk of premature mortality, psychiatric inpatient admission, psychiatric outpatient visits, disability pension and welfare recipiency” (4). This study was done over a long time in 2016, dating back to 1973 and 1985, showing the effects over time on people that had experienced a traumatic brain injury. This demonstrates that previous injury can result in cognitive and functional impairments later in life. Because this study was collected a long time ago, the numbers may be different now as more and more parents become more aware of injuries such as concussions and are more likely to seek help (we hope). This study doesn’t indicate that children shouldn’t play contact sports, but rather cautions us that if a concussion isn’t detected and treated earlier, it could lead to further complications later down the line. It’s no secret that the rise in concussions is of no surprise. Knocks to the head 50 years ago were probably not managed that well back then, as there wasn’t as much importance to place as much care as there is now nor the research done to investigate them. Now that we have the research readily available, it is important to be aware of the process, signs and what to do.

Another factor to consider from the research into concussions is Post-Concussion Syndrome (PCS). This is when the symptoms last longer than a month (5). They can affect the child much longer than that and last for months and can result in negatively affecting their cognition, physical well-being, and their mood. Symptoms may include difficulty concentrating, irritability and headaches (6). Again, this is just meant to make you aware. We are not saying that if your child is experiencing these symptoms that they will be messed up for life. This article is here so that this DOESN’T happen (aka a preventative approach).

Management for PCS does require a lot more research but some of the tools that have been helpful so far has been a multi-disciplinary approach. This means that multiple health professionals can assist with cognition, psychological symptoms, and physical symptoms. Cognitive behavioural therapy can also help and so far, a combined approach with multiple professions is the best (5).

 

What does the research say about concussion management in children?

Initial management should be to rule out a severe injury. If a child has:

  • A high-speed crash or fall from a height of greater than 1-metre.
  • Loss of consciousness.
  • Vomiting more than once after a hit to the head.

then it is crucial that they get access to a hospital immediately (i.e., call an ambulance) (11).

After a potential emergency visit, the focus on care should be on reducing further risk of injury and having adequate rest for the brain to recover. The child should only gradually return to activity and then sport. As mentioned in the beginning, a concussion is like a bruise to your brain. If you continue to hit the bruise it’s only going to get worse – it needs some rest. You’ll be amazed with how a bit of rest can positively impact the brain. This also means that their return to sport should be in stages. The absence of symptoms is a good indicator that it’s ok to progress through. Consult a medical professional to get clearance to resume sport (12).

As headaches are quite a common symptom, NSAIDS like ibuprofen may be helpful (talk to your doctor to see which medications will be helpful). However, please be aware that although such medications may help in the first few days, prolonged use is discouraged (7).

 

What are the complications of Concussions?

This is another seemingly scary section of this article BUT again, it is only meant to make you aware. If the concussion (in either an adult or a child) is managed properly, then these factors lessen. 

  • Second Impact Syndrome: Injury and/or death that could have resulted from swelling in the brain. This can be seen in people that might have resumed playing sport before they have had a chance to fully recover from a previous concussion (7).
  • Chronic Traumatic Encephalopathy (CTE): A neurodegenerative disease that may be due to repetitive head trauma (seen in sports such as boxing). Though this has been the speculation of a lot of research, the incidence and prevalence is unknown. More research needs to be done (8,9).
  • Depression: There is an increased risk of depression especially for those that have a history of concussions. This may result from injury to areas of the brain which causes a physical change in the natural chemicals in the brain. Depression can also occur (and worsen) because the child is struggling to adjust to their injury or disability. If your child has depression, it’s important for them to see a health professional. It’s not something that is “just in their head” or a case of them needing to “harden up”. It’s a medical condition, just like diabetes or asthma (9,10).

Proper management would mitigate a lot of these complications. Like we said before, adequate rest can do wonders. In Second-Impact Syndrome, you can’t get it if you are resting from the sport and if you get adequate medical clearance before you or your child resumes their sport of choice. Depression is an epidemic that affects many people around the world. You don’t need a head injury to get depression, but it’s one of the associated symptoms and complications that CAN (not will) happen due to improperly managed concussions.

 

Conclusion

Recent research compared to research that was conducted decades ago has really come a long way and awareness around concussions is more prominent. Along those same lines, proper management is important as well. Unfortunately, injuries are part of living and I hope that this article has provided the information to empower rather than discourage parents/caretakers from allowing children to have fun and participate in sport.  A lot of the complications mentioned in this article is something to keep in the back of your mind. Treat a concussion like an injury and allow the child adequate rest/recovery with proper management. This will go a long way to mitigate the effects of the majority of the scary complications we listed. What is important is learning the appropriate ways to manage them if they do happen. If you are still unsure if a child has a concussion and are unsure of the severity, your best bet is always to get them to a hospital so that any injury can be managed and treated appropriately. 

 

Sources:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6684694/
  2. https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097492childscat5.full.pdf
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827131/
  4. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002103
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388574/
  6. https://pediatrics.aappublications.org/content/142/5/e20180939
  7. https://www.uptodate.com/contents/concussion-in-children-and-adolescents-management#H16857084
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4633042/
  9. https://www.cdc.gov/concussion/headsup/clinicians/resource_center/complications_of_concussion.html
  10. https://www.braininjuryaustralia.org.au/wp-content/uploads/TBI_Depression_and_TBI.pdf
  11. https://www.rch.org.au/kidsinfo/fact_sheets/Head_injury/
  12. https://pubmed.ncbi.nlm.nih.gov/26174579/


Jai Sappal
Physiotherapist
Peak Health Services.