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Pediatric Concussions

iStock_000014803848XSmallHead injury in young children:Concussion is taking a spotlight in the media currently due to a number of tragic events both in professional football and high school sports. Better equipment, rule changes and prevention are all admirable goals. But more awareness needs to be given to the diagnosis and management of concussion and the misunderstandings surrounding this topic.

Concussion is very common in young adults and some studies say that up to 1/3 of high school athletes will suffer a concussion. Even with that number, concussion often goes unrecognized and undiagnosed. This is dangerous because a child with a concussion is much more susceptible to a second injury. Some studies put this at four times more likely to get a second concussion before full recovery. This susceptibility and the resulting damage is called Second Impact Syndrome and carries with it a 50% mortality rate. Therefore, it is extremely important to get a diagnosis and allow for full recovery.

What to look for:
Signs and symptoms of concussion are usually broken up into three categories: physical, emotional and cognitive. These could include headache, nausea, dizziness, confusion, irritable, nervousness, fatigue, forgetfulness and difficulty concentrating. The presenting symptoms may come from any of these categories and have a very wide presentation among different injuries. Loss of consciousness is actually uncommon for someone with a concussion and may indicate severe intracranial injury. Do not let absence of any particular symptom rule out a concussion.

Diagnosis:
The best way to diagnose and evaluate for concussion is through neurophysical examinations with standardized questions and tasks developed to assess physical, cognitive and emotional performance. A full neurologic exam and physical exam is used with these tools to give a complete diagnostic picture. Advanced imaging like CT or MRI are not indicated in most circumstances and appear normal in concussion injuries.

Treatment and Recovery:
Recovery in most cases will take about 7-10 days. Although about a third of concussions result in Post Concussion Syndrome which may take weeks to months to resolve. Treatment for concussion is rest; both physical and mental. Decreased physical activity, even including play can speed the recovery process. Mental rest is also important and a reduced school load may be necessary. Sleep is encouraged because the brain is healing and repairing. There is no firm evidence base for medication in most circumstances for concussion.

Return to Activity:
Children who have had a concussion should never return to play if symptomatic or if exertion creates symptoms. No child should return on the day of a concussion, even if symptoms resolve. Younger athletes tend to have longer recovery periods and extra caution should be taken as age decreases. Return to play should follow a graded, stepwise reintroduction that monitors their symptoms during slowly increasing activity over a several day period.

Resources for coaches and parents:
http://www.cdc.gov/concussion/pdf/TBI_Returning_to_School-a.pdf

CDC Heads Up: Concussion in Youth Sports:
http://www.cdc.gov/concussion/HeadsUp/youth.html

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