Concussions: What You Need to Know

Each year, more than 173,000 children and adolescents are treated in emergency rooms for concussions and other traumatic brain injuries. Everyone wants to prevent concussions, but how? Proper safety equipment, such as helmets, and general safety precautions are the best prevention currently available. And what do you do if your child or teen has a concussion? Read this guide for advice.
What is a concussion?
Concussions are traumatic injuries to the brain that happen when someone gets hit hard on the head. The blow causes the brain, which is made of soft tissue, to shift inside the skull. This shift causes temporary changes in how the brain works. Concussions rarely last more than seven to 10 days, but they can be serious.
How do I know if my child has a concussion?
Common symptoms include headache, nausea, dizziness, drowsiness, sensitivity to light and sound and fatigue. Your child may seem mentally foggy and have difficulty concentrating, or seem irritable or sad. He or she may have trouble sleeping. To be safe, any time your child takes a hard blow to the head – for example after falling off a bike or while playing a sport – see a doctor for evaluation.
When can my child return to regular activities?
Most people with concussions recover fully within a week. But it’s important to return to school and play gradually. Follow these recommendations:

  • Get lots of rest. Be sure your child gets enough sleep at night.
  • Drink lots of fluids and eat carbohydrates or protein to maintain appropriate blood sugar levels.
  • Limit activities that require a lot of thinking or concentration, including video games. It’s a good idea to stay home from school for one to three days to give your child a “cognitive rest.”
  • Limit physical activities, such as sports practice and PE. These activities can make symptoms worse.
  • As your child’s concussion symptoms improve, gradually return to daily activities. If symptoms worsen or return, cut back activities, and try again to increase them very gradually.
  • Ask your doctor to evaluate your child’s symptoms after a few days to make sure recovery is going well.

Are there special precautions when returning to school?
Some kids can return to school without much difficulty; others need a more gradual re-entry plan. When your child can concentrate for 30-40 minutes, and other concussion symptoms have lessened, your child can return to school.
Some students need extra help to perform school work at first. The amount of needd support varies from student to student, and can be gradually removed as your child improves. Ask your pediatrician to give you a letter with recommendations for your child, and share it with teachers, the school nurse, counselors and the school administrator. School staff should watch for:

  • Increased problems paying attention or concentrating
  • Increased problems remembering or learning new information
  • Longer time needed to complete tasks or assignments
  • Greater irritability/decreased ability to cope with stress
  • Worsening symptoms (such as headache, tiredness) when doing schoolwork

When can my child return to sports?
Most student athletes are eager to return to their sport. Don’t rush it. Your child should have a full and complete recovery from concussion before playing or practicing sports.
Returning to sports should be done gradually in six stages after a concussion. There should be at least 24 hours between each stage. California law says your child must be seen by a doctor to be cleared to return to contact sports.
Stage 1:  No physical activity.
Stage 2:  Low levels of physical activity. This includes walking, light jogging, light stationary biking, light weightlifting (lower weight, higher reps, no bench and no squats).
Stage 3:  Moderate levels of physical activity with body/head movement. This includes moderate jogging, brief running, moderate-intensity stationary biking, moderate-intensity weightlifting (reduced time and/or reduced weight from the typical routine).
Stage 4:  Heavy non-contact physical activity. This includes sprinting/running, high-intensity stationary biking, regular weightlifting routine, non-contact sport-specific drills.
Stage 5:  Full contact in controlled practice.
Stage 6:  Full contact in game play.
Remember, your goal is to help prevent repeated concussions, which can lead to serious brain damage later in life. If your student athlete is not improving after a concussion, or has had several concussions, consult with a doctor who specializes in concussion management, and consider changing to a sport that involves less risk.
Kate Babington, M.D., Cara Barone, M.D., Amy Heneghan, M.D., and Pam Ison, M.D., who contributed their advice to this column are board-certified pediatricians at the Palo Alto Medical Foundation’s Palo Alto Center. Advice is not intended to take the place of an exam or diagnosis by a physician.


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