My Child Has Concussion – Part 1

We all want our children to be happy, healthy and to excel in the sporting field. Any injury to them can cause our own hearts to flutter. It can be scary when you suspect that they have a more serious injury like a concussion. Maybe they are more agitated or maybe they are losing their balance – but something is just not quite right. The thought of the injury being specifically related to the brain can induce some strong anxiety! The great news is concussions are fully reversible, if managed properly. This may mean some time off school and some physical rehab which will challenge them. With time, your child is expected to make a full recovery and return to school and sports, without undue risk to further injury to the brain.

For the whole concussion journey, here are the steps you need to follow to guide your child through recovery!

HOW DOES A CONCUSSION HAPPEN?

Concussions can occur in a variety of ways but they share a common theme: a sudden jolt in the brain. Usually this is because the brain accelerates or decelerates quickly, relative to the skull.  This could mean they try to head a soccer ball but they strike an opponents head causing a sudden deceleration. Or your child could be unexpectedly tackled in rugby causing a sudden acceleration to the head.

During this moment, nerve cells are stretched leading to an electrical and chemical change in the brain. Again, these changes are temporary and are fully reversible.

FIRST STEPS

Before thinking too much about concussion it is important to rule out anything more serious. The following first aid measures should be applied by someone been trained in first aid and is within their scope.

•   Check if they are conscious by calling their name or squeezing their shoulders

– Call an ambulance if not conscious and  check their ABC (airway, breathing and circulation)

– Stabilise the child’s neck and then rule out a serious neck injury.               

– If unsure, or there is no-one on the ground who can do this, call an ambulance for help!

Focusing your thoughts to concussion is the next thing to do when other serious injuries are ruled out. The  first few seconds after a concussion are important in recognizing a concussion. There are certain things to be on the lookout for and often these things are hard to see. The more eyes on a child the better to help recognise signs of concussion. So grab your fellow parents, friends and coaches to be on the lookout! Any of these signs mean that your child should be removed from play and not to return until formally cleared.

Facial injury after head trauma

(e.g. Jaw fracture)

The above signs of concussion will significantly help healthcare professionals determine if your child has indeed sustained a concussion.

Symptoms:

The next step if there are no signs of concussion and the Maddocks questions are clear: ask about their symptoms. Ask if they felt anything strange in their head during the injury. Were you feeling dizzy at the time? Did you have any vision changes or see stars? Are you feeling any different right now? Really asking them is a key to make sure didn’t experience any immediate, unusual symptoms they wouldn’t expect from a normal bumps. Concussion is quite dynamic which means that quite often athletes will feel immediate symptoms that go away quickly. But sometimes symptoms may only develop 48 hours later.  The table below indicates some symptoms that they may mention.

The Culture of Sport

Concussions are serious and potentially life-threatening if returning to sport too early. Despite this we know that fewer than 50% of athletes will actually report their concussions. This is certainly a terrible statistic but its not completely surprising. They may feel pressured to say they have no symptoms. Or they feel like they are letting the team or coach down if they withdraw from the game. Perhaps they just don’t want to be perceived as weak. Nothing is further from the truth. We believe it takes a certain kind of strength to speak up when they know things aren’t quite right. That takes guts. Praising your child for having these ‘guts’ is a great way to reinforce them. Yet, not every child will admit this. Therefore, it is so important that parents and coaches can recognize the signs and symptoms of a concussion and prevent a potentially catastrophic outcome. 

When to go to the Emergency Department? (red flags)

At this stage you either suspect that your child has concussion or not. If you have any inkling of concussion it is certainly wise to veer on the conservative side. On the field and over the next couple of days it is important to keep a close eye. You want to be looking for any ‘red flags’ which may warrant a trip to the ED.  More often than not this trip to the hospital for your child is precautionary. Watch out for the following signs and head to the ED if you notice any.

• Increasingly restless, agitated or combative.
• Difficulty speaking or understanding speech
• Difficulty swallowing
• Altered sense of taste
• Loss of co-ordination/balance as time evolves.
• Bleeding/clear fluid from the nose or ears
• Strong personality changes

WHATS NEXT?

 If your child does not need to go to ED (conscious, no neck tenderness and no red flags and you suspect concussion).

• Immediately remove from play and sit them in a shade.
• No medications (as these can mask the signs of worsening concussion)
• Monitor your child over the next 3 hours for any deteriorating condition or red flags.
• Ensure that your child is not placed in a position where they may hit their head
• Make sure your child doesn’t drive (if they usually can!)

Monitoring your child.

For the first few hours after a concussion, you will need to keep checking in with your child. The days of waking them up at all hours of the night are gone! Any decline in status will happen in the first few hours. Look out for the red flags mentioned above and, if any of them do happen, head to the ED as a precautionary measure. If in doubt at all, there is no harm in heading to the ED!

 The first day or two

A brief period of rest for a day or two is certainly appropriate in the early stages. Your child is, however, welcome to do light physical activity (e.g., gentle walking) if there’s no increase symptoms. They are also fine to do light cognitive activity (homework, watching TV) as long as symptoms do not increase by more than 2/10. 

For example: if a headache was 3/10 and, after 20 minutes, it crept up to 5/10, its appropriate to restrict activity to blocks of 15 minutes. Rule of thumb: they can do anything if symptoms are not stirred up or they are at risk of hitting their head!

From there, it will be important to see a healthcare provider with concussion experience for the next steps. Just make sure your child does not drive though – they’re not ready for that quite yet!

Getting the concussion confirmed

Booking in with a healthcare provider with concussion experience is the next step to formally diagnose the concussion. Delay in accessing skilled healthcare practitioners is THE most predictive factor in a prolonged recovery. Children are more than twice as likely to have a prolonged outcome if they weren’t educated appropriately on the injury. That can be a little confusing  as you would think a concussion would heal on its own. Here are the reasons that proper healthcare management will HELP your child.

• Education: learning the ins and outs of what’s happening in the brain during concussion. Knowing EXACTLY the process needed to safely return to school, driving and sport. Reassurance that concussions are fully reversible from an expert.
• Diagnosis: Confirming the injury of concussion and ruling out any potentially serious injuries
• A starting point: Getting started neck exercises or balance exercises and working out the graduated return to school and sport process.
• Down the track: safely returning to moderate to vigorous exercise and then difficult clearance tests to ENSURE your child is ready to return to contact or high-risk sports.

Sydney Concussion Centre provides expertise in the diagnosis and management of concussion. We will work with your child to promote their full recovery and strictly clear them only on FULL recovery of the brain.

Community Seminars for Sporting Clubs may be available in your area. Contact our Practice Manager for more information.