More Than a Bump on the Head

Handling concussions.

It was an ordinary middle school softball game, but when the fly ball tipped off of my daughter's glove, hitting her in the cheek, it suddenly wasn't so ordinary. Other than some pain in her cheek, my seventh-grader had no swelling, bruising or any other symptoms, and so after sitting out for a few innings, she returned to the game.

My mistake. The next day, when she complained of dizziness, I took her to the doctor and found that she actually had suffered a concussion and needed at least 10 days to fully recover.

Many parents make the same mistake I did, thinking that a concussion is just a bump or a ding, according to Johna Mihalik, post doctoral associate and community outreach coordinator for the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at UNC-Chapel Hill.

"A concussion is a brain injury," says Mihalik, explaining that injuries such as a fly ball to the head, or shaking and jerking motions can cause injuries to the brain tissue.

"The space between your skull and your brain has fluid that helps absorb that shock, but when a person is hit hard enough in the head or has a blow to the body, as in a car accident, where your head keeps moving and your body stays still, your brain moves throughout the skull, and that tissue is actually functionally damaged."

Because a concussion is a functional injury and not a structural one, such as a fractured bone, it can be more difficult to know when a child actually has a concussion.

Diagnosing a Concussion

Since a concussion cannot be seen, medical imaging tests such as CT scans and MRIs cannot typically detect it, so doctors use a combination of behavioral clues and technology to determine if a brain injury has occurred.

If a young person has had a concussion, he may have symptoms that include headache, dizziness, nausea, blurred vision or sleepiness. But some of the symptoms may be subtler. Some children may complain of not feeling like themselves, or they may not act like themselves. In some cases, as with my daughter, symptoms may not show up immediately. In fact, 15 to 20 percent of people with concussions have a delayed presentation of symptoms, says Mihalik, and symptoms can intensify the 24 hours following a head injury.

It is essential to know if a child has had a concussion in order to begin immediate treatment. Since young brains are still developing, concussions in children can have an even more devastating effect than in adults, with longer lasting and more severe symptoms. In addition, a child who has had one concussion is at greater risk for subsequent concussions, and should another occur before the first one is healed, the results can be traumatic. Long-term effects from severe or repeated concussions include memory loss, psychiatric disorders, depression, anxiety and a decline in other physical and mental abilities.

Time for Recovery

As important as it is to immediately diagnose a concussion, it is equally important to allow a concussion to completely heal. Not just the physical recovery, says Mihalik, but a cognitive recovery as well. Kids with concussions should avoid activities requiring concentration, such as schoolwork, texting, reading, watching TV, playing video games or driving. Once a child has completely recovered, he should gradually begin to incorporate activities.

But how do you know when a child is fully recovered? Carolina Neurosurgery & Spine Associates offers a free computerized test to establish a cognitive baseline for middle and high school students in a five-county area around Charlotte. If a child who has already taken the test then gets a concussion, the child can take a second test, says Dr. David Wiercisiewski, who heads CNSA's Carolina Sport Concussion Program.

"The test itself looks at areas of memory and processing speed," says Wiercisiewski. "Based on those performances, you can make pretty good and specific recommendations back to the school on how to manage the academics and recovery time."

If a student suffers a concussion but has not taken a baseline test, the computer database can provide a baseline average by taking into account the child's previous academic performance, and then can measure current performance against that baseline.

"The true nature of concussions a lot of times is that the problems kind of insidiously grow," says Wiercisiewski. "Problems at school start go grow, or you can have a number of concussion injuries, but you're not going to start to realize the problems until you're a little bit older in life."

Concussion Awareness

According to the Centers for Disease Control and Prevention, U.S. emergency departments treat 135,000 sports-related traumatic brain injuries, such as concussions, among kids ages 5 to 18 each year. While this number may seem large, it can actually be good news because it means more people are recognizing the symptoms and dangers from concussions, and are seeking treatment.

In June 2011, Gov. Bev Perdue signed the Gfeller-Waller Law to raise awareness of concussion dangers among middle and high school athletes. The law, which was named after Matthew Gfeller and Jaquan Waller – two N.C. high school football players who died in 2008 after sustaining head injuries – requires concussion education for parents, coaches, administrators and athletes; establishes an emergency action plan at athletic events; restricts player who have suspected concussions from returning to the game that day; and requires them to be cleared to return to the game by a medical provider with concussion training.

Independence High School athletic director Kelly Lewis says the Gfeller-Waller Law makes the dangers of concussions more visible.

"I think it changes it for the better because one concussion is too many," says Lewis. In addition to ensuring that players, parents and coaches read and understand the concussion information that schools now must share, the law also requires that helmets, chin straps and other equipment fit properly to protect the head. Lewis also emphasizes the importance of students letting someone know if they are hurt.

Area camps say they have action plans to make sure they limit possible long-term effects from undiagnosed concussions. Michaux Crocker, camp director at Camp Cheerio, a residential YMCA camp in northwestern North Carolina, says that in addition to following initial protocol, such as requiring campers to wear helmets when horseback riding or climbing, the camp also has two nurses and a doctor on-site. Anyone who is suspected of having a concussion must go to the infirmary to be evaluated by medical personnel, says Crocker.

Importance of Parental Awareness

Although school and camp officials seem to understand the problems that can occur with concussions, it is vitally important that parents understand too. While parents want their children to be healthy, it is sometimes hard for the parents to have their children miss activities.

Wiercisiewski, a parent of teens himself, explains the dilemma: "We want to do the right thing, but we don't want them not to play."

Because some symptoms of a concussion can occur later, or since some players may try to ignore or hide their symptoms during practice, parents need to know the signs of concussions and what to do if their child exhibits them.

"We have the students for two and a half hours a day at practice; the parents have them 12 to 16 hours at home," says Lewis.

As for my daughter, I know that before she plays her next school sport, we'll have concussion awareness forms to read and sign. I'll know that if the school suspects she's had a concussion, she'll sit out of the game and won't be allowed to come back until someone trained in concussion management clears her to play. But it won't really matter what the school does because, as her parent, now that I'm more aware, I'll be doing the same thing.

Common Concussion Symptoms

After a hit to the head or a blow to the body, look for these signs:
• Headache
• Nausea or vomiting
• Sensitivity to light
• Irritability
• Not feeling quite themselves
• Confusion
• Blurred vision
• Difficulty concentrating
• Difficulty remembering

Pamela DeLoatch is a freelance parenting and business writer and mother of four teenagers in Cary.