While we may have moved past the days of referring to a blow to the head as a “bell-ringer” or allowing a player to dive back into a game while still groggy, concussions are still a painful reality for many children. These traumatic brain injuries, which can be mild or serious and affect all ages, have impacted over 2 million U.S. young people under the age of 17, according to the Centers for Disease Control and Prevention.
While most people recover well from these head injuries, early diagnosis and proper recovery management can be critical in eliminating their long-term health impacts.
To bring awareness to this topic, U.S. News & World Report hosted the virtual event “Head First: Taking on Childhood Concussions,” as part of Transforming Pediatric Healthcare, a series developed with support from Children’s Health and its flagship hospital, Children’s Medical Center Dallas.
This event assembled leading national experts who work with children and young adults who have sustained traumatic brain injuries. Their insights shed light on advances in concussion prevention, diagnosis, treatment and the latest cutting-edge research.
[READ: Here’s How You Can Lower Your Brain Injury Risk]
Childhood Concussions: What Are They?
A concussion is a type of traumatic brain injury (TBI) often caused by a blow to the head or whiplash. While concussions occur frequently during sports, children can sustain them in any setting, including from car and playground accidents or a fall from heights.
When someone sustains a concussion, the sudden movement injures the brain, explains Dr. Matthew Stokes, director of the Neuro-Concussion Clinic and a pediatric neurologist at Children’s Health. That injury causes changes to nerve cells and neurotransmission.
Experts describe a concussion as a “software” injury because structurally, the brain looks the same on imaging tests.
“But there’s a functional change in how the brain is signaling, what it’s doing,” Stokes says, “that can translate into different types of symptoms.”
[Read: Helping Kids With Anxiety: What to Do and Not Do]
Concussion Symptoms in Children
Adults can sometimes miss signs of an injury because of misconceptions of how a concussion manifests itself in a child. For example, only about 10% of all cases result in a loss of consciousness, notes Dr. Cynthia LaBella, medical director of the Institute for Sports Medicine at the Ann & Robert H. Lurie Children’s Hospital of Chicago and professor of pediatrics at Northwestern University’s Feinberg School of Medicine.
In fact, since the brain performs so many different functions, symptoms of a concussion can vary widely, she explains.
Common physical symptoms of concussion
Often, children do experience symptoms of concussion, including:
— Seizure activity or repeated vomiting, which are serious and necessitate a visit to the emergency room
— Nausea
— Headaches
— Dizziness
— Brain fog or feeling “out of it”
— Sensitivity to light or noise
Gerard Gioia, director of the Safe Concussion Outcome, Recovery & Education (SCORE) Program at Children’s National Hospital underscores this point, explaining that the best way to know if a child has sustained a concussion is to watch them closely and to note changes in their physical, cognitive, behavioral or emotional functioning. And this can be done with the help of a pediatrician.
The SCORE program has created an app called SCORE4BrainHealth (available through the Apple and Google Play stores), that can help parents, coaches and athletic trainers determine what to do based on a child’s symptoms and even guide caregivers on how to integrate a child back into academics and athletics.
“Symptomless” concussions
It’s also possible to have a concussion without the symptoms noted above. Childrens’ reactions to these injuries can be more subtle. For example, parents may notice changes in their child’s personality traits after a concussion.
“They may not be reporting any symptoms, but they just aren’t acting like their usual self,” says LaBella. “Maybe the kid is usually pretty enthusiastic and kind of a pep leader for the team, and suddenly they become very sullen and quiet, or vice versa; a kid who’s usually pretty quiet all of a sudden starts jabbering a lot.”
Acting in a way that’s uncharacteristic of their personality can be a sign that a child has sustained a concussion.
[READ: How Children’s Hospitals Are Treating Mental Health.]
Concussion Diagnosis
In addition to considering reported symptoms, doctors will generally perform neurological exams and cognitive testing to determine whether a child might have a concussion. They will take detailed medical histories of the patients and their family members. Children may have preexisting conditions that have not yet been diagnosed, like ADHD, anxiety, depression or migraines that can be exacerbated by concussions and impact treatment. Doctors will use this information to fully understand the child and how they may have been affected by the injury.
Contrary to what some parents may think, CT scans and MRIs aren’t generally used to diagnose concussions since they pick up structural damage, which hasn’t usually occurred. CTs, for example, help to identify fractures or brain bleeds.
“MRI is often used later on, when we’re trying to understand other factors that are playing into this person’s unusual or atypical or prolonged recovery,” says Gioia.
Emergency departments follow established guidelines on when to use CT scans or MRIs, and they would only be recommended for a very small percentage of concussion patients.
Stokes and Gioia note that researchers are currently making progress on blood tests that may help diagnose concussions. One FDA-approved test measures levels of certain proteins released by the brain into the blood, for example, but at the moment this work is focused on adults.
A multi-institution study currently underway called CARE4Kids will explore using imaging and blood tests to predict which children and teens might be more likely to have persistent post-concussion symptoms.
Concussions in male vs. female athletes
In sports where men and women play by the same rules, like soccer and basketball, women seem to sustain concussions more frequently than men, though the reasons are not yet clear, the panelists indicate.
Additionally, LaBella says that females may take longer to recover than males. This may be related to women’s tendency to play through their symptoms rather than reporting them.
These sex differences aren’t as apparent during childhood, but are apparent in adolescent and college-aged females, Gioia notes.
[READ: Signs and Symptoms of Depression in Childhood]
Preventing Childhood Concussions
Another common misconception is that helmets can protect kids and adults against concussions.
“Helmets were designed, especially in football, to prevent more severe head injuries, particularly skull fractures and intracranial bleeds,” says LaBella.
The experts agree that the first lines of defense in preventing childhood concussions are improved sports technique, including knowing how to fall and strengthening of neck and core muscles.
The other key development in sports that can reduce the incidence of concussion is rule enforcement to better protect players during competition, the panelists say.
Gioia has been working with a group of experts around the country to produce a “developmental readiness model” that could eventually provide guidance, based on a child’s developmental stage, about which sports activities may be safe or unsafe to participate in.
Stokes points out that in places where there are no restrictions on kids and impact in sports, children at the age of 6 and 7 are playing football in helmets that cause their heads to wobble. At that age, children don’t have the neck strength to hold up their head in a heavy helmet, much less to stabilize their head when it takes a blow or during a hard fall, he says..
When in Doubt, Sit It Out
Following the rule “when in doubt, sit it out” can be life-changing. If a child has sustained a blow to the head or whiplash, it is always safer to assume they have a concussion than to ignore signs and symptoms.
There is a major risk in sending a child back into the game after a concussion.
“They could get that second impact on top of the concussion that could result in a very severe or catastrophic injury (like) brain swelling or brain bleed,” explains LaBella.
Second, she says those children that sit out of the game rather than continuing to play generally recover better.
“You will have a faster recovery if you pull yourself out right away and rest right away. If you continue to play the rest of the game or the rest of the practice with a concussion, you may avoid getting another hit,” but end up worsening your symptoms and “that’s going to prolong your recovery.”
Active Rehabilitation to Promote Concussion Recovery
While you may have heard that the best way to get through this type of injury is to sit in a quiet, dark room, typically this is not the case. Instead, researchers and doctors are seeing positive results from what they call “active rehabilitation.”
Stokes explains that for a child who’s been participating in sports regularly, completely cutting out activity can be harmful to their mental and emotional health.
“There you take a kid who’s an athlete whose life is based on athletics, and you shut them down for two, three weeks, and you’ve created a kid who’s now losing their physical conditioning and is starting to develop anxiety and depression because they’re not participating,” he says.
Children can also develop other symptoms that may mimic those produced by a concussion, including headaches, fatigue, trouble concentrating and trouble sleeping.
The panelists all praise the benefits of active rehabilitation, rather than complete removal from athletics and academics.
“So active rehabilitation now is the way to go. And there’s been some very, very good data to show how that improves outcomes, improves recovery in kids,” says Gioia.
A small percentage of kids may have a more complex and persistent set of symptoms, like headaches or depression, panelists note, and these children can be referred to specialists for further treatment.
LaBella notes that each child is unique, so being thoughtful and flexible in mapping out and adjusting their recovery plan can help a child avoid becoming socially isolated or stressed as they get better.
The experts also recommend that kids (and adults) during recovery should aim to:
— Sleep well at night and avoiding day naps
— Eat three meals a day
— Stay hydrated
— Manage stress as much as possible
Schools also play an important role in a child’s recovery. Gioia has worked to develop the “STAMP,” which stands for symptom-targeted academic management plan and can help schools be partners in aiding a student’s recovery by recommending specific plans based on a child’s symptoms.
“It’s a progressive kind of thing. You want (kids) to be taking the next step forward, but you also want them to know when those symptoms are flaring up,” says Gioia.
Concussion care has dramatically improved in recent decades. The panelists agree that kids who are promptly sat down after an injury, examined carefully and given a customized step-by-step plan that maps out their gradual return to full activities, generally do very well and should experience no long-term repercussions from their injuries.
To view a full recording of the virtual event “Head First: Taking on Childhood Concussions,” please visit the link here.
More from U.S. News
Best Foods to Eat for Gut Health
Health Questions to Ask Your Doctor
Your Plant-Based Diet Needs These Foods for Optimal Health
Head First: Taking On Childhood Concussions originally appeared on usnews.com
