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Pediatrics

Heads Up! Why Every Parent and Coach Should Know How to Spot a Concussion

Head injuries can happen to kids of any age. Your parental instincts are important in identifying the signs of a concussion.


heads up

You’ve heard the horror stories. You’ve read about the long-term effects. You’ve labored over letting your child play football or another concussion-prone sport, and worried as you watched them out on the field.

“There’s a lot of coverage in the media. We’re a lot more cognizant about concussions, especially in athletes,” says Joy Hanson, MD, MPH, a pediatrician at The Iowa Clinic in West Des Moines. “We examine concussions much more closely than in the past. And schools have done a really good job with getting children to their provider and with return-to-play guidelines.”

Thanks to new information and these changes, doctors and schools are a lot more aware of concussions. There’s plenty you should know too. Whether you’re a parent who witnessed their toddler take a hard fall, a coach of your kids’ youth sports team or a proud supporter of your teen’s athletic endeavors, you need to up your understanding of concussions in order to act quickly.

What is a concussion?

Getting your bell rung. Seeing stars. Getting dinged. There are many creative ways to describe concussions. They all gloss over the fact that head injuries are serious business. A concussion is actually a mild traumatic brain injury (mTBI) that can temporarily affect memory, speech, vision, balance and more.

“It’s kind of like a bruise on the brain,” Dr. Hanson says. “If you don’t allow your brain to rest, that can delay healing and recovery. There’s also a risk of suffering a second impact. Those can be even worse because your brain is already injured.”

“A concussion doesn’t mean your child has to quit playing sports. But it can be serious, especially if they’re playing without giving their brain time to heal,” she says.

Dr. Joy Hanson

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What does a concussion look like?

It’s hard to spot a concussion as it happens. All hard hits to the head look serious. But if your child or a kid you’re coaching takes a hit to the head, your concussion knowledge can go a long way.

“If there’s a concern about a head injury, even if the child is acting fine, just sit them out. You want to make sure you can watch them, rest them and avoid another head injury so quickly after the first,” Dr. Hanson says. “Any big hit to the head, in sports or at home, warrants medical attention within the first 24 to 48 hours.”

Even modern medical imaging technology can’t spot a concussion. Your child can have a normal X-ray, CT scan or MRI, but still have suffered a mild concussion. It’s what comes after the brain gets rattled around that you need to be on the lookout for.

“It’s normal to have a little discomfort after hitting your head. But if your child is still in pain hours after the injury, even after taking Tylenol or Motrin, it’s a reason to worry,” Dr. Hanson says. “You need to monitor them closely to see if they are acting differently or if they’re just out of it.”

Signs of Concussion

“Acting differently” is hard to define but, as a parent, you know it when you see it. Watch for changes in your child’s awareness, demeanor and behavior in the hours following a blow to the head. While most concussion symptoms show up immediately after the head injury, sometimes they don’t set in until days or weeks later.

Take your child to your pediatrician if you see any of these signs of a concussion:

  • Physical symptoms – Classic physical symptoms are the easiest to identify. Headaches, sensitivity to light, dizziness, nausea or vomiting early on, blurred vision, balance issues, low energy and tiredness can appear within the first couple days after the head injury.
  • Problems thinking and remembering – Your child may struggle to concentrate, think clearly or absorb new information. They may be easily confused or just seem slower mentally.
  • Emotional and mood changes – If your child seems irritable, sad, nervous, anxious or just more emotional than normal, it could stem from a recent blow to the head.
  • Sleep disturbances – Keep a close eye on your kid’s sleep patterns. They may sleep more than normal, sleep less or have trouble falling asleep.

“Even with babies, you can tell if they’re acting differently. If they’re not responding well to communication or aren’t communicating well back to you, those are signs of a concussion,” Dr. Hanson says. “Or maybe they cry more than usual, are easily upset, have more frequent temper tantrums or lack interest in their favorite toys or activities.”

Concussion Symptoms That Are an Emergency

For most head injuries, the risk of a brain bleed is low, Dr. Hanson says. Although highly unusual, a concussion can cause a blood clot or bleed in the brain.

Get your child to the emergency room right away if they:

  • Look very drowsy or won’t wake up.
  • Have one pupil larger than the other.
  • Have convulsions or seizures.
  • Cannot recognize people or places.
  • Get increasingly confused, restless or agitated.
  • Show unusual behavior.
  • Lose consciousness.
  • Have a headache that gets worse and does not go away.
  • Experience weakness, numbness or decreased coordination.
  • Repeatedly vomit or have nausea.
  • Slur their speech.

“Also, if it’s after hours at our clinic, go to the ER. With any of these serious concussion symptoms, you need to go to the emergency room for monitoring, observation and potentially testing,” Dr. Hanson says.

What do you do for a concussion?

Your watchful eyes are actually an important part of diagnosing a concussion. By monitoring for all the symptoms, it’s like having an at-home concussion testing kit.

If you have concerns, please reach out to your Pediatrician for an appointment.

Once in the clinic, your doctor will perform their own concussion testing — checking reflexes, looking for dilated pupils, assessing cognitive impairments and performing other neurological evaluations.

“We’ll feel the head and make sure there’s nothing wrong with the skull. We look for bruises on the head that are in scary places. And we do our own neurological exam to spot concussion symptoms,” Dr. Hanson says.

After going home, all that’s left to do is recover. Rest is the best concussion treatment. There’s little else you or your pediatrician can do aside. You just have to wait to allow the brain to fully heal and symptoms to fade — often within a week to 10 days.

The more rest your child gets, the quicker their brain heals. So you can aid in their treatment by helping them:

  • Avoid physical activities. Even the lightest of activities — like taking out the garbage — stimulates the heart, increases blood flow to the brain and can cause concussion symptoms to worsen or reoccur.
  • Limit screen time. Cognitive activities require the brain to use energy and can slow recovery or make symptoms worse. Even low-energy things kids do every day like using a computer, playing video games, watching TV or texting should be restricted.
  • Return to play. Once symptoms have resolved, consult with your pediatrician on resuming normal activities. Returning to action too soon increases the odds of a repeat concussion and more serious neurological issues.

The entire healing process takes a lot of open communication between you and your pediatrician. Of course you want to let them know when symptoms come back or worsen. But you also need to work together to make sure your child is 100% ready to resume everyday activity and any sports.

“Most of the time, they’re just fine. Other times, we can monitor and help with long-term effects like headaches, irritability, sleep issues and problems with concentration,” Dr. Hanson says.

Fortunately, those things are rare. Most kids recover without long-term effects and don’t suffer the repeated head injuries of professional athletes. But whether it’s been a month since your child bumped their head or hours since a scary fall, your pediatrician is there to guide you.

“The good news is that kids recover fully and quickly nearly every time. We’re always here to look them over, make sure everything is OK and teach you what to look out for at home,” Dr. Hanson says.

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