“I could not leave the team behind. I needed to get back in. They told me I had to keep going and move.” These harrowing words send chills down my spine. Why all the upset? These statements represent the sentiment often carried by those who subsequently suffer from a concussion. During one of my hospital shifts, I met a young man who arrived in agony from a severe headache. He was hit in the head several times throughout the week during football practice. He was hit not 2, not 3, but 4 times before he sought help. Each impact led to worsening headache, blurry vision, and dizziness, but it was ignored.

Concussion is a group of symptoms representing a type of traumatic brain injury that results in chemical damage to the brain. Brain damage can result from a direct blow to the head or an indirect hit to the body that results in the head and brain shaking. This type of damage is frequent in children who participate in sports, especially football and soccer [1]. It, however, can occur several other ways. The CDC estimates that as many as 3.8 million suffer from a concussion annually, with females suffering more frequently.

It is imperative that parents, coaches, teachers and medical professionals recognize the signs. These can include: headache, vomiting, light sensitivity, sound sensitivity, slurred speech, emotional changes, memory issues, and problems with sleep. Loss of consciousness may or may not occur. There are several scoring systems that can help aid in a child or adolescent that you suspect experienced a concussion [2]. When in doubt, set them out! The CDC offers wonderful information and training online to become familiar with the condition [2].

As the pediatrician or concussion specialist, you can work to structure a schedule that will allow the patient to get better. This will involve a graduated program that increases their activity level as the individual improves [3]. The school should provide the student with the necessary accommodations to ensure full recovery. Rest is a crucial component of this process. Without it, the child or young adult may risk developing long term memory problems, behavior issues, and significant depression [4]. Most patients recover after two weeks but some take months to regain their baseline health. You are encouraged to follow the child or adolescent and perform the necessary exams to assess progress.

My patient spent several days in pain, unable to move from his hospital bed. He explained with great detail that he was not his normal self. He felt angrier, sadder, and unable to cope with daily activities. I have seen worse outcomes; thus, I end with a message to pass to all those who seek your care. It is okay to step out of a game when you are hurt. It takes courage to tell someone you need help. We are proud that you recognize it. You are a rock star and the game is not worth gambling your life. Also, missing one game, does not mean missing an entire season. Allow the brain the time to heal; it will love you for it!

References

1. Meehan III, W. P., & O’ Brien, M. J. (2018, November 14). Concussion in children and adolescents: Clinical manifestations and diagnosis. Retrieved from UptoDate: https://www.uptodate.com/contents/concussion-in-children-and-adolescents-clinical-manifestations-and-diagnosis?source=history_widget

2. US Department of Health and Human Services. (2017, June 22). Heads Up. Retrieved from The Centers for Disease Control and Prevention: https://www.cdc.gov/headsup/index.html

3. Centers for Disease Control and Prevention. (n.d.). Cole’s Story: Coach Saves a Wrestler’s Life by Knowing Concussion Signs and Symptoms. Retrieved from https://www.cdc.gov/headsup/pdfs/stories/coles_story_one_pager-a.pdf

4. Forgrave, R. (2017, January 10). The Concussion Diaries: One High School Football Player’s Secret Struggle with CTE. Retrieved from GQ Magazine: https://www.gq.com/story/the-concussion-diaries-high-school-football-cte

Abdelrahim Abdel, MD