Young Athletes at Risk for Concussions

The Centers for Disease Control and Prevention (CDC) estimates that 3.6 million athletes of all ages report symptoms of concussions each year. So, why is that number so high? Have sports gotten rougher, or have coaches and parents just become more aware of head injuries?

The answer is both. Part of this stems from the fact that sports are becoming more intense than in years past, in both practice and competitions. Parents and coaches have also become more aware of brain injuries and their symptoms, making it more common for children to be sent to the hospital. And more children and teenagers are getting involved in sports than ever before, with the National Federation of State High School Associations reporting that almost 7.6 million students play high school sports.

The American Academy of Pediatrics (AAP) identified football as the sport with the most head injuries, accounting for 6 out of every 10 reported cases. Soccer, hockey, and lacrosse are also considered sports with a high concussion or head injury rate.

A concussion is a head injury that causes bruising to the brain. Concussions do not cause bleeding of the brain or structural damage to the skull, and can occur with or without loss of consciousness. The AAP uses a grading scale to determine the severity, with a grade one concussion being considered a mild injury that doesn't knock the child out, to a grade three that results in loss of consciousness and memory loss.

Sustaining a concussion is a serious matter at any age, but children are especially susceptible to serious complications because their brains are still developing. Second impact syndrome, when the child sustains a second concussion before the first has completely healed, is one of the most serious risks that a child athlete faces.

General symptoms to look for when a suspected concussion occurs include:

• Fatigue and a desire to sleep.
• Confusion.
• An intense headache.
• Nausea and/or intermittent vomiting.
• Unsteadiness.

A child should immediately be taken to a physician if any of the following occur:

• Change in personality accompanied by irritability or confusion.
• Worsening headache that induces nausea or vomiting.
• Numbness, tingling, seizure, or changes in breathing pattern.
• Eye and vision changes, such as double or blurred vision.
• Unequal sized pupils.

Research suggests as many as 50 percent of child athlete concussions go undiagnosed or untreated. If a child sustains a hard hit, he should be removed from the game and screened for a potential concussion. The King-Devick test is a simple, remove-from-play sideline test that can be administered by coaches and parents to help aid in the detection of head trauma and determine whether a player should return to play.

All that is needed is a timer (such as on a smartphone) and a pre-printed worksheet. The player is asked to read a series of numbers from left to right as fast as he can. A concussed individual will take several seconds longer to read them than a non-concussed player. Read more about the King-Devick test and find pre-printed worksheets for administering the test.

If the player is exhibiting severe symptoms, seek medical attention immediately.

According to the AAP, a child who has had one concussion is 2 to 4 times more likely to have another. Because of this, the AAP has issued new guidelines to follow when dealing with a child athlete who has suffered a possible concussion:

• Children who sustain a concussion should not return to play until they receive medical clearance from a health care professional with experience in concussion management in young athletes.
• Child athletes should not be returned to play on the same day of the concussion, even if they become asymptomatic.
• All athletes should be restricted from physical activity and mental exertion until they are asymptomatic. Schools should work with the students to modify workloads to promote a quicker recovery and avoid exacerbation of their symptoms.
• Neuropsychological testing should be used as one tool in the complete management of a sport-related concussion.
• Retirement from contact sports may be necessary for an athlete who has sustained multiple concussions, or who has suffered from prolonged post-concussive symptoms.

For more information on concussions among young athletes, visit the American Academy of Pediatrics.