Kids with sports concussions need time out

September 1, 2010 By Jim Dryden
Although concussions are more common among older athletes due to more violent collisions involving bigger bodies at higher speeds, concussions have the potential to be much more dangerous in younger athletes whose brains are still growing and developing.

Between 1997-2007, the number of emergency room visits for concussions doubled in children ages 8-13 who play organized sports. Part of the reason is greater awareness, according to Mark E. Halstead, MD, assistant professor of orthopaedic surgery and of pediatrics and director of Washington University in St. Louis’ Sports Concussion Program.

“I think, overall, there probably aren’t many more concussions,” Halstead says. “What we’re really seeing is more attention. People are seeking more medical attention because that’s what we’re recommending.”

Halstead is first author on a report with new guidelines for managing sports-related concussions. The recommendations give advice to both parents and physicians and appear in the September issue of .

Young athletes are especially vulnerable because their brains are still developing and may be more susceptible to the effects of a concussion, according to Halstead. As recently as 10 years ago, a child with a low-grade concussion may have been allowed to return to action as soon as 15 minutes after symptoms had subsided, he says.

The video will load shortly.

Now, Halstead's team recommends that no athlete be allowed back into competition the same day. In some cases, he says, it may be weeks or even months before it’s safe to go back on the playing field. At the very least, he recommends — and now laws in many states require — that young athletes be evaluated and cleared by a doctor before returning to competition.

Common signs and symptoms of a concussion include headache (by far the most common symptom), dizziness or memory or concentration problems, in which many athletes will describe feeling “foggy.” Some also may feel sick to their stomachs or have issues with balance.

“If someone has taken a blow to the head, and they’re feeling some of those symptoms, parents and coaches need to assume that the player has suffered a concussion,” Halstead says. “We always tell people to err on the side of caution.”

That’s particularly important in younger children. Although concussions are more common among older athletes due to more violent collisions involving bigger bodies at higher speeds, concussions have the potential to be much more dangerous in younger athletes whose brains are still growing and developing.

“There is a problem called ‘second impact syndrome’ that affects children but is not seen in older athletes,” Halstead says. “If a child returns to competition too soon and suffers another head injury, they can develop dramatic swelling in the brain and even die following that second injury. That syndrome is unique to the pediatric population. We’ve never seen it happen in a professional athlete.”

To avoid those devastating consequences, Halstead says it’s never appropriate to allow young athletes to return to action the same day an injury is sustained. In fact, he says athletes should not return to of any kind until they are symptom-free. And in some cases, in addition to resting from physical activity, may need what he calls “brain rest,” including temporarily refraining from school work, video games, television and reading.

“All of those activities can aggravate symptoms, so we want them to refrain from those things in order to heal better,” he says. “Once they are OK when at rest, we can allow them to slowly begin physical activity, while paying close attention to ensure that symptoms don’t return.”

These are the first concussion guidelines published for athletes younger than high-school age. Previous guidelines used in older athletes defined concussions in stages, as either grade 1, 2 or 3. The length of rehabilitation was determined by the grade of the concussion.

These new recommendations, Halstead says, urge doctors to avoid that kind of “cookie cutter” approach and to allow individuals back into competition only after they feel better and symptoms have subsided. Verifying that, however, requires cooperation from the patient.

“That’s the trouble with a concussion as opposed to a knee injury,” Halstead says. “When a kid hurts a knee, he or she goes limping off the field and can’t put weight on the leg. With a head injury, a lot of times we’re relying on the athlete to tell us that he or she is having problems. We want kids and coaches to know the signs and symptoms. That way, if there’s any question, they can be evaluated. Especially in children, concussions aren’t something to ‘monkey around’ with.”

More information: Halstead ME, Walter KD and the Council on Sports Medicine and Fitness, Clinical Report Sport-Related Concussion in Children and Adolescents. Pediatrics vol. 126 (3) pp 597-611 Sept. 2010 (published online Aug. 30, 2010. DOI: 10.1542/peds.2010-2005)

Related Stories

Recommended for you

Protein regulates vitamin A metabolic pathways, prevents inflammation

October 23, 2017
A team of researchers from Case Western Reserve University School of Medicine have discovered how uncontrolled vitamin A metabolism in the gut can cause harmful inflammation. The discovery links diet to inflammatory diseases, ...

One in 4 women and 1 in 6 men aged 65+ will be physically disabled in Europe by 2047

October 23, 2017
By 2047 one in four women and one in six men aged 65 and above is expected to be living with a physical disability that will severely restrict everyday activities, reveals an analysis published in the online journal BMJ Open.

New insights into controversial diagnosis of adolescent chronic fatigue

October 23, 2017
Crucial new research could provide some clarity around the controversy surrounding the diagnosis and treatment of chronic fatigue syndrome (CFS) in adolescents. The research by the Murdoch Children's Research Institute published ...

Do boys really have a testosterone spurt at age four?

October 23, 2017
The idea that four-year-old boys have a spurt of testosterone is often used to explain challenging behaviour at this age.

Our laws don't do enough to protect our health data

October 23, 2017
Have you ever wondered why your computer often shows you ads that seem tailor-made for your interests? The answer is big data. By combing through extremely large datasets, analysts can reveal patterns in your behavior.

New prevention exercise programme to reduce rugby injuries

October 23, 2017
A new dynamic 20-minute exercise programme, performed by rugby players before training and pre-match, could dramatically reduce injuries in the sport according to a benchmark study published today (Sunday 22 October).

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

Bob_B
not rated yet Sep 01, 2010
If headers are one of the standard ways to pass a soccer ball how can young children NOT be having concussions regularly?

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.