In pediatrics, concussion, or mild brain trauma, is a frequent cause of medical visits. Concussions are thought to affect millions of children a year and often occur from motor vehicle accidents, falls, other blows to the head, and other dramatic accelerations/decelerations of the head.
A concussion is noted to alter the functioning of the brain, typically temporarily, with more common influences on balance, visual processing, sleep, and headache. Symptoms tend to maximize over the first 48 hours. Rapid progression of drowsiness, headache, or vomiting and development of focal neurological deficits (arm weakness, change in eye movements, double vision) demands evaluation at the Emergency Room. Rapid deterioration can be from brain swelling or bleeding around the brain, which would commonly be evaluated with MRI or CT in the ER.
Outpatient clinic evaluation is more likely needed to address releasing the patient back to contact sports or because there is the persistence of symptoms. Obvious symptoms, including balance and headache, can resolve early, within hours or days, but commonly last three weeks. These symptoms commonly worsen with physical or mental activity.
Subtle symptoms, such as influences on attention, recall, school performance, IQ, and mood, can last up to 18 months and seem more manifest in those with pre-existing difficulties (ADHD, learning difficulties, etc.)
The more obvious symptoms typically dictate a “return to sports.” Although multiple return to play guidelines are published, most support that an athlete should not return to contact sports until (s)he is greater than one week free of noticeable symptoms. The interest in allowing this recovery is to prevent a second-hit phenomenon because a second concussion has an exaggerated effect on an incompletely recovered brain.
It has been noted that exercise following a recent concussion will often cause worsening of symptoms but does not lengthen recovery time. The goal is to make a second hit during the vulnerable period as unlikely as possible.
Most parents with affected children will note that they will be clumsy with reduced insight during the recovery phase. I cannot number the times when a concussion patient had a superimposed concussion by slipping on the floor in sock feet or hitting their head on a locker or car door. Be careful, but again all is not avoidable.
Fortunately, the severe potential consequence of concussion- death- happens almost exclusively in the setting of contact football. Concussion five days ago with continued headache, sleep problems, intolerance to exercise or mental demands, inattentiveness, and mild clumsiness is not unusual. If one is avoiding contact sports-like activities and symptoms are stable or are slowly improving, you are doing what can be done. If you are having difficulty navigating recovery, speak with a physician about the present circumstances.
Not all physicians are comfortable with concussion oversight. You may want to consider a physician with interest in sports injuries, or a neurologist. If a physician sends you to another physician for “treatment” of a concussion, understand there is not a drug that speeds healing, but rather you will receive guidance on managing symptoms.
I hope this is helpful, and I wish the best to the health of your children.
