March 10, 2023
What is a Concussion?
A concussion is quite simply a blow to the head. Often this happens in sports and it has been brought to light in the past few years specifically with retired players who played in the NFL who have shown long-term debilitating neurological symptoms following several blows to the head during their careers. But a concussion can also happen from a fall. In fact half of reported concussions happen after a fall. *
One of the primary problems with diagnosing a concussion is that the symptoms are subjective. There is no one test that can be performed to officially diagnose a concussion. Many athletes minimize their symptoms because they want to play, but we now know that taking that risk can result in long term neurological damage.
What Does a Person Feel when They Have a concussion?
Here are some of the symptoms that might be observed by others:
- Trouble remembering event before or after a hit
- Seems dazed or “off”
- Seems confused about a play, where they are or what they are doing
- Having trouble walking or moving in a clumsy way
- Slow to respond to questions
- Loss of consciousness (even if its short)
- Changes in mood or personality
Other symptoms reported after a concussion may include:
- Headache or feeling pressure
- Feeling nauseous or vomiting
- Sensitive to light or noise
- Trouble with coordination or balance
- Feeling like they are moving more slowly
- Difficulty remembering things or confused
- Just feeling “off”
When do you see the signs and symptoms of a concussion?
This is the frustrating part! Some people feel these symptoms immediately after the injury. Others do not feel anything until hours or days after the injury. This is why it is so important to monitor someone who is suspected of having suffered a head injury.
What do you do if you suspect a concussion?
If a child or teen is playing in a game, they should be removed from the game immediately. Even if the child or teen insists on playing, if any of the above signs or symptoms are observed, it is simply not worth the risk.
We now know that after a person suffers a concussion, they are more susceptible to a second injury. These repeated injuries are what increase the risk of long term permanent neurological damage.
It used to be recommended that patients who suffered a concussion be placed in a dark room with no electronics and just left to rest. However, as everything in medicine, with new knowledge also sometimes comes changes in recommendations. Concussions are no exception.
What is recommended:
Experts recommend that kids and teens who suffer a concussion rest for a day or 2 and then resume activities slowly as tolerated. Slowly helping them to resume their regular activity results in quicker recovery than strict rest.*
A new study (Pediatrics, 2022, October 17), is suggesting that returning to snap chat and Net Flix may help too. Yup, you read that right.
The study looked at 700 patients between the ages of 8-16 after an injury and found that those that participated in screen time of 2-7 hours a day, recovered faster. Screen time included phones, ipads, television and computers.
Those patients that reported less or more than 2-7 hours a day of screen time in the first 7-10 days after injury, reported more headaches and tiredness in the first month after injury. After a month, both groups reported similar symptoms, showing no difference in the long term recovery of these patients.
This study is different from the 2021 study (JAMA Pediatrics 2021, Sept. 7) which found screen time to delay the recovery of patients. However, this study looked at the first 48 hours after injury, not 7-10 days after a concussion.
So what do we do now?
Reviewing both studies, we can conclude that rather than the old recommendation of strictly doing “nothing” and resting, including screen time, should be revisited. As with most things in life, moderation is key and it seems that a moderate amount of screen time after 48 hours can actually help symptoms and eventually with resuming play. That’s good news for all the parents struggling to keep their kids away from screens after a concussion!
Not only does a strict recommendation of sitting in a dark room and resting not help the symptoms of a concussion, we also know that it increases reports of anxiety and depression in these patients, especially teenagers.
Let’s Review:
- Rest and observe in the first 24-48 hours
- If any of the following signs are noticed seek treatment right away in the ER
- One pupil larger than the other.
- Difficulty waking the patient up
- Headaches that are getting worse or just not going away
- Difficulty speaking, moving, walking or unsteady
- Vomiting with or without nausea
- Acting strangely or confused
- Loss of consciousness
(**Please note that in infants you should also watch for inconsolable crying and or refusing to eat as well- head injuries in newly walking toddlers are very common!)
- Follow up with your doctor. Your doctor will need a detailed history of the injury and your child/teen’s symptoms immediately after the injury. They may be able to reassess and monitor your child after an injury via telemedicine. Make sure you have a plan for how and when your child should return to normal activities.
Possible Long Term Effects of concussions:
While most children recover fully from a concussion within 4 weeks, approximately a third may have lingering symptoms. It is important to check a child’s vision after a concussion as well. The American Academy of Pediatrics recently made a statement about the importance of checking vision after a concussion. Many children may not notice the visual changes that occur after a concussion and most pediatricians do not screen for vision after one. It is also important to check a child’s ability to track objects and their ability to focus on both near and far objects. Missing a visual deficit can result in kids getting frustrated in school, becoming tired or losing interest. Some children may even have to temporarily wear glasses to fix the blurry vision.
Lastly, your child/teen will need to play an active role in their recovery by answering questions honestly. It is normal for kids and teens to simply want to jump back into a normal routine but we need to make sure they understand that they must be “fully back to normal” before returning to play.
**If your child/teen has suffered a concussion, there are online sites that are helpful for self-reporting and can be used as an adjunct to your child’s care. This should never be used as a replacement for care but rather shown to your pediatrician, to monitor your child’s symptoms.