Concussions in Youth
Every year, more than 400,000 kids are sent to emergency departments for serious brain injuries. Injuries from car crashes, playgrounds, or sports are the most common ways that kids get concussions.
- Children aged 0 to 4 years, older adolescents aged 15 to 19 years, and adults aged 65 years and older are most likely to sustain a TBI.
- Almost half a million (473,947) emergency department visits for TBI are made annually by children aged 0 to 14 years.
What to Expect?
For most people, symptoms of a single concussion end within a couple of weeks. For some, they may last for several months. “Postconcussive” symptoms are usually not signs of permanent damage or serious health problems. Most symptoms go away without any treatment. However, it is very important that your child take time to heal. Doing too much too soon after a concussion can make things worse. Activities like sports and physical education (PE) should be avoided until a doctor says they are safe. Besides making current symptoms worse, these activities may place your child at risk for a second concussion. Having another concussion before your child has fully recovered from the first one is dangerous. It may slow your recovery or increase the chance for lifelong problems.
How to Help Your Child Heal?
At least during the first few days, your child should get plenty of rest and try to maintain a good nighttime sleep pattern. Your child will probably need to avoid sports and mental exertion for at least one week.
Rest and sleep will help the brain to heal. If your child has any symptoms they should not participate in any risky activity. They should also avoid activities that require mental exertion. That may mean time off from school. Doing too much too soon can make symptoms worse. Your child should get plenty of rest and, in the beginning, they should avoid the following:
- Physical education
- Sports practices
- Heavy lifting
- Amusement park rides
- Deep concentration (video games, computer use, texting, television)
- Reading and writing (schoolwork, job-related)
- Activities involving loud noise
Depending on your child’s progress, they may need a gradual return to school. This may mean a shorter school day or frequent breaks throughout the day. They should also gradually increase their time spent on activities like texting, playing video games, using the computer, and completing homework. There are no structured guidelines for returning to cognitive activity. The following were developed by the authors as a guide.
Return to Play
The following are general guidelines for returning to sports. Your child should not proceed to the next level unless they have had no symptoms at the current level for 24 hours:
- No activity: complete physical and cognitive rest.
- Light aerobic exercise: walking, swimming, or stationary cycling keeping intensity less than 70% of the maximum predicted heart rate. No resistance training.
- Sport-specific exercise: Skating drill in ice hockey, running drills in soccer. No head impact activities.
- Non-contact training drills: Progression to more complex training drills (passing drills in football and ice hockey)
- Full contact practice: Following medical clearance participate in normal training activities.
- Return to play: Normal game play
If your child has had two concussions and/or lost consciousness for minutes (rather than seconds), then they may need to rest for two weeks or longer. After a third concussion, they should refrain from sports for the remainder of the season. In all cases, you should consult your doctor prior to resuming sports and other high risk activities.
You may use ice or a cold pack for 10 to 20 minutes at a time on the part of your child’s head that hurts. Put a thin cloth between the ice and your child’s skin. Make sure to give your child pain medicines exactly as directed. If your child is not taking a prescription pain medicine, ask your doctor if your child can take an over-the-counter medicine. However, do not give your child two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful. Also, do not give aspirin to anyone younger than 20. It has been linked to Reye syndrome, a serious illness.
Behavior and Mood
Changes in behavior and mood are common after a concussion. Just like the other symptoms, they usually resolve over time. However, your child may need treatment for mental health issues. You should contact your child’s doctor when mood changes involve any of the following:
- Serious thoughts of harming oneself or others
- Sadness that lasts for most of the day
- Feelings of hopelessness
- Panic or anxiety attacks
- Recurrent nightmares about the injury
- Social isolation
Mood symptoms can also affect recovery. It may take your child longer to get better if he or she had symptoms of depression or anxiety before the injury, or have symptoms of anxiety, panic, or fear related to the event that caused the injury.
Return to Cognitive Activity
Day 1: Complete cognitive rest
- Video games
- Loud noise
Day 2: When headache free, add 2 hours of the more familiar and easier of the above tasks, with no more than 30 minutes at one time.
Day 3: If there are no symptoms for 24 hours with step #2, add 4 hours of any of above tasks, no more than 1 hour at a time.
Day 4: If there are no symptoms for 24 hours, attend half day of school, with no homework. Activities requiring thinking and concentration at home should be light and limited to no more than one hour at a time. If symptoms occur at school, go to the nurse’s office, lie down, and skip the next period. If symptoms occur again in the next period after resting, go home.
Considerations at this stage which may increase symptoms:
- Math and chemistry classes
- Noise from the bus
- Core classes should be attended over non-core classes
- Depending on the student, they may be better off avoiding morning classes or only attending morning classes
Day 5: If there are no symptoms for 24 hours, attend full day of school, with no homework. Same recommendations apply as in #4.
Day 6: If there are no symptoms for 24 hours, resume normal cognitive activity, including homework.
If symptoms occur at any level, reduce activity.
Special Considerations for Athletes
Returning to play before your child’s brain is fully healed is very dangerous. Second Impact Syndrome is a serious and potentially fatal condition. It occurs when a person suffers a second concussion before the symptoms from a prior concussion have resolved. Your child can experience long-term brain damage as a result of SIS. Three or more concussions over time can also produce permanent brain damage. Appropriate management of concussions in athletes is essential. It is also important that your child follow safety rules, wear proper sports equipment, and tell you and/or their coach if they feel any concussive symptoms or have had a hit to the head.
Get more information about the Kaiser Permanente Youth Sports Concussion Program.