Your child is in the thick of the game, running her heart out in a race with an opponent to chase down the ball. Suddenly, that opponent throws an elbow, striking your daughter in the temple. Your daughter crumples to the field, lying motionless for what seems like an eternity. The referee stops play and you and her coach rush to her side. She appears dazed, but is alert and able to count the fingers held up by her coach. She walks to the sideline without assistance and you think all is well.
Then she surprisingly asks you what the score of the game is and why she is on the bench, followed by complaints of dizziness, headache and feeling like the sun is “too bright.” You consider concussion, but recall that she didn’t lose consciousness. You remember an article that instructed “when in doubt, sit them out” until further medical evaluation if concussion is suspected.
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A visit to the local urgent-care center reveals that your daughter has, in fact, suffered a concussion and should “rest until she feels better.” You are given a sheet with red flags that would warrant a trip to the ER if they occur over the next 24 to 48 hours (unequal pupils, cannot be awakened, severe headache that worsens, slurred speech, weakness, numbness, decreased coordination, repeated nausea/vomiting, seizure, unusual behavior, lost consciousness) and are told that you do not need to wake her every hour to check on her symptoms.
This seems like satisfactory advice at the time, but as you drive home, you realize that many issues have been left unresolved. Should she return to school on Monday? Should she attend the field trip at the end of the week that she’s been looking forward to all quarter? What about homework? Her ballet class? Somehow, the instructions to “not return to play until symptoms resolve” seem oversimplified and don’t cover all the bases.
The International Concussion in Sport Group estimates that 33 million children and adolescents internationally sustained a concussion in 2016. In the United States, an estimated 1.1 million to 1.9 million sports-related concussions occur each year in patients aged 18 and younger. Adolescents, in particular, are at significantly greater risk and are estimated to be five times more likely than other age groups to sustain an injury. In addition, loss of consciousness is no longer a reliable indicator of concussion, since it occurs in less than 10 percent of injuries. Recovery estimates vary, ranging from a week to a month or more in youth athletes.
In the past, primary recommendations from college and professional athletes were generalized to youth, with the highest priority placed on return to sports. The medical field is becoming well-versed in updated concussion management strategies, including the importance of gradually returning youth to tolerated and safe aspects of their daily life, even before concussion symptoms completely resolve. Most providers now recognize the importance of a comprehensive “return to life” approach that encompasses home, school, social relationships and sports/recreation in concussion management for injured youth. However, we frequently hear of providers who are relying on outdated knowledge to guide patients.
Florida state law dictates that injured athletes must receive medical clearance from a qualified health professional before returning to play. As a parent, how can you tell who will provide your child with the best care?
First, find a concussion specialty clinic that offers a multidisciplinary approach to management. Concussion is a multifaceted injury with post-injury complaints ranging from physical, cognitive and emotional to sleep-related symptoms. Each patient will experience concussion symptoms differently. A team with a group of providers specializing in these domains will help treat the unique symptoms presenting in each individual, while helping you and your child understand what is happening in his or her brain.
Next, ask the medical team how they plan to prevent any potential negative outcomes during concussion recovery. Your child’s provider should work with you, your child and your family to construct a comprehensive, symptom-relevant set of accommodations within the first week of recovery. This should include a coordinated plan to work with school personnel in implementing, monitoring and adjusting support recovery in the academic setting. It should guide you and your child in basic management strategies across home and school settings, including a balancing of physical activity with rest breaks. A collaborative set of supports could potentially reduce post-injury morbidity and the risk of prolonged recovery.
Finally, you should feel free to ask all questions you might have regarding your child’s recovery. With the media frenzy surrounding concussion, it can be easy to jump to conclusions regarding the long-term implications of trauma on the developing brain. In reality, research is at the tip of the iceberg. In clinic we’ve heard many parents and athletes asking about long-term risk. Some have even considered retiring from contact sports. In some instances, the anxiety surrounding concussions has led to more harm than good, and often fails to consider the positive benefits of sports. You can rest assured that when identified and treated by trained professionals, most concussions resolve and your child will heal and return to his or her typical level of pre-injury functioning.
The University of Miami offers comprehensive concussion management for children, adolescents, and adults with our multidisciplinary team. We are pleased to announce the recent addition of our Pediatric Concussion Program, serving South Florida youth ages 5 and older. To make an appointment with a University of Miami Sports Medicine Institute concussion expert, call 305-243-2074.
Dr. Danielle Ransom is the pediatric neuropsychologist with the Sports Concussion Program and the Co-Director of the Pediatric Concussion Program at the University of Miami Sports Medicine Institute.