It's another typical hockey season, which means plenty of rough play, falls and tumbles. It's all part of the game. A mom comes into my office with a common story. Her son is 15 years old and had a concussion last month playing hockey. She wants to know if it is safe for him to keep playing. First of all, I am pleased to see this parent seeking medical advice, as too often concussions are treated as non-events. The answer to her question depends on several factors, all to be addressed once a sport medicine assessment is completed.
Any parent would be upset if their child suffered a concussion. Although medical reports are difficult to track, about 10 per cent of emergency room visits for children are for head injuries, with indications that up to 40 per cent of kids in contact sports may have had a concussion by the time they reach college age.
Even though sport science has produced some advances in protective equipment, no one is concussion-proof and kids -- not just parents -- should be aware of the symptoms.
What Is a Concussion?
A concussion is a complex injury that causes a disturbance in brain function. It usually starts with a blow to the head, face or neck, and sometimes involves a temporary loss of consciousness, although a blackout is only one possible symptom.
Many other symptoms are often brushed off as benign. These include confusion, memory loss, being unaware of game details such as the score and the period of play, and feeling "foggy."
You might get a headache or a feeling of pressure in the head. Ringing in the ears, visual problems, nausea and balance problems can also occur. Fatigue, emotional irritability and mental slowness can be present in the hours and days following the incident. If a player has any of these symptoms, they must go for an assessment right away.
How To Get a Diagnosis
Do not ignore the non-blackout symptoms mentioned above. Unfortunately, a pervasive mindset in some sports is that getting "dinged" is part of the game and you need to tough it out. This thinking is dangerous, because it exposes the child to further injury when his or her brain really needs a rest. It also prevents the child from obtaining a proper medical assessment as soon as possible.
With a loss of consciousness, it is clear to everyone that emergency medical services need to take the player from the ice to the hospital on a spinal board stretcher. Even when the player does not black out, however, medical management is still important.
Older children may have an athletic therapist on the bench and any symptoms of concussion should be reported to the therapist immediately. No players with concussion symptoms should return to the same game or practice. They should also be assessed by a physician, preferably the same day. If symptoms do not appear until several hours after the game, the child should still seek medical assessment.
They'll be asked a series of questions to test their memory, concentration and mental functioning. The physician will test vision, balance and neurologic functioning. Head scans such as a CT or MRI are not always ordered or needed with concussion symptoms. Although, it is a great relief to have a normal head scan for your child, scans after a concussion usually are normal. Thus, a normal scan does not mean the concussion is less serious or will resolve more quickly.
Treatment/Return To Sport
Anyone who has suffered a concussion needs to rest their brain until all the symptoms are gone. This means they should be able to read, do math and think at their usual pace, with no headaches, fatigue or other symptoms.
For kids, this can mean a few days resting at home, not doing school work and, definitely, no exercise. A followup schedule should be set with the physician to monitor your child and decide when it is safe to exercise and return to sport.
There is no timetable chart to follow; each child needs a treatment program tailored to his symptoms and circumstances. Younger children seem to take longer to recover than adults and it is not unusual for children to be out of sports for a month after suffering a concussion.
If a player suffers one concussion, they are more likely to sustain a concussion in the future with less trauma. Researchers believe the younger the child, the more vulnerable the brain may be to these repeat concussions.
Helmets and other protective equipment are improving all the time and children should always wear their protective equipment, even for casual games (including tobogganing).
There is some controversy as to whether our kids are playing more aggressively with more equipment. Sporting bodies obviously have to monitor the aggressiveness to discourage head injury. The best thing you can do for your children is to become knowledgeable about concussion symptoms and to seek medical treatment for your child, even if it seems like a minor hit.
In addition, do not enroll your child in any sport without medical clearance if they have a history of concussion. Any time your child receives a sport camp physical or checkup, a history of concussion must be reported to the physician.
Educate your kids about concussions and encourage them to report any symptoms as soon as they happen. Remember, your children need a healthy brain not just for sport, but for school, work and the rest of their lives.