September 6, 2022
By Elizabeth M. Pieroth, PsyD, ABPP, MPH
We know there are physical and emotional benefits of kids playing sports but there are also risks associated with sports participation. For many parents the fear of injury, including concussions, is a significant concern when their children start playing sports. Concussions can be particularly difficult because they can be challenging to diagnose, and parents often receive contradictory information about how to treat their child with a concussion.
A concussion can occur when a person is struck in the head or takes a hit to the body that moves the head forcefully. Concussions can cause cognitive (thinking), physical, emotional and sleep-related symptoms and every concussion can present differently. Fortunately, not all contact to the head results in a concussion but it is important to look for any signs or symptoms of concussion after contact (chart below).
Signs (Observable by Others)
- Appears dazed, confused
- Responds slowly
- Forgets instructions/assignments
- Moves clumsily
- Loss of consciousness
- Show mood/personality changes
Symptoms (Reported by the Patient)
- Headache, head "pressure"
- Nausea or vomiting
- Visual changes
- Dizziness or imbalance
- Sensitivity to light or sound
- Confusion, feeling "out of it"
- Unable to concentrate or memory problems
If any of these signs are observed by others or the child reports any of the above symptoms, they must be removed from play. Athletes, parents or coaches should not be asked to determine if the athlete has suffered a concussion but should simply remove the child from any activities that risks additional injury. The athlete should then be evaluated by a medical professional properly trained in concussion assessment.
Not all suspected concussions require an emergency room visit but there are “danger signs” that indicate a more serious injury may have occurred. When you remove an athlete from play, their symptoms typically subside a little or stabilize. If the individual is reporting increasing headache, confusion, fatigue or worsening of other symptoms, they should be urgently evaluated. Additionally, if there is repetitive vomiting, evidence of seizure activity, any loss of consciousness or inability to speak, the child should be seen in the emergency room. Finally, loss of sensation in the arms or legs can occur after a spinal cord injury. Do not move the patient and contact the local EMS for transport.
Once a diagnosis of concussion has been made, the individual should rest comfortably at home for a brief period. One of the biggest misunderstandings about post-concussion care is that it requires “complete rest” or removal from all physical and cognitive activity. Current science tells us that it is not the best approach for concussion care. What we now know is that individuals who slowly increase their level of activity, as tolerated, within a few days after a concussion recover more quickly than those who are highly restricted. Early activity has been shown to be safe in both adults and children but should be done under the guidance of an appropriately trained medical professional. Some patients will be highly symptomatic beyond the first couple of days so may need to progress their activity more slowly. For additional information, see my Tedx talk on this treatment (watch here).
We typically recommend that an athlete starts “low level” exertion by day 3 or 4 after a concussion, if their symptoms are manageable. This may simply mean a 10–15-minute walk. If the person’s symptoms increase with this activity, they continue at this low level or take a slightly shorter walk. Most athletes will report it “just feels good to be moving again!” If this activity does not increase the symptoms, we ask the patient to increase the time and intensity of their exertion, again as tolerated. We never want the patient to engage in any activity that significantly increases their symptoms or puts them at risk for additional contact to the head or other injury.
Not allowing the patient to remain inactive for too long of a period is also important because we know that overly restricted patients can become hyper-focused on their symptoms, which can result in increased fear and avoidance behaviors. Many young patients with anxiety, depression or other mental health conditions appropriately use exercise to manage their conditions. Therefore, exercise should be encouraged but monitored.
Additionally, keeping a child out of school for long periods of time can cause increased stress and worry about the work to be made up. We generally recommend 1-2 days off school, depending on the severity of the symptoms. Some individuals with more severe symptoms may benefit from additional time off, but a student does not need to be fully without symptoms to return to class. Academic accommodations should be requested during their initial recovering time, such as delaying any examinations and requesting extensions on assignments, if needed. Removal from gym or highly stimulating classes (e.g., band) should be allowed to help reduce symptoms during the school day. Additional patient-specific accommodations should be made for the student with a greater degree of symptoms.
We do not recommend that a child return to an activity that risks additional contact to the head while they are recovering. We want to prevent additional injuries or complicated recoveries. Their return to sports play should be supervised by a medical professional experienced in working with concussed athletes.
Research has shown us that the sooner a patient is evaluated and treated by a concussion specialist, the sooner they recover. We know that an appropriately managed concussion results in quicker recovery and return to school and activity. So, do not delay seeking out specialized care for your child.
Finally, most pediatric patients will recover in 1-3 weeks, although it is not uncommon for children to take up to 4 weeks to recover. Some patients will continue to have symptoms beyond that normal recovery but there are effective treatments for those persistent symptoms. If your child continues to have symptoms, you should seek out a referral to an experienced concussion specialist.
Elizabeth M. Pieroth, PsyD, ABPP, MPH is the Director of the Concussion program at Rush University Medical Center and Midwest Orthopaedics at Rush. She has been involved in the assessment of players in the National Hockey League since 1997 and is the Head Injury/Concussion specialist for the Chicago Bears, Blackhawks, White Sox & Fire, the Rockford IceHogs, Chicago Steel, the National Women’s Soccer League and the MLB Umpires Association.
Dr. Pieroth is the Co-Director of the NFL Neuropsychology Consulting Program. She is also on the Board of Directors of the Brain Injury Association of Illinois and is a member of the USA Football Heads Up Advisory Committee, the NFL Head, Neck and Spine Committee, the US Soccer Concussion Task Force and the Amateur Hockey Association of Illinois Safety Committee. She has received numerous awards for her work within the youth sports community.
Dr. Pieroth sees patients in Chicago, Oak Brook, Naperville, Oak Park and via telehealth (708-236-2775 for appointments).