Childhood concussionNational Pharmacies
Childhood concussion is very common and it is estimated that 80 per cent of childhood concussion remains undiagnosed. Reasons for this poor diagnosis rate include lack of concussion awareness and education (from player, coach and parents), poor reporting of symptoms (either intentional or otherwise) and downplaying of symptoms by children and parents.
Only 30 per cent of concussions are associated with loss of consciousness and a direct injury to the head is not required to suffer concussion. Concussion can be defined as a transient mild brain injury, which has been caused by trauma and results in a functional, rather than structural brain injury.
Symptoms and signs that may be associated with concussion include:
- Loss of consciousness
- Lying motionless, slow to get up
- Confusion, disorientation
- Dazed/blank stare
- Memory impairment
- Balance disturbance
- Nausea or vomiting
- Headache or ‘pressure in the head’
- Visual or hearing disturbance
- Behavioural or emotional changes
This information is well illustrated in the Concussion Recognition Tool 5. http://bjsm.bmj.com/content/early/2017/04/26/bjsports-2017-097508CRT5
If any of these symptoms or signs are present, the player should be removed from the field and medically assessed.
If there is any doubt as to a diagnosis of concussion, a player should sit out the game and be reassessed (if in doubt, sit them out).
Red flags, such as neck pain or deterioration of any of the above symptoms or signs warrant referral to a hospital emergency department.
Once a player has been diagnosed with concussion he/she requires a minimum of 2-3 days of physical and cognitive rest. They will often require a short period of time away from school, followed by several days of modified schooling where the duration and intensity of schooling is deliberately limited.
In the recovery period following a concussion children may complain of:
- Difficulty concentrating
- Memory impairment
- Sensitivity to light and noise
- Feeling ‘slowed down’
After concussion has been diagnosed, review with a doctor familiar with concussion and its treatment should occur as soon as possible. A further medical review is required whilst recovering to assess the player’s cognitive state and formulate a plan for a graduated return to sport.
Any time up to 4 weeks is a considered a “normal” recovery period after a childhood concussion – this is significantly longer than the expected 7-10 day recovery in adults.
The Australian Institute of Sport and the Australian Medical Association protocol states that a concussed junior player should not engage in competitive physical activity for at least 2 weeks after their symptoms have resolved. This means that all players should miss a minimum of 2 matches after a concussion.
At this time there is no scientific evidence than suggests that repeated mild sports concussions lead to long-term brain damage. However, scientific research continues in an attempt to confirm or disprove this fact.
Despite extensive testing, there is no evidence that the use of helmets reduces the rate of childhood concussion.
Childhood concussion is very common and often remains undiagnosed. It is important that we are aware of the signs and symptoms associated with concussion so we can diagnose and then treat it appropriately, in order to ensure a positive outcome for the injured player.
Dr Steve Kennett, Sports Doctor Wakefield Sports Clinic, SASMA Member
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