School is back in session, which means that student athletes are hitting the fields — and, too often, their noggins. Coaches used to tell players to "shake it off," but no longer. Medical experts now warn that even a seemingly mild head injury can result in brain damage.
Lewis First, chief of pediatrics at Vermont Children's Hospital at Fletcher Allen and editor-in-chief of Pediatrics, describes how parents can help recognize and prevent head injuries.
KIDS VT: Explain the types of head injuries children experience.
LEWIS FIRST: There are two ways to think about head injuries: There are those that affect the skin surrounding the skull and brain, what we call external head injuries. When you bump your head, you'll get a lump or "goose egg " from leakage from blood vessels filling the space between the skin and skull. Then you have internal head injuries, those that affect the skull, brain and blood vessels inside the skull. Those can be life-threatening traumatic brain injuries. One of the common internal head injuries is a concussion — a bruise to the brain. A single first concussion doesn't usually involve serious bleeding or brain swelling. However, the more you shake or bruise the brain, the more likely it is that permanent brain injury will result.
KVT: What are the signs of an external head injury?
LF: A lump, bump, cut or scrape. A child may cry but otherwise appear absolutely normal. They might even have a headache for an hour or two or even vomit once, but that's it. They may also develop a black eye, but this type of external injury is rarely dangerous.
KVT: Since parents or coaches may not know whether a head injury is serious, what should they do first?
LF: Observation is key. What you may think is just a bruise to the skin may represent a concussion. With minor lumps and bumps, apply an icepack every 20 minutes for the first couple of hours. Then, observe the child. Most studies show that if the child has no change in symptoms in the first 12 hours, they're probably fine.
KVT: What warning signs should parents watch for?
LF: The most serious symptoms are loss of consciousness, head or neck pain, repeated vomiting, convulsions, a change in mental status, an inability to walk, balance or speak, or any weakness on one side. If you're a coach and your player seems dazed, confused or lightheaded, doesn't know who they're playing, or can't recall what happened, those are all signs that a concussion has occurred. You need to get that player off the field and seek immediate medical attention.
KVT: What are the consequences of ignoring a head injury?
LF: The side effects of concussions can last for hours or days, and about 15 percent of kids have symptoms that last for months. Those can include persistent headaches, memory loss and problems with concentration. A concussion is a very serious injury. Because you cannot see the bruise, many players, particularly in middle and high school, want to get back in the game as quickly as possible. But they may be doing themselves a disservice.
KVT: Are the effects of head traumas cumulative?
LF: Studies show that repeated concussions can lead to lasting brain injuries. There's about a four-fold increased chance that the second concussion will result in more serious signs, symptoms and risks of permanent brain damage.
KVT: How do you treat sports-related head injuries?
LF: If a child has been sidelined due to a concussion, he or she should not return to play without a doctor's permission and without going through a gradual return-to-play routine. Kids need complete physical and mental rest to heal the bruise that occurs from a brain injury. That means no sports, schoolwork, physical activity, video games or computer time. Basically, they must lie down and listen to music until they're symptom-free for at least 24 hours.
KVT: What about not letting children fall asleep after a concussion?
LF: If they're up, watch them for the first 12 hours. If they're sleeping, I recommend that parents check on them every two to three hours to make sure they're moving and breathing normally. You may want to shake their shoulder and make sure they recognize you and can respond. Don't wake them fully unless they don't fuss when gently nudged. If they don't fuss, sit them up to awaken them. If there is minimal response or your child is still confused, seek medical attention.
KVT: Any other recommendations?
LF: All kids playing sports should be wearing protective gear. Also, children need to understand the rules and basic skills of the game. If they don't learn the fundamentals, they're setting themselves up for injuries. Another simple measure: Look at the athletic field before a practice or game and clear away any debris and fill in holes and ruts.