About Concussions

A concussion is a type of traumatic brain injury. The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. The brain can move around inside the skull and even bang against it. If the brain bangs against the skull — for example, due to a fall on a playground or a whiplash-type of injury — blood vessels can be torn and the nerves inside the brain can be injured. These injuries can cause a concussion.

Anyone who has a head injury should be watched closely for signs of a concussion, even if the person feels OK. An undiagnosed concussion can put someone at risk for brain damage and even disability. So anyone who has any symptom of a concussion should be examined right away by a doctor.

Sports-related concussions are receiving increased attention. Doctors now recommend these steps after a suspected concussion:

1. The player should immediately stop playing or practicing.
2. The player should get checked out by a doctor before returning to practice or play. Kids who get concussions usually recover within a week or two without lasting health problems by following certain precautions and taking a break from sports and other activities that make symptoms worse.

Signs and Symptoms

Someone with a concussion may be knocked unconscious, but this doesn't happen in every case. In fact, a brief loss of consciousness or "blacking out" doesn't mean a concussion is any more or less serious than one where a person didn't black out.

If your child might have had a concussion, go to the emergency room if he or she has any of these symptoms:

• loss of consciousness
• severe headache, including a headache that gets worse
• blurred vision
• trouble walking
• confusion and saying things that don't make sense
• slurred speech
• unresponsiveness (you're unable to wake your child)

Call your doctor right away to report other problems, such as vomiting, dizziness, headache, or trouble concentrating. Then you can get advice on what to do next. For milder symptoms, the doctor may recommend rest and ask you to watch your child closely for changes, such as a headache that gets worse.

Symptoms of a concussion don't always show up right away, and can develop within 24 to 72 hours after an injury. Young children usually have the same physical symptoms as older kids and adults, but cognitive and emotional symptoms (such as irritability and frustration) can appear later, be harder to notice, and last longer. Sleep-related issues are more common in teens. Though most kids recover quickly from concussions, some symptoms — including memory loss, headaches, and problems with concentration— may linger for several weeks or months. It's important to watch for these symptoms and contact your doctor if they last. Often, in these cases, children need further evaluation and treatment.

Diagnosis

To diagnose a concussion, the doctor will ask about how and when the head injury happened, and about your child's symptoms. The doctor also may ask basic questions to test your child's consciousness, memory, and concentration ("Who are you?"/"Where are you?"/"What day is it?").

The doctor also will do a physical exam and focus on the nervous system by testing balance, coordination, nerve function, and reflexes. Sometimes a computed tomography (CAT scan or CT scan) or magnetic resonance imaging (MRI) brain scan will be done to rule out internal bleeding or other problems from the injury.

Some kids who have head injuries from playing organized sports are examined by a coach or athletic trainer immediately after they're injured. This is known as sideline concussion testing because it might happen on the sidelines during a game. Sideline testing is common in schools and sports leagues. By watching a player's behavior and doing a few simple tests, a trained person can see if immediate medical care is needed.

Lots of schools or sports leagues use computerized programs that test players at the start of a sports season to measure their normal brain function and ability to process information. These tests are called baseline concussion tests. After a possible injury, sideline test results are compared with baseline test results to help doctors determine if there's been a change in brain function and to help make a diagnosis.