It sounds extreme, but a seemingly harmless bump can affect your child’s brain. Let’s demystify this realm of child safety with the latest information.
“MOMMY, I bonked my head.” That’s how Amanda Gonzalez’s then 4-year-old son, Adam, greeted her at camp pickup one July day. He seemed fine, but because he had a little blood in the spot where he hit his head—apparently on a cement post while playing a game—she took him to a walk-in clinic. The doctor said Adam didn’t need stitches and told Gonzalez to just keep an eye on him. But the next day, his camp counselor called to say that Adam had been complaining of a headache and nausea and wasn’t eating. A mother of four who’d seen plenty of playground accidents, Gonzalez freaked out. “I said, ‘That’s a concussion! Why didn’t you call me sooner?’”
She recognized the symptoms, but she was still caught off-guard. “You expect kids to hit their head, but your mind doesn’t automatically go to concussion when the injury doesn’t seem that bad.”
Yet concussions are more common than parents may think, and they have the potential to be very serious. A recent study in Pediatrics estimates that up to 2 million children have sports- or play-related concussions every year. And we’ve all heard scary stories in the news about the lasting effects of head injuries in professional and student athletes.
Even though parents and coaches are now more aware of concussions, underreporting is still a big problem, says Frederick Rivara, M.D., coauthor of the Pediatrics study and director of the Seattle Pediatric Concussion Research Collaborative. Kids may not tell anyone that they don’t feel well if they want to stay in a game, and young kids may not even realize they’ve been injured. Because concussions can be so confusing, we’ve gathered the up-to-date facts about head bonks.
What exactly is a concussion?
It's a "mild traumatic brain injury” caused by a blow to the head or other jolt that forcefully shakes the brain. “At the cellular level, brain tissue and neurons stop functioning correctly for a short period,” says Steven Broglio, Ph.D., director of the NeuroTrauma Research Laboratory at the University of Michigan in Ann Arbor.
What are the symptoms?
Severe ones include a bad headache, vomiting, confusion, dizziness, an inability to walk straight or other balance problems, and sensitivity to light and sound. If your child has any of those, take her to the E.R. But symptoms can be more subtle: a milder change in walking or balance, headache, one or two dilated pupils, fatigue, difficulty concentrating, or just acting differently, says Dr. Broglio.
What if I’m not sure?
Keep a close eye on your child. If he continues to seem fine for 24 to 48 hours after a head bonk, there’s no reason to worry or make an appointment to see the doctor. With a young kid who normally stumbles around in an unbalanced fashion or often has mood swings, trust your instincts. Call your pediatrician or visit a walk-in urgent-care clinic if your child develops minor symptoms, his behavior seems off, or you just want peace of mind, even if two days have passed. And despite what you may have heard, it’s fine to let him sleep. “The old advice to wake a child up every four hours to make sure he’s okay can make things worse,” says Dr. Broglio. “We all know how kids act when they don’t get a good night’s sleep.”
How is a concussion diagnosed?
"We used to assume that a child had to lose consciousness to have a concussion, but now we know that if she’s symptomatic, she has one,” says Barry Kosofsky, M.D., Ph.D., director of the Pediatric Concussion Clinic at Weill Cornell Medical Center, in New York City. (Fewer than 10 percent of kids with a concussion black out.) Doctors today conduct a variety of tests to assess balance, cognitive function, and eye movement. “Fifty percent of brain function is exhibited through the eyes,” says Dennis Cardone, D.O., codirector of the NYU Langone Medical Center Concussion Center. New tools are helping with faster diagnoses. For example the King-Devick Test, which can be run on a tablet, is easy enough for sports coaches to use on the sidelines.
Should I insist on a CT scan?
No. “Most of the time, imaging isn’t necessary,” says Dr. Kosofsky. CT scans and MRIs aren’t sensitive enough yet to show signs of a concussion, so it’s not worth exposing your child to the radiation of a CT scan. Depending on the severity of his symptoms in the first 12 to 24 hours after a concussion, the doctor might suggest imaging to rule out a more serious brain injury
What’s the best treatment?
“The brain needs to rest—and both mental and physical rest are important for recovery,” Dr. Broglio says. Doctors used to recommend staying in a dark room without any stimulation for a few days but now warn that this can make a kid feel even more groggy and disoriented. Instead, have your child stay home from school or camp, and limit her activities for as long as symptoms persist and she doesn’t feel like herself. Most symptoms usually subside within a week or two, although it can take an additional week or so for concentration and memory to get back to normal.
If your child stays home for more than a few days with moderate to severe symptoms, work with your doctor on a gradual reentry plan. And remember: If she gets a headache or other symptoms, your child should head home to rest. “A headache is how the brain says ‘slow down,’ ” says Dr. Kosofsky.
When can my child play sports again?
He shouldn’t participate in sports, gym class, or recess until he is symptom-free for two weeks, Dr. Kosofsky insists. That means, for example, he’s able to make it through a full school day and band practice feeling good. Why? Your child is particularly vulnerable after a concussion. If he gets injured again before the first injury has healed, he could develop potentially fatal swelling in his brain called second-impact syndrome, or another blow to the head might cause long-term cognitive problems. Unfortunately, once a child has had a concussion, he’ll be more likely to have another one. “It takes less force to cause a second concussion, and the symptoms may be more pronounced and lasting the second time,” Dr. Cardone says.
How can I lower my kid’s risk if he’s an athlete?
You can't keep him in a bubble, and young children are naturally prone to bumps and falls. Helmets protect against injuries like skull fractures but won’t necessarily prevent a concussion because the brain can still get jostled. Four things you can do:
- Ask whether the coaches or teachers take concussionsafety training. They should promote good sportsmanship and teach ways to stay safe, such as proper hitting and checking techniques for football and hockey.
- Know when to pull your kid out of a game or an activity. Dr. Cardone says you shouldn’t be afraid to ask about protocols and policies but also to use your judgment: If your kid takes a rough hit, regardless of whether he says he’s fine, you can insist he sit out the rest of the game to be safe.
- Talk to your child about the dangers of concussions and of continuing to play while injured. Kids often don’t want to let down their teammates or coaches, be seen as weak, or feel left out of games, so let your child know what’s at stake, and encourage him to speak up if he feels dizzy or has a headache after a hit.
- Follow expert recommendations for contact and risky sports. Many advise sticking with flag football until age 14, no checking in ice hockey until age 15, and no heading the ball in soccer until age 12.