The New Concussion Rules

Brush up on the latest concussion protocol for kids, along with the signs and symptoms of this common type of traumatic brain injury.
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With the popularity of youth sports, along with traditional kid pursuits like bike riding and climbing trees, the risk of a concussion is ever-present and shouldn't be taken lightly. Fortunately, more awareness and a better understanding of the signs and symptoms of concussions in kids are helping both doctors and parents know how to keep children safe.

Here's the latest research and guidelines on kids concussion protocol from the U.S. Centers for Disease Control and Prevention, as well as advice from experts to help you keep your child safe both on and off the field.

What is a concussion?

A concussion is a type of traumatic brain injury—or TBI— caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth. This fast movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging the brain cells.

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Signs of a Concussion

These are the most common signs parents can observe if they worry an injury has caused their child to suffer from a concussion:

Appears dazed or stunned.

  • Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent.
  • Moves clumsily.
  • Answers questions slowly.
  • Loses consciousness (even briefly).
  • Shows mood, behavior, or personality changes.
  • Can’t recall events prior to or after a hit or fall.

According to the CDC, In rare cases, a dangerous collection of blood (hematoma) may form on the brain after a bump to the head. Call 9-1-1 or take your child or teen to the ER right away if, after a jolt to the head or body, he or she has one or more of these danger signs:

  • One pupil larger than the other.
  • Drowsiness or inability to wake up.
  • A headache that gets worse and does not go away.
  • Slurred speech, weakness, numbness, or decreased coordination.
  • Repeated vomiting or nausea, convulsions or seizures (shaking or twitching).
  • Unusual behavior, increased confusion, restlessness, or agitation.
  • Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously.

Symptoms of a Concussion

These are the most common symptoms children and teens report when experiencing the effects of a concussion:

  • Headache or “pressure” in head.
  • Nausea or vomiting.
  • Balance problems or dizziness, or double or blurry vision.
  • Bothered by light or noise.
  • Feeling sluggish, hazy, foggy, or groggy.
  • Confusion, or concentration or memory problems.
  • Just not “feeling right,” or “feeling down.

Latest Concussion Protocol for Physicians

In September 2018, the CDC released a new guideline for concussion protocol in kids based on 25 years of research in efforts to improve care. They now recommend against routine X-rays for diagnosis and encourage the use of "validated, age-appropriate symptom scales" to diagnose a concussion. And while they urge physicians to assess for risk factors in kids that may prolong recovery, they are also recommending doctors counsel patients to return gradually to non-sports activities after no more than 2-3 days of rest.

As always, the CDC notes patients should be provided with instructions on returning to activity that are customized to their symptoms, so parents can expect lots more information from their child's doctor when it comes to treatment for a concussion.

Latest Concussion Protocol for Parents

Take all head bumps seriously.

The American Academy of Pediatrics (AAP) recommends calling your pediatrician if your child sustains anything beyond a light bump on the head. That advice seems to be getting out: More children are being seen in emergency rooms with head injuries that they sustained while playing sports, according to a recent report from the Cincinnati Children's Hospital Medical Center published in Pediatrics. This likely means that parents and coaches are doing a better job of recognizing the signs and complications of concussions, but there's still work to be done. Another study, published in the journal JAMA Pediatrics, found that nearly 60 percent of middle school girls continued to play soccer even though they'd displayed concussion symptoms.

When in doubt, sit it out.

"A player should never return to the field or court if there is any evidence of a concussion. Repeat this mantra: 'When in doubt, sit them out,'" urges Elizabeth Pieroth, Psy.D., a neuropsychologist at NorthShore University HealthSystem in Chicago and the concussion consultant for the Chicago Bears, Blackhawks, Fire, and White Sox, and Northwestern University.

The National Football League, the National Federation of State High School Associations, and the CDC have all been working together to make sure this happens. Currently, all 50 states have youth concussion laws on the books. Each state law is different, but the main points are the same: Train coaches and officials to recognize concussions and get kids off the playing field, court, or rink when a head injury occurs.

Brain rest is as important as physical rest.

Typically, a child with a concussion will recover within about three weeks, but it may take longer for someone whose symptoms are more severe. On the other hand, most students with mild to moderate symptoms can head back to school with a gradual return-to-school plan, including classroom accommodations and adjustments in his schedule (no gym class, reduced reading, periodic rest breaks).

While at home recovering from a concussion, children should avoid brain-taxing activities that can worsen symptoms. Every concussion is different: Some children may not be able to tolerate video games, computer use, and a lot of reading. On the other hand, playing simple board games and cards, listening to audiobooks, and helping out in the kitchen may be better activities while the brain is recovering. Some TV is also okay, but don't let it consume your child's day. Symptoms should be used as a guide for which activities to engage in, explains Gerard Gioia, Ph.D., a pediatric neuropsychologist at Children's National Medical Center in Washington, D.C., and the director of Safe Concussion Outcome, Recovery, and Education (SCORE). In general, moderation is the rule and if symptoms worsen, that is the sign to stop an activity.

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