Your child has a concussion. Now what?

Football season has officially started.

While it’s a fun time of year that many student-athletes look forward to, it's also time to freshen up on our knowledge about concussions so that we don’t put our kids at risk for severe long-term symptoms.

Mismanaged concussions can lead to severe headaches or a prolonged feeling of “fogginess” which can harm our athletes’ ability to learn. And it’s not just high school football players we need to be concerned about. Any athlete can suffer a concussion, including young children. 

So what should parents know? 

A recent study in Pediatrics looked at how long it took for athletes to recover following on a concussion depending upon rather they returned to play or were immediatly removed from the game. Those who went back in to play were nearly 9x as likely to suffer symptoms for more than 21 days. They also had worse scores on neurologic testing and had more severe symptoms than those that were removed.

Not removing an athlete from play is not the only mistake that parents and sports teams can make in regards to concussion management.

Here are 8 ways that parents and sports teams mismanage concussions that could be putting kids at risk:

1)They don’t recognize that a concussion has happened. If you notice a hard hit or hit to the head and see any of the following: headache, confusion, memory loss, nausea or vomiting or excessive fatigue, you have to assume it was a concussion until proven otherwise. If you notice any of those symptoms during an athletic event, even without an observed injury, you should still be very concerned. You don’t have to lose consciousness for it to be a concussion.

2)They trust the athlete to report their symptoms. Highly motivated student athletes know better than to report all of their symptoms because they know that it will get them removed from play. If you notice a hit and see the athlete acting different in any way, you must consider that a concussion despite the fact that they may say that they are “fine.”

3)They insist on a trip to the ER after a concussion. Most concussions can be handled by the trainer in conjunction with a doctor who has some advanced knowledge of concussion management. If the child is conscious and alert enough to talk with you, it can probably wait until the next day as long symptoms aren’t worsening or the athlete’s alertness isn’t decreasing. All that said, if you are worried about the athlete’s symptoms, go to the ER.

4)They insist on head imaging (CT or MRI) after a concussion. Head imaging is usually not necessary after a concussion assuming that symptoms are steadily improving over time. Remember that a head CT does involve radiation so minimizing its use is important.

5)They let the athlete return to play in the same game. As the study above mentions, this can be devastating to the child’s recovery. Prolonged and severe symptoms may be the result, leading to impairment for school work and a longer time to return to the sport.

6)They wake the child up overnight to check them after a concussion. This old teaching is one that still hangs on in the parent and trainer community despite a lack of evidence that it helps in any way. In fact, because rest is commonly what a concussed athlete needs, it could theoretically recovery worse. Would I walk in a few times at night and check on my son if he had a concussion? Sure, but I wouldn’t wake him up to give him a mental status exam.

7)They allow the student to participate in school activities too soon. After concussions, it’s not uncommon for students to need a slow return back to full activities, including school work. I don’t like this time period to be too long, but a couple days of half schoolwork might be necessary. You should work with a doctor who is able to fine-tune the play for your child.

8)They allow the athlete back into the sport too soon. An athlete that has had symptoms of concussion should not return to exercise until they are completely symptom free. If their main symptom is headache, they should be headache free before returning to light exercise, moderate exercise, sport specific practice and finally games. If symptoms return at any of those steps, they must step back to the previous level of activity until symptoms are gone. Again, working with a trainer and doctor who understand return to play protocols is critical to keeping your child safe.

Watching your student-athlete closely after a concussion, removing them from play the minute you notice symptoms and being cautious with their return to play will protect them from prolonged symptoms. It is critical that we remember that they are students first and that not protecting them after a concussion can result in prolonged impairment from school work.

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.