Pediatricians are charged with making difficult health decisions for children on a daily basis, but when it comes to sports concussions, that is, brain injuries caused by a bump, blow, or jolt to the head or body, the balance of being both a pediatrician and a parent can be extremely challenging. Working closely with fellow parents is a critical part of protecting young athletes.
At my son’s recent taekwondo tournament, his teammate, Jason, received a legal kick to the head during a sparring match. Although I missed Jason’s match, hearing what happened from his mother and spending a few minutes talking with him was similar to so many encounters I’ve had with patients I treat for concussion in my clinic. When Jason’s mother asked for my advice though, I hesitated to answer. I was there as a parent and not as a pediatrician and I knew how hard Jason had been training for this competition. He was technically still eligible to compete that day in events that had no risk of contact. And, like more than 90% of athletes who suffer concussions, Jason never lost consciousness, not even briefly. By the time we chatted, he had rested and was smiling; a casual observer might not have realized Jason was injured at all.
The fact is, no matter how well he appeared, Jason had suffered a concussion, which is a significant traumatic brain injury. He showed many of the signs and symptoms described in the U.S. Centers for Disease Control and Prevention’s (CDC) Heads Up materials designed to educate athletes, parents and coaches. He complained of headache and grogginess, and struggled answering simple questions. He was unsure of his match’s final score and when he tried to stand up, he moved clumsily and unsteadily.
These and other concussion symptoms such as confusion, poor concentration, and depression are thought to be due to impairments in normal brain cell function that are not visible on brain CT scans. For this reason, a CT scan is not sufficient to clear an athlete to return to play. Instead, a concussed athlete should be withheld from activities like exercise, gym class, reading, and video games playing that increase their brain’s energy needs, since these activities may worsen symptoms and slow recovery. Called “cognitive and physical rest,” this treatment for concussion, allows time for their brains to heal. Return to play and learning should be gradual and under the supervision of a licensed health care professional.
Avoiding a second concussion is particularly important. Sustaining a second head injury before recovering fully from the first could result in second-impact syndrome, involving potentially life-threatening brain swelling. New research suggests the “sensitive period” for re-injury may be even longer than previously thought. This summer, a study published by researchers at Boston Children’s Hospital found that concussion patients who had a previous head injury within the past year suffered symptoms three times longer than those who had not.
Given what we are learning about the risks of concussions, what does this mean for youth participation in sports such as competitive martial arts, football and ice hockey in which players purposefully hit or collide with one another? Some experts recommend raising the age when full contact is introduced to give children more time to grow and develop athletic skills that may help them reduce their risk. Concussions are not limited to so-called collision sports, however. In a recent study, basketball, soccer, baseball, bicycling and snow skiing accounted for more than 38% of all emergency department visits for sports related concussions for 8 to 19 year olds.
In our city, the Boston Public Health Commission, in partnership with other injury prevention organizations, has promoted sports concussion awareness as well as initiatives to reduce the risk of injuries from falls by distributing bicycle helmets and child-proof window guards. Boston Public Schools has policies which comply with Massachusetts law mandating concussion awareness training for middle and high school athletes, their parents, and their coaches, as well as clearance from a licensed health care professional to begin graduated return to learning and play for injured athletes. You can find links to theses resources at www.bphc.org/playsafe.
At the taekwondo tournament, as I considered what to say to Jason’s mom, I thought about my own son who was also competing. In the end, his mother, his coach and I all remembered the most important thing that every parent should know about sports concussions: No single tournament, game, or athletic season is worth risking a child’s health.
In the end, when in doubt, sit them out!
Dr. Huy Nguyen is the Medical Director at the Boston Public Health Commission and a pediatrician at the Dorchester House Multi-Service Center.