Let's Include Children in the Concussion Discussion

By Jay Selman MD , Chief of Neurology at Blythedale Children's Hospital in Valhalla, Westchester County, New York

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The hospitalization of US Secretary of State Hillary Clinton for the effects of concussion, along with the regular-season brain injuries suffered by high-profile NFL players such as Philadelphia's Michael Vick, Chicago's Jay Cutler, and San Francisco's Alex Smith have put concussions front and center in the national discussions. Combined with a recent study by the American Academy of Pediatrics on children’s injuries – including concussions – doctors and parents now have more than ever to consider when it comes to a major health problem previously relegated to the pages of medical journals, instead of top stories for national magazines and TV news. 

Perhaps nowhere is the shift in the “concussion discussion” more evident than in the National Football League. The NFL has reportedly paid out millions to settle brain injury cases among its players – even as the league, for decades, denied a link between their sport and concussions.

And recently, The New York Times reported on two separate stories involving youth football teams – one about a Pee Wee football game that ended with five players, all under age 10, suffering concussions. The coaches of both teams and officials who oversaw the game were suspended, justifiably so. But most concerning is that the game ever reached that point at all.

Only under the threat of lawsuits and bad PR has the shift toward addressing concussions taken place. The NFL, facing litigation, has finally put a player safety and education program in place to address brain injuries. Pee Wee football already has an excellent injury prevention program in place, despite the glaring exception noted above. And here in New York, lawmakers passed more stringent laws to address these types of injuries in school athletes – to "end the macho approach," as a recent Albany Times Union article put it.

As a society, we have become aware of the potentially serious effects of repeated head injuries. And while prevention of concussions and traumatic brain injury, or TBI, is key, educating our parents, coaches and school staff is also key. Recognizing the symptoms of concussion is a good place to start.

It is important to note that a concussion is a brain injury that may or may not result in a loss of consciousness. The victim may not even be aware of having had the injury. He or she may appear completely normal yet be confused, disoriented, unsteady, irritable or depressed. Coaches and training staff may observe changes in player performance or behavior on the sidelines. Children and teens may complain of headaches, unusual fatigue, difficulty studying, or change in mood. And their parents may observe changes in attention, concentration, memory, or behavior.  Teachers may notice a change in academic performance or study habits. And all these symptoms may have a delayed onset.

Once suspected, a concussion requires an evaluation by a trained medical professional. If the injury happens during play, the coach or trainer can administer a standard sideline screening under accepted guidelines.  Under New York State law – and laws in other states – a child or teen must not return to sports or recreational activities until cleared by a physician. A medical evaluation, beginning with the pediatrician or family physician, will assess the player's condition.

The cornerstone of treatment after a concussion is physical and cognitive rest. This excludes any type of strenuous physical activity, team sports, and situations which might put the child or teen at risk of another injury. The school should adjust homework demands. Adequate sleep and hydration are essential.

Until a few years ago, physicians used tables and charts to determine when someone could play again after a concussion. Current recommendations mandate that this be a gradual, individualized process. When the injured athlete no longer has symptoms at rest and has been cleared by a physician, then he/she may begin to do light physical activity. The patient will proceed through further steps of more intensive activity without any problems, as supervised by the physician.

The serious consequences of untreated concussions across the country and the understanding of the results of repeated head injuries in professional football, hockey and other sports raised the awareness of the importance of these conditions. And while state laws are a good start, much more needs to be done in terms of prevention and education.

The long-term health of our children is at stake. That’s worth more than a football game, wouldn’t you say?

Jay Selman MD

Article written by Jay Selman MD
Chief of Neurology at Blythedale Children's Hospital in Valhalla, Westchester County, New York