Understanding and Helping Children with Concussions
Patricia McGuire MD FAAP
Have you ever hit your head on a car door and a few hours later noticed that you didn't remember something that happened within the last few hours? Chances are you had a concussion.
According to the CDC, "a concussion is caused by 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 rapidly back and forth." Despite everyone focusing on it, unconsciousness only occurs 10% of the time.
The highest rate of emergency room visits for concussions and other traumatic brain injuries is in the 0–4-year age group. Right after that comes the 15-19-year-old group, and after that is the 20-24-year-old group.
Estimates of the prevalence of LCHI (lifetime concussion head injuries) range from 3.6% to 7.0% for children ages 3–17 years and from 6.5% to 18.3% for adolescents 13–17 years. 10-20% of all children with concussions will have a post-concussive syndrome.
What determines the severity of a child's concussion?
Several factors combine to cause the degree of damage a child has to their brain in an injury. These include:
• the impact itself,
• how the head and neck move,
• how stiff or rigid the area around the head and neck is, and
• how the brain tissues are affected at macroscopic (eye level) and microscopic levels.
The injury impact leads to varying levels of structural damage such as torn blood vessels or damaged nerve fibers, and functional changes such as how well the blood flows through the area and what happens to the child's alertness or confusion.
What are the immediate symptoms of a concussion?
Immediately, or within a few hours after a child is injured, he may complain of the following symptoms:
• Nausea and/or vomiting
• Blurred vision
• Concentration and memory problems
Concussions are divided into three categories of severity according to WebMD:
• Grade 1 or mild – symptoms last less than 15 minutes, and there is no loss of consciousness
• Grade 2 or moderate – symptoms last more than 15 minutes, but there is no loss of consciousness
• Grade 3 or severe – there is loss of consciousness, even if it is only for a few seconds.
Do you know how long concussion symptoms last? Longer than you think!
For children who have had no previous or only one previous concussion, the median time for the symptoms to resolve is 12 days.
If a child has had two or more previous concussions, the average time to recovery increases to 24 days. The median time is 28 days, and if the child has had at least one other concussion in the previous year, it increases to a median of 35 days.
How long do children have symptoms after their concussion?
• Three out of four children have symptoms at one week,
• One out of three children have symptoms at four weeks, and
• One out of seven children has symptoms at three months
Children with persistent symptoms beyond the average time for a concussion, which is longer than a month, suffer from post-concussive syndrome. These symptoms can go on for months to even years after the initial trauma.
Factors that might delay recovery include your child having:
• a history of a previous concussion or other brain injuries
• neurological or mental health disorders
• learning difficulties
• family and social stressors
So how do you help your child after a concussion?
Adults (parents and teachers) need to understand these problems and adjust for the child's symptoms. They need to be more patient. Specific recommendations include:
• Have your child's doctor provide recommendations for how long to stay home to rest after the concussion, usually 2-3 days. During that time, the brain needs to rest, requiring the child to get plenty of sleep and rest as needed during the day to aid in healing. It also is essential for the child to use less of the following:
• Computers, tablets, or cell phones
• Activity – low levels of activity are encouraged, such as walking, jogging, or riding a stationary bike (but not a street bike)
Talk with your child's school about the expected duration of the symptoms. Types of adjustments and accommodations could be to:
• Adjust the length of time in class, with rest periods as needed.
• Adjust for in-class work and homework assignments.
• Have another student take notes for your child to lessen stress on his brain.
• Change grading to audit or another form of rating that will not negatively impact his CGPA.
• Make sure that the school understands that it could be anywhere from a couple of weeks to a few months.
• Avoid sports and PE activities that put your child at risk for another injury to the head and brain.
• Return to school gradually. Don't try to go for entire days at first. If symptoms do not worsen during this time in school, expand the school day's length. If symptoms worsen, cut back on the school day.
Request a 504 plan of accommodations if your child has symptoms beyond a month or if there are issues of cooperation by school personnel: Examples include:
• Assign less homework,
• Provide extra help to make sure he understands class lessons,
• Re-teach materials that he may not remember anymore,
• Provide rest periods due to increased fatigue and sleep problems at night if these are present
Patience is the key to helping your child recover from a concussion. Pushing too fast is not safe for the brain or the child's mental health. And always reach out to your physician if your child's symptoms worsen or are not improving by one month after the accident.