Dazed and Confused…How to Identify and Care for an Athlete with a Concussion

August 31, 2015 | Health Advice | By: Naomi Wyatt

Every parent knows the feeling: You’re standing on the sidelines of your son’s football game, proudly cheering on your little quarterback, when he gets hit. He falls to the ground, the other team’s biggest player falls on top of him. You watch helplessly as your child pulls themselves up, stumbles unstably to the sidelines, pulls of his helmet and starts puking. Your child has a concussion.
Concussion is the term for when a blow to the head is hard enough to cause the brain to swell. Similar to when you hit your shin on something hard, and the spot where you hit it swells up and becomes a hard knot, when something hits the head hard enough, the brain can swell up. However unlike other parts of your body, the brain is in a hard casing, the skull, so it has a limited amount of space to swell. The swelling changes the way some of the processes in the brain work, which can be seen as changes in your childs behavior.
Symptoms can happen immediately, such as passing out after being hit on the football field, or stumbling to the sidelines and vomiting. However symptoms can also take several hours to show up or be noticed, for example being extremely tired or showing difficulty with memory can take a while to notice, particularly in a younger child.
As a parent, it’s difficult to know how to take care of your child after they’ve gotten a concussion. If your child is showing any of the following, take them to the Emergency Room:

  • Loss of consciousness
  • Agitation, extreme sleepiness (difficulty staying awake), confusion or loss of short term memory (asking the same question over and over again)
  • Vomiting
  • Severe headache
  • Head injury acquired through high-impact acivity
    • Vehicle crash
    • Struck by high-velocity object
    • Fall of >5ft for child over 2 years old, >3ft for child 2 and under
  • Abnormal behavior
  • Signs of skull base damage
    • Black eyes
    • Excessive runny nose
    • Bruising on the bone behind the ears
    • Asymmetry of their face muscles (drooping of one side of the mouth or one eyelid, one eye pointing in a different direction than the other)
    • Difficulty hearing
    • Eyes quivering when they try to look at something
    • Blood coming out of their ears

Even after seeing the doctor, your child may still demonstrate symptoms of a concussion, such as balance problems, dizziness, amnesia, light/noise sensitivity, memory problems, sleepiness, irritability and behavior changes, which can last for 7-10 days after the head injury.
If your child gets hit on the head and has a concussion, then they should immediately stop the athletic activity they were doing. They should be allowed to rest from athletic activity and, depending on severity, may require a few days off school to allow their brain to rest from the injury. Try to keep your child away from too much music, television, and video games, as these stimulate the brain, which prevents it from resting and recovering. They will require a lot of sleep, particularly during the initial recovery period. Ibuprofen can be used during this period for headaches, however aspirin should be avoided. Be sure the patient drinks plenty of water.
When addressing whether or not an athlete can return to playing, there is a 6-day recovery plan that can be started after the child is asymptomatic:

Day 1.) full day of rest after concussion symptoms have stopped
Day 2.) light aerobic exercise
Day 3.) sport-specific exercise
Day 4.) non-contract drills
Day 5.) contact practice drills
Day 6.) normal practice and game playing

If symptoms of the concussion appear at any time during this six day plan, the athlete should return to day 1 of the plan and rest for 24 hours. Additionally, your child should see a doctor for medical clearance before returning to an impact sport after having had a concussion.
The reason it is so important not to participate in contact sports until symptoms of a concussion have resolved is because the concussion resembles a state of increased vulnerability for the brain. That is, small impacts that wouldn’t normally cause damage can cause permanent damage to the brain if they occur during the concussed state. Additionally, allowing your child to rest with little stimulation (no TV, video games, or sports) will make recovery from a concussion faster.
Some patients can experience a postconcussive syndrome, which consists of headaches, dizziness, difficulty concentrating, problems seeing, mood swings and anxiety. While postconcussive syndrome has been reported 3 months after the concussion, if the patient has symptoms lasting more than 3 weeks, they should be brought back to the healthcare provider for re-evaluation.
Concussions are a big concern in the medical community as football season draws closer. Be sure to look for the warning signs listed above if your child gets hit in the head, and follow the 6-day recovery plan carefully. Remember, when an athlete has a concussion, their brain is more easily damaged, so it is important to make sure you recognize the symptoms of a concussion, and give your kid the appropriate amount of rest they need to fully recover. Have a great football season!

Article By: Stefani Fontana, MS3