Identifying, treating and understanding concussion in children

Attitudes toward pediatric concussion have changed a lot since Dr. Chris Oakley, Director of the Pediatric Headache Center and Headache Medicine Fellowship at Johns Hopkins, was young. After not receiving adequate treatment for injuries sustained in childhood sport and horseplay, he now lives with migraine.

As his story demonstrates, post-traumatic headache and migraine are potential after-impacts of concussion. Dr. Oakley spoke with AMF about what today’s parents should know and do if they suspect their child has a concussion.

Identifying pediatric concussion

A concussion describes a brain injury where the brain gets jostled from the sudden movement. “From that, a multitude of symptoms can arise.” Dr. Oakley says. Some may be evident to parents, physicians, coaches, teachers, and friends, while others are more internal. “You’ll see mood changes. You’ll see more fatigue, sleep pattern changes, the child not being able to do what they used to do from a focus or energy standpoint.”

Headache is one of the first symptoms that patients describe, and one of the last to go away. According to Dr. Oakley, “That could be any type of headache, head pressure, soreness, generalized or a focal area of a certain point on the head that hurts.” Other symptoms include dizziness or balance problems, blurry or fuzzy vision, and issues articulating thoughts or retaining information.

However, there is no “test” for concussion yet, although researchers are working on some. “There’s no blood test or picture you can take that actually shows a concussion,” Dr. Oakley says. It’s most important to uncover the event that led to the head injury. “It doesn’t always mean a direct contact: even in a car accident where there’s a sudden stop-and-go type movement, where maybe you don’t hit your head–that sudden jerking can jostle that brain, and then shortly thereafter a small child might develop any number of these symptoms.”

Protecting children from concussion

Dr. Oakley doesn’t think it’s necessary to prohibit children from playing sports like football or soccer. “I see just as many kids that get concussion from things that are outside of sports.”

When it comes to sports, Dr. Oakley explains, the best prevention is education. “You want to take the time to make sure you have the right coaching, that the right techniques are being taught, that you have the right equipment in place to try to minimize the potential risk of head injuries.”

While it’s nearly impossible to protect active children from ever suffering head injury, symptoms and severity can be reduced by parents and coaches who take concussion seriously. “Even if it doesn’t look that bad to begin with, one of the biggest problems is not recognizing that first head injury. Then, before they have a chance to recover, another hit to the head happens. They do compound over time, especially in a short timeframe,” he says.

What to do in the case of pediatric concussion

According to Dr. Oakley, if you think your child has a concussion or a head injury, the first step is to pull the child from their activity to reduce the risk of worsening the problem with another blow to the head. If a parent observes any signs of concussion symptoms, like confusion, headache or nausea, they should call a pediatrician or other medical provider. If the provider identifies a likely concussion, parents should seek education on next steps, “whether it’s online resources or pamphlets or even simply getting referred to a specialist, whether it be a sports medicine provider, a concussion clinic or a neurology clinic.”

Children who have endured serious hits should go to urgent care or the emergency room.

Dr. Oakley wants parents to know they should never second-guess pulling a child from an activity. “Even with those small bumps to the head, you’re never wrong when it comes to caring for your child and getting them checked out.”

A gradual return to play

Concussion protocol aims to return children to normalcy as quickly as possible, but in a safe way. There is a step-by-step approach to gradually return to play, socializing, and classwork. “It takes time. If you put too much pressure on them or hold them to too high of a standard from the get-go, you’re going to do more harm than good,” Dr. Oakley says.

If Dr. Oakley has one takeaway, it’s that it’s essential for parents and coaches to take pediatric concussion seriously.

“So many of the kids I see aren’t given the credit they deserve for having such a difficult diagnosis and medical problem,” he says. “On the outside, many of these kids can put up a front and they look pretty good. They still can go to school, do their activities and have their lives because kids can cope amazingly well. But internally, they’re struggling.”