Head Games

Carolyn Thompson of Chestertown, Md. is a mom of a typical active six year old. This past February she signed up her son Finn for ice skating lessons in Easton as a fun diversion in the winter months. Unfortunately the fun was short lived.

“He had just started to become more confident on the ice when suddenly his skates slipped right out from under him and he slammed his back and head against the ice,” Thompson shares. “He hit his head hard, but he was wearing a helmet. He stood right back up after he fell, and he never lost consciousness.”

Initially Finn seemed fine. He continued skating for about 30 minutes with no complaints. “It wasn’t until I took his helmet off,” Thompson says, “that he started to complain about it hurting his head, and his eyes started blinking rapidly.” She thought his blinking was due to the windy conditions, but the next day his teachers sent a note home from school about the blinking and she became concerned that something might really be wrong.

Like many people, Thompson thought you needed to lose consciousness to have a concussion. When she took him to the pediatrician the next day, she learned otherwise, “She diagnosed him with a concussion right there. Motor tics are not a common symptom, but they can be caused by a concussion. I kept him home from school from that point, but his symptoms did worsen for a few days.” Finn developed slurred speech, his eyes would drift off into a vacant stare and it took him longer to wake up. Finn is not alone. According to the Center for Disease Control, In 2014, an estimated 812,000 children ages 17 or younger were treated in U.S. emergency departments for concussion or traumatic brain injury (TBI), whether alone or in combination with other injuries.

Often people are under the misconception that a concussion is not a traumatic brain injury. “Concussion is indeed a type of traumatic brain injury,” says Dr. Christina Johns, pediatrician and senior medical advisor for PM Pediatrics. “It is most often caused by a bump or blow to the head that causes a type of “shearing” effect on the brain where the brain moves rapidly back and forth, ultimately resulting in a temporary loss of normal brain function. Especially when there are multiple, repeated head injuries like this, long term consequences can occur such as memory and attention difficulties as well as ongoing headaches.”

“Most of the time symptoms are seen immediately or within the first several hours after the impact,” Johns says. “Headache, nausea, sensitivity to light, not remembering the sequence of events prior to the injury are all common acute symptoms that can linger for days and for some much longer, but typically the symptoms are noted soon after the injury.”

Finn’s doctor told Thompson his brain needed time to heal, advising him to keep him off of all screens and away from bright lights, loud noises and strenuous activity. In addition, he had to refrain from all sports and play that

might cause another head injury until all of his symptoms resolved. When he was ready to return to school, he was to be allowed breaks from class as needed, granted extra time to complete tasks, and his doctor even said no test taking until he was completely healed.

Johns says those who have sustained a concussion need to have a few days of rest and hydration. “This means no eye or brain strain and lots of fluids. It’s very important to partner with a healthcare professional familiar with concussion treatment so that a tailored plan can be created for each individual.”

Previously, doctors followed a strict protocol insisting students refrain from school. However, similar to the directives Finn’s doctor prescribed, Johns says, “We no longer recommend that students are out of class for days and weeks, but rather encourage an earlier return to a light load in school and extremely light physical activity after a few days of rest with very slow increase under the guidance of a trained clinician. If symptoms return at any point in the process then it’s important to back off as it’s a sign that the body isn’t quite ready yet.”

Finn made a full recovery and his summer has been filled with swimming, biking, boating and jet skiing. His mother hopes others can learn from their experience, “Finn’s fall happened so quickly that if I had been peering down at my phone for even 30 seconds, I would have missed it and would not have put all of the pieces of the puzzle together. I wish I had known that concussions can happen to a child even if he is wearing a helmet, kids don’t have to show serious symptoms like loss of consciousness or vomiting to have a bad concussion, and that symptoms don’t always show up immediately.”

Thompson feels if she had been more educated about concussions, she would have gotten Finn medical attention quicker and he would have begun getting the necessary rest sooner. “The faster a child receives medical attention and appropriate rest following a concussion, the greater their chances are for a speedy, full recovery.”

Finn and his dog Claddagh enjoying summer after recovering from a concussion last winter.

HEADS UP

The CDC has developed the HEADS UP resource for parents who wish to become more informed about concussions, including how to recognize, respond to, and minimize the risk of concussion or other serious brain injury. at cdc.gov/headsup/ parents/index.html

As part of the HEADS UP resource, the CDC has provided the following signs for parents to look for which may indicate a concussion:

• Appears dazed or stunned

• Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent

• Moves clumsily

• Answers questions slowly

• Loses consciousness (even briefly)

• Shows mood, behavior, or personality changes

• Can’t recall events prior to or after a hit or fall

HEADS UP also includes a full list of danger signs and symptoms warranting a call to 911. cdc.gov/headsup/basics/ concussion_danger_ signs.html

Baseline Concussion Testing Many schools now require baseline concussion testing for student athletes. The testing is typically for athletes over the age of 10 and takes place prior to the start of practices. Generally repeated every two years, testing may be more frequent if there is a history of concussion.

The testing is used to assess an athlete’s balance and brain function, including memory, learning, concentration and problem solving. In addition, it can determine the presence of any concussion symptoms from previous injuries. Results from baseline tests are used and compared to a similar exam conducted by a health care professional if an athlete has a suspected concussion during the season.

This allows healthcare providers to ascertain the extent of the brain injury, and determine when the athlete can safely return to school and sports. If it is not offered by your child’s school, your child’s healthcare provider may offer the testing.