When Your Child Gets a Blow to the Head

New guidance from the CDC on coping with concussion in kids

When Your Child Gets a Blow to the Head

Your daughter clunks heads with another player during a soccer game and then feels “dizzy and weird.” The coach recommends a trip to the ER. After the doctor checks her out, he says she has a concussion and should take it easy for a while.

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You’re relieved but also a little confused. What exactly is a concussion? And what does “take it easy” mean?

The Centers for Disease Control and Prevention (CDC) recently issued guidelines to help parents, coaches and doctors better answer questions like this. They set standards for children through age 18 to help doctors distinguish a mild brain injury from a possibly life-threatening condition, and specified strategies for recovery.

“Doctors should diagnose and manage pediatric brain injury based on the best evidence,” says Edward Benzel, MD, a Cleveland Clinic neurosurgeon who helped write the CDC guidelines. “We reviewed the past 25 years of research to create the recommendations.”

Concussion defined

A concussion is a type of brain injury resulting from a bump, jolt or blow to the head. The injury may or may not have involved loss of consciousness. Bruised nerves and blood vessels and chemical alterations in the brain cause a temporary loss of normal brain function.

Symptoms may last for several weeks. You can expect your child to feel tired, have a headache and maybe complain of vision problems. She may have trouble concentrating, be forgetful or seem to be “in a fog.” Some kids are overly emotional, and many have disrupted sleep — either sleeping a lot or not enough.

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Follow a plan for recovery

The CDC recommends the following recovery strategy for a child with concussion (before resuming sports):

  • Complete rest is OK, but for the first two or three days only.
  • Avoid aspirin for pain relief. Instead, ask your doctor if another over-the-counter medication — such as acetaminophen — can be taken.
  • Start back to school (for partial days and with extra breaks if necessary) and resume light activities other than sports.
  • Gradually become more active to resume a normal schedule.
  • If symptoms get worse or problems that had resolved come back, cut back again.

The same general plan should be followed for returning to sports after your child is fully participating in regular nonathletic activities.

“Start out slow — beginning with gentle aerobic exercise, then sport-specific drills, then contact activities, and finally full participation,” says Dr. Benzel. “Let symptoms be your guide — go back a step if they return.”

He adds that under no circumstances should a child return to sports or recreational activities on the same day that a head injury occurred.

Red flags

During recovery, be aware of signs of a serious brain injury. Call 911 if any of the following appear:

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  • Persistent, severe or worsening headache.
  • Significant nausea or repeated vomiting.
  • Unusual behavior, such as increasing confusion, restlessness or agitation.
  • Drowsiness or inability to wake up.
  • Slurred speech, weakness, numbness or poor coordination.
  • Convulsions or seizures.
  • Loss of consciousness.

If no complications arise, expect a recovery timetable of about four to six weeks. During that time, your child should gradually improve while increasing activities.

What if symptoms don’t resolve as expected? If your child is still having headaches, sleep problems, visual issues, moodiness or trouble thinking after several weeks, see your doctor. She may need to be referred to a neurologist or clinical psychologist familiar with head injury.

The CDC guidelines are published in JAMA Pediatrics. Additional information on concussions is available at the CDC’s HEADS UP website.

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