Youth and Concussions
Q: My 10-year-old son plays football. I’ve been reading a lot in the past year about head injuries in sports, especially football, and I’ve become concerned. What do I need to do to make sure my boy is as safe as possible while pursuing this sport? What should I watch out for and how should I respond if he does get a hard knock to the head?
A: On a 1 to 10 scale about anxiety, where 1 equals “ignorance is bliss” and 10 is when you forbid your child from doing almost anything, “concern,” to me, is nearer the low end, where it belongs.
Children’s lives are filled with potential for accidents, but as I have written in previous columns, I believe that boys and girls should revel in exploring their world. It is sad to see the child who fears the oceans’ waves, or hesitates to sled down Suicide Hill, or whatever they called it in your neighborhood.
That being said, concussions are a significant part of growing up, and certainly not just in football. Other organized sports with frequent concussions include lacrosse, hockey, soccer and baseball. Potentially dangerous unorganized sports, in addition to the ones just mentioned, include bicycling, skiing, snowboarding, skateboarding and horseback riding. Essentially, everything that’s fun.
What exactly is a concussion? A concussion is a traumatic injury to the brain due to a direct blow, or a sudden whiplash-type injury. It is helpful to think of a concussion as a brief (or sometimes prolonged) altered state of consciousness. Loss of consciousness is not a necessary part of the definition. The child or athlete who is briefly dazed or confused, who as they say in football, has had his “bell rung,” has had a concussion.
The overwhelming percentage of concussions, sports-related or otherwise, are mild and do not appear to leave any permanent effects. To think, however, that the “bell ringing” or similar episode is just “part of the game” is foolish in the extreme. Likewise, playing through the pain in the long run is not good for your child or his team. And, yes, it is true that at all ages boys are more frequently affected than girls.
Speaking more specifically to your questions regarding your son and football, there are things you can do to allow him to enjoy the sport he loves, while keeping the risks to their minimum. More than anything, you need to be sure the league he plays in, and the coach he plays for, put his best interests ahead of winning. Yes, everybody wants to win, and it is a rare game where winner and loser go home equally satisfied and proud of how they played, but placing winning as the overwhelming goal is likely to place your 10-year-old second. This should never be the case.
Do the coaches discourage players from sitting out if hurt or dizzy? Are the players expected to “suck it up” and play through pain? In football, are they taught to lead with their head, or to use their helmet as a ram? Does the league not adhere to its own rules? If the answer to any of these questions is “yes,” then that’s not where you want your son to play.
This means that a parent must get out and watch practices as well as games, and you must talk to the coach if you have hesitation about his methods. Speak with other parents, particularly those whose kids have already had a particular coach. Please, however, don’t take my cautions as veiled criticism; wonderful and dedicated coaches abound.
If your child does have a head injury, what should you be looking for at home, and when can he go back to play? While headache, nausea, dizziness or visual changes are obvious symptoms, concussion may cause fatigue, depression, a feeling of being in a “fog,” or difficulty with school and short-term memory. These are, admittedly vague symptoms, but they are very important. Athletes will often play down symptoms, wanting to get back into the work of the team. If your son doesn’t seem “right” to you, he probably isn’t, regardless of what he says. When in doubt, sit him out.
Any concussion merits a visit and discussion with a medical provider. A trip to the emergency room is not necessary in all cases, nor is a CT scan of the head. Many people have become increasingly anxious after the well-publicized death of actress Natasha Richardson following seemingly minor head trauma. Despite this unpredictable and tragic event, CT scans should be ordered judiciously. They are not without
potential effects of their own and can have cumulative effects over a lifetime.
Children should not return to football or other sports until absolutely symptom-free. Return may be delayed for longer periods depending on the severity of the concussion, and—very importantly—if there have been any other recent head injuries. Symptoms can occasionally be quite long-lasting. There remains much to be learned about concussions in adults, and even more about concussions in the developing brains of children, so expect recommendations to keep evolving.
Locally, we are fortunate to have available to us the Central New York Sports Concussion Center, run by psychologist Brian Rieger, Ph.D. The Sports Concussion Center acts as a resource to both patients and doctors; it can be reached at 464-1908. I have had recent need to interact with the center and can enthusiastically recommend the staff.
As with many of the questions I deal with, concussion is a complicated issue. This brief introduction may provoke many more questions. Talk to your doctor, or the Sports Concussion Center, or feel free to send in a question or comment. ■
Dr. Alan Freshman, father of two grown sons, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at firstname.lastname@example.org.