Thirteen-year-old Anna slips from the uneven bars, slamming the mat headfirst. Dizzy and nauseous, she does not tell her coach for fear he will pull her from practice or worse, the upcoming competition.
She resumes practice shortly after, unaware she suffered a concussion. She falls again. This time the impact causes permanent brain damage. Within seconds, her dream to perform gymnastics, go to college and become a veterinarian shatters.
Although most concussions are reversible, they can cause life-changing injuries like Anna’s if not allowed to fully heal. Those of us entrusted with the health and wellbeing of children – and even young athletes themselves – need to take this injury seriously. Young, developing brains are more sensitive to the effects of concussions, placing them at greater risk of long-term brain damage. Fortunately, certain actions can help prevent or minimize this damage.
Effect of multiple concussions
But first, let us look at what happens when a direct or an indirect blow to the head triggers a concussion. Damage to brain tissue causes temporary chemical and metabolic changes within the brain cells, making it more difficult for cells to function and communicate. If a cell loses too much energy during this process, the cell dies and cannot be replaced. If a second injury follows before the brain recovers and is still highly vulnerable, a stroke or other life-threatening injury can occur.
Therefore, after the first concussion, children should immediately stop participating in activities that put them at risk of another head injury. A second injury is more likely while the child continues to experience slower reaction time, decreased balance and coordination, and other concussion symptoms.
I tell my patients, “You’re not the same person you were before your concussion, but you will be if you protect your brain and allow it to fully recover.” Reducing mental and social activities for one to two weeks or until concussion symptoms resolve protects the brain and helps healing.
National attention on the link between multiple concussions and long-term brain damage in professional athletes has underscored the need to protect athletic children and adolescents from a similar fate.
At Valley Children’s, I consistently see a significant decline in a child’s functioning following only a few minor concussions within a year or two. Each additional concussion seems to cause greater injury, longer recovery and more permanent difficulties. After two or more concussions, I advise parents to seriously consider removing their child from activities with high risk of head injury.
Similar to Anna, children frequently return to an activity before full recovery. They may be concerned about letting the team down or disappointing their parents or themselves. Rather than being cautious after a child’s injury, the coach or teacher may tell the child to “Shake it off” and get back in the game.
The result shows up in our emergency rooms. Sports-related concussions account for more than half of all ER visits by children ages 8 to 13, according to the National Athletic Trainers’ Association. Many other activities, from skateboarding and bicycle riding to cheerleading, can cause this injury as well.
People often do not realize that concussion may or may not involve loss of consciousness. Emergency medical attention is needed if the child experiences vomiting, loss of consciousness, seizure or other major symptoms. Otherwise, if symptoms persist more than two weeks, the child should see a pediatric specialist for evaluation.
The cost of winning
Athletic and recreational activities provide physical, emotional, mental and social benefits that far outweigh the risk of serious injury – but we need to use common sense, especially when it comes to our children. The cumulative effect of concussions over a lifetime, and the sensitivity of a child’s maturing brain to injury should be considered when deciding how young a child begins playing sports, particularly contact sports like football.
Society tends to define success only by winning rather than continuous improvement. The win-at-all-costs attitude pressures our kids to keep playing, even after a head injury – but at what price? Every time children continue to play soon after a concussion, they risk severe complications. For each successive concussion, children are trading precious brain cells for touchdowns, goals, trophies or glory.
We all have a responsibility to ensure our kids reach their full potential. To help them achieve their long-term goals and dreams, we must protect their brains.
For more information, please visit the Centers for Disease Control and Prevention at http://www.cdc.gov/headsup/parents/ or the Brain Injury Association of America at http://www.biausa.org/brain-injury-children.htm.
This Op-Ed was written by Paul Lebby, PhD, FNAN, Medical Director of Neuropsychology and Director of Neurodevelopment at Valley Children’s Healthcare