What is a concussion?
A concussion is a brain injury that affects the way you think and remember things for a short time. It can cause many symptoms, but they can’t be seen on x-rays or computed tomography (CT) scans.

What causes a concussion?
Any blow to the head, face or neck, or somewhere else on the body that causes a sudden jarring of the head may cause a concussion, such as being hit in the head with a ball or being checked into the boards in hockey.

What are the symptoms and signs of concussion?
A person does not need to be knocked out (lose consciousness or pass out) to have had a concussion. Some of the problems that may happen with a concussion are shown in Table 1.

What should you do if a child gets a concussion?
The child should stop playing the sport right away. Do not leave him alone. A doctor should see him as soon as possible that day. If a child is knocked out, call an ambulance to go to a hospital immediately. Do not move the child or remove sport equipment, such as a helmet. Wait for the paramedics to arrive.

How long will it take to get better?
The signs and symptoms of concussion often last for 7 to 10 days but may last much longer. In some cases, children may take many weeks or months to heal. A child who has had a concussion before may take longer to heal.

How is a concussion treated?
The most important treatment for a concussion is rest. That means not exercising, bike riding, play wrestling with family or friends, playing video games or working on the computer. Children may have to stay home from school because schoolwork may make their symptoms worse. Children who go back to school or resume activities before they are completely better are more likely to get worse and to have symptoms longer.

Even though it is very hard for an active child to rest, this is the most important step. Once a child is completely better at rest, he can start a gradual increase in his activities (see below). It is important to see a doctor before returning to activity to ensure that he is completely better.

When can children return to school after a concussion?
Sometimes children who have a concussion find it hard to concentrate in school, and may get a worse headache or feel sick to their stomach if they try to learn. Children should stay home from school if their symptoms get worse while they are in class. Once they feel better, they can try going back to school for half days at first. If they are okay with that, then they may go back full time.

When can a child return to a sport after a concussion?
Children should not go back to sports if they have any concussion symptoms or signs. They must rest until they are completely back to normal. After they have been back to normal and have been seen by a doctor, they can then go through these steps to gradually increase activity:

1. Complete rest until all symptoms have gotten better.

2. Light exercise, such as walking or stationary cycling, for 10 min to 15 min.

3. Try a sport-specific activity (such as skating in hockey or running in soccer) for 20 min to 30 min.

4. Move to ‘on field’ practice, such as ball drills, shooting drills and other activities with no contact (for example, no checking and no heading the ball).

5. Once cleared by a doctor, move to ‘on field’ practice with body contact.

6. Game play.

Note: Each step must take at least 1 day. If a child has any symptoms of a concussion (headache or feeling sick to the stomach) that come back during the activity, he should stop the activity immediately and rest for 24 h to 48 h. The child should be seen by a doctor and cleared before starting the stepwise plan again.

When should a child go to a doctor?
Every child who gets a head injury should be seen by a doctor as soon as possible. A child who has been diagnosed with a concussion should see a doctor immediately if symptoms get worse, such as:

• being more confused;

• worsening of a headache;

• vomiting more than once;

• not waking up;

• having trouble walking;

• experiencing a seizure; or

• behaving strangely.

Problems caused by a head injury can get worse later that day or night. A child should not be left alone and should be checked on through the night.

If there are any concerns about a child’s breathing or sleep, wake her up. Otherwise, let her sleep. If she seems to be getting worse, see a doctor immediately. No child should go back to a sport until they have been cleared to do so by a doctor. 

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Posted: September 2006