“Mommy, I don’t feel good. I think I need to go to bed.” My 7-year-old son, Henry, stood in front of me, glassy-eyed and nauseated. Normally, his asking to go to bed half an hour early would have set off alarm bells, but I was sick myself. Figuring he was coming down with whatever I had, I put him to bed. Looking back, I could easily have killed him.
The next morning, I found out Henry had hit his head on the concrete floor of the garage while playing. I rushed him to the pediatrician’s office, but our regular doctor was away. The on-call pediatrician instructed us to stop activities that caused Henry any pain. This meant that for the first two weeks of his recovery, my son played as he normally would. He would usually stop after a moment, saying he had a headache. What we didn’t know was that the doctor’s advice was wrong, and we were causing brain damage to our son.
According to the journal Continuing Education in Anaesthesia, Critical Care & Pain in 2013, “traumatic brain injury (TBI) is the leading cause of death and disability in young adults in the developed world.” Concussions are a mild form of TBI. Though there has been a great deal of media attention about concussion dangers in sports, “The majority of kids’ concussions come from falling, riding bikes and other accidents,” says Richard Ellenbogen, M.D., a neurosurgeon at Seattle Children’s Hospital.
This makes it critical for parents to learn to recognize the signs of concussion themselves. Ninety percent of concussions do not result in loss of consciousness, so Ellenbogen suggests that parents think of a concussion as “any neurologic change that differs from the baseline.” Symptoms include headache, nausea or vomiting, unusual behavior, irritability and sensitivity to light or noise.
A child who exhibits these symptoms after hitting his head should see a doctor. While most kids recover quickly from concussions, Ellenbogen explains that “10 percent are more challenging and require treatment by a specialist.”
Emergency preparedness
If a concussion clinic is not available, the emergency room may soon be the best place to go. Megan Moore, an assistant professor at the University of Washington’s School of Social Work, has been studying the possibility of social workers helping with TBI treatment for adults who come to the ER. Moore and her team developed SWIFT, an intervention method in which social workers offer education and resources on TBI treatment and recovery.
The preliminary results have been promising for adults suffering from TBI, preventing what’s known as “functional decline” after they leave care. Moore is working to develop a similar intervention for families and children who come to the ER for concussion treatment. This could help doctors provide patients with another layer of treatment for head injuries.
Even when a concussion is clearly present, knowing when to seek medical care can be difficult. D’Lyn Lee of Auburn, Wash., struggled with what to do when her then 10-year-old daughter, Sydney, fell on the playground last year.
“She had a headache, her head was sore at the sight of impact, and she felt a little sick to her stomach,” Lee says. Though she thought a concussion was likely, Lee wasn’t sure if they needed a trip to the doctor. This changed when the symptoms didn’t go away after a few hours. Sydney’s behavior “just seemed ‘off,’” Lee recalls, so she took her daughter to the emergency room, where Sydney was diagnosed with a concussion and had her activities restricted until she was symptom-free.
Sending a child with a concussion back to school is “a double-edged sword,” Ellenbogen says. “Children often can’t concentrate, can’t focus, but a child who is out for too long can fall behind.” He suggests sending children back for half-days until they show they are ready for a normal schedule. A child who is still struggling after the advised recovery time should be reevaluated by a concussion specialist.
Think fast
Rapid intervention is especially critical in preventing repeat concussions. Though researchers are not yet sure why, Ellenbogen says, some children are at greater risk of second-impact syndrome (SIS), which occurs when a second concussion follows an initial head strike before the first injury has had time to heal. This causes the brain to swell rapidly and may lead to death. When parents worry about a child missing out on activities, Ellenbogen reminds them, “What’s more important than a practice or a game? The child’s life.”
Repeat concussions may have long-term consequences. My son’s recovery was made more difficult by the repeat concussions he sustained until we saw our regular pediatrician, who quickly put him on a concussion plan. Henry was prone to sudden bouts of crying, experienced visual migraines and couldn’t complete even the simplest homework. Four months of school passed before he seemed back to normal.
The lifetime risks associated with repeat concussions are still being discovered. “We don’t know everything, but this is the area where research is being done,” Ellenbogen says. “We do know that the benefits of sports and other physical activities for children far outweigh the risks.” Parents should help mitigate potential injury by teaching kids to engage in physical activities safely, such as wearing helmets when riding bikes.
Although Henry does not have permanent cognitive difficulties three years after his initial injury, he does suffer from migraines and is at greater risk for repeat concussions. Had we received the right treatment immediately, much of this would have been prevented. Now when Henry hits his head, we drive straight to the concussion clinic.
