Concussions: Recognizing Symptoms and Knowing When to go to the ER

It’s back-to-school time again, which means the start of school sports.

Out of the various sports-related injuries suffered by student-athletes, concussions can be serious. This is a good time to review common symptoms as well as some guidelines that can help you know when to take your child to the emergency room.

A concussion is defined as any temporary neurologic symptom due to direct or indirect force to the head. Symptoms may be as severe as loss of consciousness or as mild as a headache.

A child or adult who exhibits any of the following symptoms should be taken immediately to the emergency room:

  • A worsening headache that won’t go away
  • Weakness, numbness or decreased coordination
  • Repeated vomiting or nausea
  • Slurred speech
  • Extreme drowsiness, or if they cannot be awakened
  • The pupil (the black part) of one eye is larger than the other
  • Convulsions or seizures
  • They can’t recognize people or places
  • They become progressively more confused, restless or agitated
  • They exhibit odd or unusual behavior
  • They become unconscious, even if it’s for a very short time

Very young children or infants who have experienced a head injury should be taken to the emergency room if they won’t stop crying, can’t be consoled or if they refuse to nurse or eat.

However, many people who suffer head injuries may only experience milder symptoms, such as dizziness, difficulty concentrating or irritability. The important thing to remember is that these symptoms, however mild, should not be ignored. If those conditions persist, or if more severe symptoms develop, they should be taken to the emergency room.

Any symptom of concussion should be thought of as a sign that your child’s brain is still healing. It is important that during this healing time there is not another injury to the head. A second injury to the head can cause permanent damage which is rare but not worth the risk.

It is a myth that children must be kept awake after a head injury. This comes from a time when the only way to monitor a child with a head injury was his or her mental status. We now know more about the risk factors for more serious diagnoses and we have imaging technology to rule them out. But, not all children need imaging after a head injury, because modern imaging does produce some radiation. We do not recommend letting a child who is still having symptoms sleep through the night before being evaluated.

For children who suffer head injuries, I recommend a graduated return to normal activity. For the first 24 hours after injury, a child should have complete cognitive rest, which means no difficult reading, no loud noise or loud music, and no mentally rigorous activities that require concentration such as schoolwork or video games.

Then, if and only if there are no neurologic symptoms as mentioned above, during the first 24 hours activity may be increased slowly. Start by simply walking around the block and increase your child’s activity level everyday if they are not experiencing symptoms with the goal of full sports or activity in one week.

Remember: if you’re worried or in doubt about your child’s injury or illness, take them to the emergency room. If it feels like an emergency to you then the emergency room is the place to go. And of course, we are always available to guide you through this process.

Click here to learn more health information about school athletes in our latest issue of Amazing Magazine.