May 12, 2014
News Review From Harvard Medical School -- Study Details Child Concussion Symptoms
In a study, most children with concussions felt better within 2 weeks. But some emotional symptoms that did not show up at first were among the most lasting, the study found. The study included 235 children and young adults who were diagnosed with concussions in an emergency room. They answered questions about symptoms regularly during the next 3 months, or until symptoms went away. When they first went to the ER, children's most common symptoms were headache, fatigue, dizziness and taking longer to think. The symptoms most likely to develop later included sleep problems, frustration and forgetfulness. Symptoms that lasted longest were irritability and sleep problems (a median of 16 days each). Next came frustration and poor concentration (14 days each). One month after injury, nearly 25% still complained of headache. About 20% each felt fatigue or continued to take longer to think. The journal Pediatrics published the study. HealthDay News wrote about it May 12.
By Henry H. Bernstein, D.O., M.H.C.M.
Harvard Medical School
What Is the Doctor's Reaction?
Remember cartoons where someone bangs his head and sees floating stars? It may be funny on TV. But it is different in real life. When you bang your head, you can suffer a concussion. This is an injury or bruise to the brain that can disturb the way it works.
Each year, more than 400,000 kids go to the emergency room for head injuries. Car crashes, playground injuries and sports activity are the most common ways that they occur.
A new study in the journal Pediatrics kept track of 235 children who were diagnosed with concussions in the emergency room. Their ages ranged from 11 to 22 years. They filled out the Rivermead Post-Concussion Symptoms Questionnaire a week after their ER visit. They filled it out again at 2, 4, 6, 8, and 12 weeks after their ER visit, or until all symptoms went away. The questionnaire collected information on the types of symptoms seen with concussions. It also tracked how long the symptoms lasted.
A concussion makes it hard for children to:
- Pay attention (concentrate)
- Remember things
- Learn in school
Physical symptoms, such as headache, tended to happen right away. Emotional symptoms, such as being irritable, came later on during the child's recovery. Cognitive symptoms, such as being unable to think clearly, were present throughout.
The study found that the concussion usually caused problems in the first two weeks. Nausea, depression, dizziness and bad vision went away quickly. Other symptoms could last longer than two weeks. These included:
- Feeling irritable
- Sleeping poorly
- Being frustrated
- Having poor focus
Even a month after the brain injury, kids may still not be right. At that point:
- 1 in 4 had headaches
- 1 in 5 had fatigue
- 1 in 5 took a longer time to think
A concussion can be a very serious brain injury. The results of this study should help patients, parents and doctors know what symptoms to look for, when to expect them and how long they might last.
What Changes Can I Make Now?
The best treatment for a concussion is rest from physical and mental activity. There is no specific medicine used to treat a concussion. When your child has had even a mild brain injury, consider taking these steps:
- Watch your child closely.
- Adjust your child's schedule and school work.
- Excuse your child from gym class, recess and sports.
- Tell your pediatrician if symptoms get worse or your child's behavior changes.
- Keep in mind that returning to school does not mean returning to play.
It is hard to know when to return to physical activity. The timingis different for every child with a concussion. Symptoms often go away in 7 to 10 days. But some children may take weeks or months to get better. There are tests that can show whether or not the brain looks normal. But knowing how well the brain is working is not so easy to tell.
All sports activities should be stopped until symptoms have completely gone away.
- Discuss with the doctor when it is okay to go back to sports.
- Do not let your child play sports until your doctor says OK.
- Plan a step-by-step way to ease your child back into play and sports.
- Pay close attention to symptoms that come back, last too long or get worse.
- Realize that your child may need to avoid all contact sports if he has had:
- More than one concussion
- Symptoms for more than three months
Prevent concussions as much as possible. Have your child follows these safety tips:
- Use a helmet for all riding activities and contact sports.
- Make sure helmets are in good condition and fit properly.
- Always wear a seat belt.
- Follow the rules of the game and play safely.
- Never ignore a head injury, no matter how small it seems.
- Let the coach, trainer or parent know whenever the head is injured or your child feels symptoms.
Remember that children with all types of brain injury (from mild to severe) might have a concussion. It is often hard to know how severe a brain injury is in a child. Concussions in children are still serious, even when no obvious harm is found.
What Can I Expect Looking to the Future?
Brain injury is a hot topic of research. We are learning more and more about the effect of even mild brain injury on children of all ages. Researchers will continue to study how children recover from brain injuries. This will help in providing the best care right after a child has a concussion.
In addition, expect parents, families and doctors to be further educated all about concussions, including the best ways to prevent them.