Sports-related traumatic brain injuries are bound to take center stage and rekindle anxiety among parents whose children play football, with the upcoming Super Bowl and the recent release of Will Smith's film "Concussion."
But sports medicine and trauma specialists at Ann & Robert H. Lurie Children's Hospital of Chicago caution that such dramatic Hollywood accounts - while raising important questions about public health and the politics of professional sports - could inadvertently focus too much attention on a single sport, obscuring the reality that about half of all pediatric concussions occur during non-athletic, recreational activities.
‘Sports-related brain trauma is a very real, very grave concern, but many brain injuries occur off the court and off the field and have nothing to do with sports.’
"Sports-related brain trauma is a very real, very grave concern, but many brain injuries - some of them more severe than concussion - occur off the court and off the field and have nothing to do with sports," says trauma specialist Rashmi Kabre, MD, Director of Pediatric Trauma, Division of General Pediatric Surgery, at Lurie Children's and Assistant Professor of Surgery at Northwestern University Feinberg School of Medicine.
In school-aged children, concussion - defined as mild traumatic brain injury - is most commonly caused by falls, hits and collisions during athletic activities. However, nearly half of all concussions occur during activities like biking, sledding, climbing, skiing, skateboarding, car accidents and riding ATVs. And when it comes to more serious brain injuries, sports are not the leading cause of brain trauma among kids. Age also matters. For children under 5, falls from furniture or tumbles down the stairs are far more common causes of brain injury, Kabre adds. She also notes that the severity of concussion is not predicated on how the injury occurred.
"The bottom line is that concussions can and do occur in and off the field, but for non-professional young players, the benefits of team sports far outweigh the risks," says Cynthia LaBella, MD, Medical Director, Institute for Sports Medicine, at Lurie Children's and Associate Professor of Pediatrics at the Northwestern University Feinberg School of Medicine.
Dr. LaBella also notes that the type of brain injury portrayed in the movie - chronic traumatic brain encephalopathy - is believed to result from multiple concussions and head blows sustained over an entire football career. Traumatic brain encephalopathy is marked by progressive brain cell damage and permanent changes in the brain's structure. By contrast, a concussion causes only temporary changes in the function of brain cells and does not affect the structure of the brain.
A primer on pediatric concussion:
No two concussions are the same
Concussion is a spectrum condition, ranging in presentation and severity. More importantly, the same injury packing similar force and impact can often cause different degree of brain injury in different children. The good news is that with proper care and full rest, the overwhelming majority of kids go on to make full recovery within two weeks and suffer no long-lasting neurologic damage.
Not all concussions look the same
Most people know the textbook symptoms of concussion - dizziness, headache, confusion, loss of consciousness and vomiting. However, less common and more subtle signs include unusual irritability, new-onset emotional instability, mood swings, forgetfulness, nervousness, agitation, inability to concentrate and unusual sleeping patterns.
Many teens can exhibit signs of emotional instability and act distracted, but the key words here are "new" and "unusual," the Lurie Children's experts say. Parents know their children best, and can spot the swift onset of uncharacteristic behavior. In addition, pediatricians warn, symptoms of concussion may not appear for a few hours following a hit or a fall, and may not become pronounced until a child tries to read or learn. They advise watching out for signs and symptoms beyond the immediate aftermath of an accident.
Younger kids and toddlers generally don''t know how to interpret their symptoms and cannot describe them well, if at all. Therefore, emotional clues are much more critical in that age group. Watch out for crankiness, restlessness and excessive crying or excessive sleepiness. Vomiting and inability to food keep down are also more common in younger children.
Gender can shape risk
n sports with similar rules for both genders, such as soccer and baseball or softball, girls are more likely to suffer concussions than boys. The factors behind this gender disparity remain unclear, but experts say one reason may be the weaker muscles in women''s necks render them less able to absorb the force of a blow to the head, making girls more vulnerable to injury. Another explanation, Dr. LaBella says, may be that girls are more likely than boys to report symptoms and see a doctor.
More than a concussion?
More serious brain injuries, such as bleeding in the brain, can mimic the symptoms of concussion and may be initially ruled out as such. Progressively worsening symptoms over a few hours or days following injury can portend serious brain damage and require emergency attention. These signs include severe headaches, seizures, recurrent vomiting, slurred speech, difficulty waking up and confusion.
No matter the severity, full recovery is critical. A second blow to the head sustained shortly after the original injury and before symptoms have resolved can amplify the damage exponentially. In rare cases, such secondary blows can lead to brain swelling that causes severe, long-lasting injury and even death, experts warn. It is therefore critical to ensure a child's symptoms are fully resolved before resuming physical activity and returning to school. That call should always be made by a physician.
Recovery time varies from child to child. Some 85 to 90 percent of teens recover within two weeks, but younger kids may take as long as two to four weeks to bounce back. Importantly, LaBella notes, athletes should never return to play on the same day of suffering a concussion even if their symptoms vanish shortly after injury.