Concussions & Kids

Concussion symptoms, treatment and protection

It was the homecoming football game Saturday against rival St. Jerome, an important day for 11-year-old Eddie Guarnaccia of Southampton, PA, and tensions were high. 

“I had the ball, put my head down to run and got hit on my head with the other guy’s helmet,” recalls Eddie, who was tackled, fell back and hit the ground. 

Because Eddie wasn’t knocked unconscious, he was able to get himself up. His dad, Ed, the offensive-line coach, conducted a quick sideline evaluation, determined that Eddie seemed OK and put him back in the game. Unbeknownst to his dad, Eddie had suffered a concussion.

Signs of a concussion

Families think that most concussions cause a loss of consciousness, but this happens only 10 percent or less of the time, explains Thomas Drake, MD, children’s rehabilitation specialist at Cooper University Health Care in Camden, NJ. Like Eddie, a child may look and seem OK because there may be no bump or swelling.

Because collisions and hits happen so often in high-contact sports (even ones that may not be obvious, like girls' soccer and snow sports), many players, including Eddie, don’t think twice when they do occur. “You can’t judge the injury by the mechanics of what you saw happen,” says Dr. Drake. Sometimes kids seem to experience a fairly minor blow but have very significant symptoms, while for others it’s the reverse.

“There can be immediate concussion symptoms and delayed ones that initially don’t seem like a big deal,” says Rochelle Haas, MD, pediatric rehabilitation medical specialist at Nemours/Alfred I. duPont Hospital in Wilmington, DE.

Concussions: a "silent epidemic"

“In 2007, the Centers for Disease Control recognized that concussions were likely a silent epidemic — underdiagnosed and misdiagnosed. They were completely missed and mistreated,” says Dr. Drake. This prompted the CDC, the NFL and 26 other sports organizations to launch “Heads Up” to educate coaches, medical providers and parents about this stealth danger. 

“A concussion is a very difficult thing to define, because there is no way for me as a doctor to see, feel, touch or measure it,” states Dr. Drake. Neurological scans are not fail-safe, because not all concussions lead to detectable bleeding or bruises.  

Dr. Drake explains that a concussion is a functional injury that results in problems in four main areas — physical, cognitive, behavior and sleep. Symptoms may be immediate or delayed. Some patients may experience a raft of symptoms; others, just one.  

Next page: Concussion treatment, recovery and return to activity

Concussion recovery and return to activity

Cognitive rest, which entails resting in a dark room without mental stimulation (reading, texting, watching TV), is critical to decrease metabolic activity around the concussion and help the brain recover. 

“If you look at the data in the pediatric population, about half of [concussion patients] are better in 10 to 14 days,” says Dr. Haas. Many pediatricians, like Gerard Margiotti, MD, who practices in Feasterville-Trevose, PA, have stringent return-to-school guidelines that address educational areas where the child — who may look fine yet not be functioning up to her pre-injury self — may need support.

Returning to sports should always be gradual, explains Dr. Margiotti. “Any child who has a concussion can never under any circumstances return the same day.” Dr. Haas explains the premise: “For a typical adolescent male involved in a high-contact sport who has had an incomplete concussion recovery, getting hit again could trigger massive brain swelling that is fatal 50 percent of the time.”

In fact, a well-publicized, near-fatal, second-impact injury experienced by middle school football player Zackery Lystedt prompted all 50 states to adopt youth-sports concussion legislation that includes the slogan: “When in doubt, sit them out.”

Protective gear

Regardless of risk, kids are going to play high-impact sports. “We can’t prevent concussions, but every little bit of protection we can give to the kids makes sense,” says Dr. Margiotti. (Click here for more on protection on all sorts of sports injuries.)

Back on the gridiron, Eddie Guarnaccia (left) now wears a “bullet-proof” helmet from Kennett Square–based Unequal Technologies, made with Kevlar polymers designed to decrease impact acceleration, under parental orders. “I know there’s a risk in football, but Eddie loves and lives for it,” says his mom, Lynne. “I will always protect his brain for him — even if he doesn’t want me to.” 

Lynda Dell is a freelance writer who is an experienced PA-certified early childhood educator.