School has started across the country, and youth sports are a serious topic of concern to parents. Dr. Saad Saad, a noted pediatric surgeon, is excited to share news of the official guidelines issued recently by The Centers for Disease Control and Prevention (CDC).
These are the first guidelines to outline treatment for children with concussions, providing parents, coaches, and doctors with the tools they need to ensure the best outcomes for young people with mild traumatic brain injury, Dr. Saad reports.
More than 800,000 children seek treatment for traumatic brain injury every year, according to the CDC’s National Center for Injury Prevention and Control.
Research has shown that repeated blows to the head, such as from playing football or heading a soccer ball, can lead to long-term memory loss, dementia and other serious health issues.
What exactly is a concussion?
A concussion is a traumatic brain injury—or TBI—caused by a bump, jolt, or blow to the head, explains Dr. Saad Saad. The injury can also be caused by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around – or twist in the skull – which creates chemical changes in the brain. In some cases, the brain is stretched, which damages brain cells.
Concussions are serious, says Dr. Saad. Doctors may describe a concussion as a “mild” brain injury because it is usually not life-threatening. However, there may be serious effects from a concussion.
In certain rare cases, a dangerous collection of blood (hematoma) may form on the brain after a bump, blow, or jolt to the head or body that may squeeze the brain against the skull. This must be treated immediately in the emergency department.
Dangerous signs of a concussion:
One pupil larger than the other
Drowsiness or inability to wake up
Headache gets worse and won’t go away
Slurred speech, weakness, numbness, or decreased coordination
Repeated vomiting or nausea, convulsions or seizures (shaking or twitching).
Unusual behavior, restlessness, increased confusion, or agitation
Loss of consciousness (even a brief loss of consciousness should be taken seriously)
Children and teens who show – or report – any of these symptoms may have a concussion, explains Dr. Saad Saad. If they say they just “don’t feel right” after a bump, blow, or jolt to the head or body, they may have a concussion or more serious brain injury.
Signs of concussion typically show up soon after the injury, Dr. Saad Saad explains. However, some symptoms may not show up until several hours or days later. A child or teen might be confused or dazed at first, then an hour later might not remember getting hurt.
You should continue to check for signs of concussion several days after the injury. If any concussion signs get worse, you should take the child to the emergency department right away.
Recovery from concussion
Most children with a concussion feel better within a couple of weeks, advises Dr. Saad Saad. However, symptoms will last for a month or longer. Concussion symptoms may appear during the normal healing process or as your child gets back to their regular activities. If there are any symptoms that concern you or are getting worse, be sure to seek medical care as soon as possible.
How to make your child feel better
Changing your child’s daily activities in the short term will help them get back more quickly to a regular routine. As your child starts to feel better, you can slowly remove the restrictions.
If your child’s symptoms do not worsen during an activity, then the activity is OK for them, advises Dr. Saad. If symptoms worsen, the child should cut back on that activity. Each concussion and each child is unique, so the child’s recovery should be customized based on symptoms.
The first few days after injury, your child should simply take it easy.
Physical activities should be limited to avoid any symptoms getting worse.
Activities that involve thinking should be very limited.
Prohibit activities that are risky for your child’s head and brain.
Help your child get a good night’s sleep; encourage naps during the day.
2. Light Activity
When the child starts feeling better, gradually return to relaxing activities at home.
Avoid any risky activities.
Return to school gradually.
If any activity does not cause symptoms to worsen, then it’s OK.
If symptoms worsen, cut back on the activity until it is tolerated.
Get maximum sleep at night. Don’t allow loud music or screen time before bed. Keep the room dark. Keep bedtime and wake up on a fixed schedule.
Reduce daytime naps. Or return to a nap schedule appropriate for the child’s age.
3. Moderate Activity
When symptoms are nearly gone, most regular activities are fine.
Breaks are important if concussion symptoms worsen.
Return to the regular school schedule.
4. Back to Regular Activity
Recovery from a concussion is evident when your child can participate in all regular activities without any symptoms.
Dr. Saad Saad also notes:
Make a follow-up appointment with your child’s doctor or nurse.
Ask about safe over-the-counter or prescription medications to help with symptoms. Ibuprofen or acetaminophen are typically advised for headache, but ask your doctor or nurse to clarify.
Limit soft drinks or caffeinated items (tea, chocolate) during recovery so your child will rest.
Dr. Saad Saad Explains Post-Concussive Syndrome
Very often, children and teens feel better within a couple weeks after a concussion, says Dr. Saad Saad. However, some symptoms can last for months or longer. Talk with the health care provider if symptoms continue or worsen after the child returns to regular activities.
This is called post-concussive syndrome, explains Dr. Saad. While it rarely occurs after one concussion, post-concussive syndrome is common when there have been multiple concussions.
There are many people who can help you and your family as your child or teen recovers. Talk with your medical provider, family members, and others about how your child or teen is feeling. If you do not think he or she is getting better, tell your medical provider.
Dr. Saad Saad explains that a person with a severe brain injury needs to be hospitalized. There may be long-term problems with:
Coordination and balance
Speech, hearing or vision
A severe brain injury is serious as it affects all aspects of life, including relationships, and ability to work, do household chores, drive, and other normal activities.
Getting back to school
Dr. Saad Saad explains that most kids and teens will only need a little help as they recover from a concussion. However, when there are ongoing symptoms, a variety of formal support services may be necessary. These support services may vary widely among states and school districts.
The child or teen may feel emotional if they cannot return to school or hang out with friends right away. Frustration, sadness and even anger are common. Talk with your child or teen about this. Be as supportive and encouraging as possible.
Returning to sports and activities
An athlete who has had a concussion should only return to sports/practices when the healthcare provider has approved, advises Dr. Saad Saad. Parents should work closely with the team’s certified athletic trainer.
The return to sports should be a gradual process as outlined below. Parents and coaches should watch for concussion symptoms after each day’s activity.
The athlete should only move to the next step when they have no new symptoms, Dr. Saad explains. If symptoms return or if new symptoms develop, the athlete is pushing too hard. The athlete should stop these activities and the doctor should be contacted. When the athlete has rested and has no more concussion symptoms, the athlete can resume activity.
Step 1: Back to regular activities (such as school)
Regular activities are okay with the doctor’s approval. Return will be in stages. After a few days of rest (2-3 days), light activity (short walks) and moderate activity (riding a stationary bike) are allowed if they don’t cause worse symptoms.
Step 2: Light aerobic activity
Begin with light aerobic exercise that increases the athlete’s heart rate — 5 to 10 minutes walking, light jogging or on an exercise bike. No weight lifting allowed.
Step 3: Moderate activity
Continue activities that increase heart rate with body or head movement — brief running, moderate stationary biking, moderate weightlifting. Time and weight should be less than typical.
Step 4: Heavy, non-contact activity
Add heavy non-contact physical activity — sprinting/running, high-intensity stationary biking, regular weightlifting routine, non-contact sport-specific drills.
Step 5: Practice & full contact
Athlete may return to practice and full contact in controlled practice.
Step 6: Competition
Athlete may return to competition over days, weeks, or months.
Prevention & Helmet Safety
Dr. Saad Saad advises you can help prevent head and brain injuries with a properly fitted helmet:
Worn correctly (latched under the chin)
Appropriately certified for use
No helmet is concussion-proof, but a properly fitted helmet is the best assurance your child is protected from a serious brain or head injury, advises Dr. Saad. It is also important to educate your child or teen on avoiding hits to the head.
About Dr. Saad Saad, Pediatric Surgeon
Dr. Saad Saad has performed thousands of complex pediatric surgeries on children of all ages, from infants to teenagers during his 40-year medical career. Dr. Saad has served as the Surgeon-in-Chief and the Co-Medical Director of K. Hovnanian Children Hospital at Hackensack Meridian Health Care System in New Jersey. During the 1980s, Dr. Saad was invited to serve as pediatric surgeon for the Saudi Royal family. Over the years, he has participated in eight Medical Missions to Jerusalem to perform free complex surgeries on poor children.