Coronavirus Update:What patients and families need to know
When a concussion is suspected or first diagnosed, parents often have questions about the injury and how to help their child. These questions can arise the first day of the injury or may occur several days to weeks after the injury. There may be questions about returning to school or returning to sports or recreational activities.
- All concussions are serious.
- Most concussions occur without loss of consciousness.
- Recognition and proper response to concussions when they first occur can help prevent further injury.
- When in doubt, sit them out.
What Children’s National Offers
The Children’s National SCORE Concussion program is staffed by neuropsychologists and neuropsychology post-doctoral fellows who can assess and treat children, teens and college student-athletes, ages 4-22, who have sustained a concussion. An important part of treatment is educating the student and parents about concussions, the risks of re-injury, and ways to ensure recovery.
Our staff will conduct a complete evaluation that measure attention, memory and speed. These help us understand the child or teen’s cognitive functioning. We will work with the child or teen and parents to develop a treatment plan to support full recovery. That plan will include a timetable for returning to school, sports and other life activities.
Parents will receive a copy of the ACE Care Plan, which summarizes this information. This plan also will help parents communicate the evaluation results and treatment recommendations to school personnel, the referring physician or other medical professionals. Return visits may be scheduled to adjust treatment until the child has fully recovered and symptoms are no longer present.
Frequently Asked Questions for Parents
Yes, you should be sure to inform your pediatrician of your child's concussion. He or she may want to schedule an appointment to examine your child, send you to the emergency room, or they may choose to refer you to a concussion specialist.
After a concussion is diagnosed, talk to your physician about the use of medication for headache pain or other symptoms. Relieving headache pain is certainly appropriate but does not replace the need for cognitive and physical rest if symptoms are at all present. Be aware that symptom improvement with medication does not mean that the brain has recovered. Symptoms must improve while not on medication before returning to typical activities, particularly contact sports. Decisions about continuing to use other medications should be done in consultation with your physician.
No, sleeping does not make brain injuries worse. In fact, sleep is actually very important for recovery. The brain's energy after a concussion is reduced significantly and there may be a powerful urge to sleep. The general recommendation is to let your child sleep after their injury, but occasionally check on them (gently push or nudge them) to be sure that they respond to you in some way. You do not need to wake them up fully.
The concern is that if your child is sleeping, you cannot see possible signs of a more severe brain injury, related to a bleed in the brain or swelling. These signs are listed in the Danger Signs:
- Headaches that worsen
- Very drowsy, can't be awakened
- Can't recognize people or places
- Repeated vomiting
- Increasing confusion
- Neck pain
- Slurred speech
- Weakness/numbness in arms/legs
- Unusual behavior change
- Significant irritability
- Less responsive than usual
If the child is not responsive to gentle prodding, you should seek emergency medical care.
It is very difficult (if not impossible) to predict the length of recovery of a concussion at the time of the injury. No specific time period should be given without regard to the child's symptom recovery. The decision to return to a sport is an individualized medical decision, and based on the child's actual symptom recovery. Once the symptoms are fully gone, the child can begin a supervised gradual return to play program.
You should be concerned, but you should also consult a concussion specialist to understand if there is likely to be any possible lasting effects for your child. The effects of multiple concussions vary widely for different individuals. Some may still recover quickly, while others do not. There are no steadfast rules as to how many concussions are too many, but if your child has had multiple concussions, you should seek the advice of an expert.
The long-term effects of concussions will vary greatly, although most individuals recover fully without long-term effects. If you are concerned about lasting problems, seek an evaluation from a concussion specialist.
Neuropsychological testing is one of the tools used in a concussion evaluation. The testing involves assessing the child's attention, memory and speed of thinking. These functions are sensitive to the effects of a concussion. Cognitive performance that is not normal for that child can be one indicator that the brain is not working properly. However, there are many reasons why a child's neuropsychological test performance can be abnormal and, if possible, it is important that a skilled neuropsychologist be involved in interpreting the results of these test findings.
Children who are no longer highly symptomatic can spend limited amounts of time with friends doing low-key, supervised activities. Sleepovers are not recommended because of the tendency to stay up late and sleep in less than optimal conditions.
The types of activities and how much they do depend on their level of symptoms, and whether the activity makes symptoms worse. Playing games, computer time and texting may be fine, as long as they do not make symptoms worse and do not interfere with rest or return to school. Activities that risk re-injury must be avoided.
Rest means reduced physical and cognitive activity. The goal is to minimize brain activity to promote healing. Resting can be lying in a quiet room, reading a magazine or watching mindless television. Resting does not include spending long periods of time in activities such as walking around the mall for hours, studying for long periods of time or listening to loud music. Too much activity too early may delay recovery.
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