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Written by:  Pamela DeLoatch
Date: February 1, 2012

It was a normal middle school softball game, but when a fly ball tipped off my daughter's glove and hit her in the cheek, it suddenly wasn't so ordinary. Fortunately, other than some pain in her cheek, my seventh-grader had no swelling, bruising or other symptoms, and after sitting out for a few innings, she returned to the game.

My mistake. The next day, when she complained of dizziness, I took her to the doctor and found that she actually had suffered a concussion and needed at least 10 days to fully recover.

Many parents make the same mistake I did, thinking a concussion is just a bump or ding, says Johna Mihalik, post-doctoral associate and community outreach coordinator for the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at UNC-Chapel Hill.

"A concussion is a brain injury," Mihalik says. Injuries such as a fly ball to the head or face, or shaking and jerking motions, can damage brain tissue.

"The space between your skull and your brain has fluid that helps absorb that shock, but when a person is hit hard enough in the head, or has a blow to the body as in a car accident where your head keeps moving and your body stays still, your brain moves throughout the skull, and that tissue is actually functionally damaged," Mihalik says.

Because a concussion is a functional injury and not a structural one — such as a fractured bone — it can be more difficult to know when a child actually has one.

Diagnosing a concussion

Since a concussion cannot be seen, medical imaging tests such as CT scans and MRIs cannot typically detect it, so doctors use a combination of behavioral clues and technology to determine if a brain injury occurred.

Symptoms may include headache, dizziness, nausea, blurred vision or sleepiness. Other symptoms may be less obvious. Mihalik says some children who have suffered a concussion may complain of not feeling like themselves, or may not act like themselves.

Some symptoms, like in my daughter's case, may not show up immediately. In fact, 15-20 percent of people with concussions don't show symptoms right away, Mihalik says. Over the next 24 hours, however, symptoms can intensify.

It's essential to identify if a child has had a concussion to begin treatment immediately. Since young brains are still developing, concussions can have an even more devastating effect on children than they do on adults, with longer-lasting and more severe symptoms. In addition, a child who has had one concussion is at a greater risk for subsequent concussions.

If a child suffers another concussion before the first has healed, the results can be traumatic. Long-term effects from severe or repeated concussions include memory loss, psychiatric disorders, depression, anxiety, and a decline in other physical and mental abilities.

Time for recovery

As important as it is to immediately diagnose a concussion, it is equally important to allow a concussion to completely heal — not just physically, but cognitively as well, Mihalik says. Kids with concussions should avoid activities that require concentration, including schoolwork, reading, driving, texting, watching TV or playing video games. Once a child has completely recovered, he should begin to incorporate activities gradually, Mihalik advises.

Raising awareness of concussion dangers

According to the Centers for Disease Control and Prevention, U.S. emergency departments treat 135,000 sports-related traumatic brain injuries, like concussions, suffered by children ages 5-18 each year. While this number seems high, it may actually be good news because it shows that more people are recognizing the symptoms and dangers from concussions and seeking treatment.

In June, North Carolina became the 21st state to enact a concussion-related law when Gov. Bev Perdue signed the Gfeller-Waller Concussion Awareness Act to raise awareness of concussion dangers among middle and high school athletes. The law, named after Matthew Gfeller and Jaquan Waller — two N.C. high school football players who died in 2008 after sustaining head injuries — requires concussion education for parents, coaches, administrators and athletes; establishes an emergency action plan at athletic events; restricts players who have suspected concussions from returning to the game that day; and requires them to be cleared to return to the game by a medical provider with concussion training.

High school athletic directors from Durham, Wake and Orange County schools say this law doesn't make a difference in the way they have addressed concussions because they already monitored athletes for possible concussions. After the deaths of Gfeller and Waller, the N.C. High School Athletics Association increased awareness of and training about concussions, says Larry D. McDonald Sr., director of athletics for Durham Public Schools.

Bobby Guthrie, Wake County Public School System's senior administrator for athletics, says the new law simply adds backbone to current safety practices. "There is no choice in the matter," Guthrie says about concussion safety.

Area camps also have action plans to make sure possible long-term effects from undiagnosed concussions are limited. Michaux Crocker, director at Camp Cheerio, a residential YMCA camp in northwestern North Carolina, says in addition to following initial protocol, such as requiring campers to wear helmets when horseback riding or climbing, the camp also has two nurses and a doctor on site. Anyone who is suspected of having a concussion goes, or is taken to, the infirmary to be evaluated by medical personnel.

"You don't want to wonder," Crocker says.

Growing support for proper diagnosis and treatment

Whether on the professional, college, high school or middle school level, awareness of a concussion's side effects is growing.

"I think the number of student athletes with long-term disability — more than three months — has dramatically reduced with the increased awareness and increased overall referrals for evaluation following a traumatic head injury event," says Dr. John. D. Wooten, a child neurologist at Raleigh Neurology.

Although that is encouraging, not everyone is on board yet. Sometimes kids don't want to be teased by teammates for fear that they may appear less committed if they take themselves out of a game after a hit. Parents who don't want their child to miss a big game may protest if the athletic director or coach suspects their child has a concussion and pulls the athlete out for the day.

"All you hear is that you've got to be tough," Guthrie says about the cultural norm.

But with consistent education to and from coaches, he says, students (and their parents) will learn that they need to let the coach or someone know if they don't feel well after an injury that may have caused a concussion.

"It's not a matter of weakness," Guthrie adds.

As for my daughter, I know that before she plays her next school sport, we'll have concussion awareness forms to read and sign. If the school suspects she has had a concussion, she'll sit out of the game and won't be allowed to come back until someone trained in concussion management clears her to play. But it won't really matter what the school does. As a parent who is now more aware, I'll be doing the same thing.  n

Pamela DeLoatch is a mother of four teenagers and freelance business and parenting writer in Cary.


Common Concussion Symptoms

Watch for these symptoms after a hit to the head or blow to the body:

  • Headache
  • Nausea or vomiting
  • Sensitivity to light
  • Irritability
  • Not feeling like themselves
  • Confusion
  • Blurred vision
  • Difficulty concentrating
  • Difficulty remembering



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