Concussions are Brain Injuries — Sit Your Kid Down (Op-Ed)

Dr. Nirav Shah is a board-certified neurosurgeon with expertise in complex spinal surgery, intracranial tumor/ radiosurgery and concussion therapy. Most recently, he offered a presentation to the U.S. Trotting Association about concussion treatment and rehabilitation. He is on staff at CentraState Medical Center in Freehold, N.J. He contributed this article to Live Science's Expert Voices: Op-Ed & Insights. 

According to the U.S. Consumer Product Safety Commission, every three minutes a young athlete from 7- to 19-years-old is taken to an emergency room for concussion treatment. Children between the ages of 12 and 15 accounted for almost 50 percent of those injured. One of the latest questions for researchers studying the short- and long-term effects of concussions isn't when student-athletes can safely get back in the game but, more importantly, how long to wait before they can safely return  to the classroom.

As young athletes start to gear up for fall sports, including football, soccer, cheerleading and wrestling, parents, coaches and teachers should know how to recognize and properly respond to head injuries, particularly concussions. Studies have shown head injuries are more likely to occur in the spring and summer months and on weekends, when children are most active outdoors. They can just as easily occur when children are playing in the backyard or riding their bicycles as they do on the sports field. [Preventing Concussions is About Care, Not Coddling (Op-E)]

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But how do you know when to seek medical treatment for a head injury? As a neurosurgeon, this is a question I am often asked, but usually after the brain injury has already taken place. Keep in mind, "head injury" and "brain injury" are not necessarily the same thing — not every head injury will impact the brain.

New research out of UCLA shows that the side effects from concussions can linger long after physical symptoms — dizziness, headaches and light sensitivity — have disappeared. Clinical findings reported in the Wall Street Journal have also found that the mental exertion of normal, routine class work can actually worsen the effects of a concussion and impede successful recovery. The study found that the harder recovering students try to focus on any mental activity, the more severe the resulting headaches or dizziness may become.

General concussion symptoms

A concussion is an injury to the brain that changes how the brain normally works. It is usually caused by a significant, sudden blow or jolt to the head. 

Here's an analogy I use with patients to describe what happens during a concussion: Your brain is like jello in the skull. When the impact takes place, the jello is swished around the hard skull. That movement of the brain is what causes the concussion symptoms.

Throughout life, most children bump or hit their heads more than once without causing damage to the brain. But for accidents or injuries that result in a significant impact to the head, adults should be ready to recognize the most common physical signs of a concussion. Also keep in mind that following a concussion, some children will continue to experience symptoms for weeks after, which often include:

• A brief period of confusion or memory loss following the injury;
• Headache, vomiting, dizziness;
• Acting dazed or losing consciousness for even a brief time. 

When to call 911

I recommend to patients that if a child has sustained a significant trauma to the head, bring them to your pediatrician immediately, or go to your local hospital for evaluation and treatment by a medical doctor with expertise in head trauma. If the child is unconscious for more than a minute, is bleeding heavily, or experiences any mental confusion, do not move the child or sit him/her up. Call 911 for emergency medical care and transport to the nearest hospital.

Why are concussions so serious?

Make no mistake — a concussion is an academic injury, in the sense that it is detrimental to the capacity for future learning. Many parents still don't realize that children who have experienced concussions will have some degree of negative impact on their academic performance. Scientists studying the effects of concussions are challenged by the fact that not all concussions affect the brain the same way. Further, a child who bumps her head on the door is not in the same situation as someone who hits her head diving for a soccer ball. 

The cognitive effects of a blow to the head can temporarily make focusing on studies, taking tests or listening in classrooms more difficult. Concussion-related memory problems, mental sluggishness and inability to focus can affect grades, standardized test scores and classroom placement. New research suggests the younger the injured athlete, the more long-lasting the cognitive effects from the concussion. Teens, for example, are more vulnerable than adults to lingering effects of a concussion on short-term memory. 

When can kids get back in the game?

There is no clear-cut protocol for concussion recovery in comparison to the way a doctor would provide therapy for a broken arm. The way the human brain recovers from an injury is different for every person. You should consult with your child's doctor about when and if it is safe to return to sports.

Concussion care is challenging because doctors are dependent on symptom feedback from patients. That said, the treating doctor will schedule regular office visits with a child to monitor and assess his or her condition, hopefully revealing a continual lessening of the original symptoms. The doctor determines when the patient can resume any degree of normal activities — not parents, the injured child, coaches or teachers.

What can you do to protect a child?

With the expanded concentration on the study and treatment of concussions, physicians now have vastly improved tools and understanding to help younger patients return to normal brain function even after the brain has been compromised. As neurosurgeons, our ultimate goal is to restore the child's ability to pursue normal social, emotional and intellectual pursuits with renewed vigor and enjoyment. To learn more about concussions, the Centers for Disease Control (CDC) offers helpful information on their website at cdc.gov/concussion.

Follow all of the Expert Voices issues and debates — and become part of the discussion — on Facebook, Twitter and Google +. The views expressed are those of the author and do not necessarily reflect the views of the publisher. This version of the article was originally published on Live Science.