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Concussions: How Much Do You Know to Protect Your Teen?

Maybe you know someone whose teenager has suffered a brain injury playing sports -- a colleague at work, the neighbor down the block, your BFF from college. Would you recognize the signs if your child had a concussion? What you don't know could hurt him.

By Lambeth Hochwald

Sports-and recreation-related brain injuries have led to a 60% increase in ER visits among kids 19 and younger over the last decade. Test your knowledge of concussions. Take our quiz.

1. True or False

The number of concussions among kids isn't actually rising, and the scary headlines are mostly media hype.
Fact is, there's genuine reason for concern. A 2011 study by the Centers for Disease Control and Prevention (CDC) found that there were an estimated 173,000 ER visits annually among kids 19 and younger due to sports- and recreation-related brain injuries, including concussions—a 60% jump over the prior decade. At Boston Children's Hospital alone, concussion-patient visits per month have increased 15-fold in the last five years. Dozens of youth concussion clinics have reportedly opened in nearly 35 states since 2010, and the problem is so severe that last fall the Institute of Medicine launched a sweeping 15-month study of sports-related concussions—and their link to both short- and long-term health issues—in kids from elementary school through early adulthood. ANSWER: FALSE

2. A concussion is defined as:

A) Any knock or blow to the head
B) A traumatic, usually temporary brain injury that disrupts cerebral function
The brain consists of soft tissue, which is cushioned from everyday bumps by the cerebrospinal fluid it floats in. Concussions occur when there's a jolting impact to the head or body, which may cause the brain to slide against the inner skull wall. That can result in bruising, blood vessel damage and nerve impairment, all of which can affect mental stamina and make the brain work longer and harder to complete even simple tasks. ANSWER: B

3. True or False

Even though my kids don't play contact sports, they're still at risk.
While football-related concussions tend to get the most attention (they account for 41% of the concussions experienced by high school athletes), the most common cause of concussion-related ER visits for kids 19 and younger is bicycle accidents, says the CDC. For girls ages 10 to 19, concussions occurred most often while cycling or playing soccer or basketball. "Any accident with significant impact to the head—a player-to-player collision, getting hit with equipment or falling hard on the ground—can cause a brain injury," says Kevin Walter, M.D., cofounder of the Sports Concussion Program at the Children's Hospital of Wisconsin in Milwaukee. ANSWER: TRUE

4. Which of the following is a sign that your teen has a concussion?
A) Confusion or fogginess
B) Loss of consciousness
C) Sensitivity to light and sound
D) Depression or psychological changes
E) Amnesia
F) Any of the above

Confounding as it may be, there is no definitive test for concussion. Diagnosis is based on a neurological exam by a physician. Symptoms can differ widely: They may be subtle or severe, immediate or delayed, and last for days or weeks. Headache, dizziness and disorientation are the most common, while less than 5% of kids lose consciousness, according to research. The severity of any amnesia, however, may be one of the main indicators of the degree of injury. "If a child can't remember the first part of the game or doesn't remember getting home afterward, he should be evaluated for concussion," says Jeffrey Kutcher, M.D., associate professor of neurology at University of Michigan Medical School and director of the Michigan NeuroSport Concussion Program. Whenever your child sustains a blow to the head, monitor him for 24 hours to make sure he's behaving and responding normally. If he's not, see a doctor immediately. ANSWER: F

5. Yes or No
After another player at a football game slammed my 16-year-old, he told the coach that he felt "off." The coach pulled my son aside and asked him how many fingers he was holding up. But isn't that test too simple to determine whether it's safe to return to the field?

The so-called sidelines test can't detect if your child has suffered a concussion. "Coaches shouldn't make that call," says Dr. Walter. "What they should do is know the signs—feeling 'off' is one of them—and get the child appropriate treatment if they suspect head trauma." That means having an athletic trainer or medical professional perform a physical exam and a series of cognitive tests, including repeating sets of words or numbers backward. If the child answers correctly, there's no immediate need for a doctor, but he should sit out the rest of the game and be rechecked every 10 to 15 minutes, since symptoms can appear later. ANSWER: YES

6.True or False
My daughter wears a helmet when she plays field hockey, so I can rest assured that she's safe from harm.
Helmets and mouth guards can prevent facial, tooth and skull fractures, but they do not protect the brain against concussions. Your child should always wear a helmet appropriate to the activity she's involved in, even if it's not a contact sport. Check the label to verify that the helmet meets federal and/or voluntary safety standards. Make sure it fits snugly and that the chinstrap is fastened. ANSWER: FALSE

7. Yes or No
My 15-year-old daughter got a concussion playing soccer 10 days ago. Her coach says she can return to the team. Should I let her?

Only a qualified doctor can make that assessment. Currently 43 states have sports concussion laws, most of which require that school-age athletes diagnosed with a concussion get written authorization from a medical expert before they play again. "Problem is, each state has a different definition of who can do the clearance," according to Dr. Walter. "Some say a licensed health care professional, which could be a nurse or chiropractor but she needs up-to-date education in concussion care." What you want your child to avoid at all costs is second-impact syndrome—being subjected to another blow to the head during the crucial period shortly after sustaining the first concussion. "That can be a fatal combination," Dr. Walter says. "The syndrome is rare, but it does happen." Young people may also be prone to post-concussion syndrome, in which they have persistent symptoms like headaches, irritability and dizziness. Unfortunately, among parents of children ages 12 to 17 who play school sports, less than 10% have read or heard about the risk of repeat concussions, according to a 2010 survey. And experts don't know how long this vulnerable period lasts or what the best treatment is. One common therapy is cognitive rest—avoiding mental and sensory stimulation, including bright lights and loud noises as well as video games and TV—for about two weeks. It may well be longer before it's safe for your child to play again, so consult a pediatrician and a specialist. ANSWER: NO

8. True or False
Kids rebound from concussions more quickly than adults.
This is one of the few injuries where the younger you are, the longer it takes to recover. That's because the adolescent brain is still developing and therefore more vulnerable. Girls are particularly at risk. According to research, high school girls playing the same sports as boys have higher rates of concussion, more symptoms and greater declines in visual memory. As for recovery, there is no standard timetable. It varies according to the individual, the incident that caused the injury and whether the child has pre-existing conditions or had a previous concussion. "Clinical observations suggest that the majority of preteens and teens recover in two weeks, compared with the one week that we see in adults," says Dr. Kutcher. But the sobering fact is that as many as one in five children with a concussion suffer diminished higher-order reasoning skills comparable to those who've had severe brain injuries, in some cases lasting as long as two years or more. ANSWER: FALSE

SCORECARD
If you answered correctly: 7-8 questions Congratulations on being so well informed. At the next game, share your knowledge with other parents while watching from the sidelines.
5-6 questions You're on your way to becoming concussion savvy.
4 or fewer It's time to start studying so you can learn how to prevent, recognize and respond to a concussion. Learn more from your pediatrician or take a free online course at cdc.gov/concussion.

Parent To-do List

Before your child steps out onto the field, make sure:

Is Dad on Board?

Men can be a little too gung-ho when it comes to sports. A recent nationwide survey found that 90% of fathers who played high school football and suffered a concussion, or suspected they did, still want their sons in the game, while more than half of them believe there's too much hype about head trauma. Fact is, teen athletes are under intense pressure not just from dads but from peers and coaches as well. In today's pervasive "culture of tough," which rewards playing with pain or shrugging it off, teens may be reluctant to report symptoms of concussion and other serious injuries for fear of looking soft. "Moms can help counter this by talking to their kids—and their husbands—and emphasizing that concussion is no wimpy injury," says Dr. Walter. "An environment that encourages reporting a concussion rather than hiding one is key to our children's safety."

The Lowdown on Baseline Tests

If your teen is offered a preseason neurocognitive screening, by all means sign up. Thousands of school districts are having tween and teen athletes take the computerized tests, which measure memory, reaction time and concentration (there's no comparable test for younger kids) and can be used to detect changes in brain function after a teen sustains a head injury. However, experts agree that a post-injury test should not be taken too soon after a concussion. "It puts extra demands on the brain, and can trigger dizziness or nausea or even exacerbate other concussion symptoms," says Michael O'Brien, M.D., associate director of the Sports Concussion Clinic at Boston Children's Hospital. What's more, the test alone can't be used to confirm a concussion—and even when taken weeks after an injury, it is not sufficient to determine whether an athlete has recovered enough to get back in the game. "They are being misused far more often than not," says Dr. Kutcher, who cautions parents not to over-rely on the screenings. "Every week I see patients who were allowed to return to the field, based solely on the test, when they shouldn't have been." Another caveat for parents: Warn your kid against deliberately underperforming on the original baseline in the hope that it will be easier to meet those lowered scores should he or she suffer a concussion. Specialists say that while teens sometimes try to deceive them, internal quality controls can spot those who are faking it.

Originally published in the September 2013 issue of Family Circle magazine.

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