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Wednesday, November 12th, 2008

Emily Halevy | CWK Producer

During football practice, 16-year-old Jesse Noel got into a fight with another player.

“Basically, there was a fight and somebody hit you in the face, and the back of the head with a football helmet?” Dr. Michael Ziegler of Children’s Healthcare of Atlanta asks Jesse.  Jesse nods his head yes.

Now the boy has a split lip and a gash on the back of his head.  What’s more, he can’t remember what happened after he was hit, and he has a headache.

“And you said you didn’t pass out or no one saw him pass out, but you don’t really remember getting into the locker room?” asks Dr. Ziegler.  “No,” Jesse says, “I kind of just like blacked out.”

“He didn’t have any vomiting, he didn’t seem to have any alteration of his mental status according to his family, very shortly after the injury or at the time we evaluated him in the emergency room,” explains Ziegler. “So, he would sort of fit into the classification of a grade one concussion.”

90 percent of all concussions are grade one.  It’s the mildest kind.

“I’d say if he’s fine between now and when we get you home, you don’t need to wake him up every hour or two hours, that really is sort of old school,” Ziegler tells Jesse’s parents.  “As long as he’s doing things the way Jesse does and behaving the way Jesse does, then you’re in good shape.  Okay.”

Jesse also needs stitches.  Eleven for his lip: 2 on the inside and 9 on the outside.  And five more for the back of his head.  All of which will dissolve in about a week.

Still, the doctor warns, “He needs to stay out of sports at least until his headache is gone and then a couple more days after that.  Two more days after all of them symptoms are gone.  And certainly for the next 24 hours keep a close eye on him- any vomiting, you know any change of behavior, any sleepiness that concerns you, any like, not making sense when he’s talking.  Those are emergencies.  He has to come right back to the closest emergency room.  But by tomorrow night if he’s fine, don’t worry about it.”

Tips for Parents

Helmets hit in football, heads collide in soccer and punches are thrown in boxing – all actions that could possibly result in a concussion.  While concussions are common among athletes, especially high school students, they can be quite dangerous.  Studies show that high school athletes who suffer from more than one concussion are nine times more likely to show severe symptoms, including loss of consciousness, confusion and memory loss.

University of Pittsburgh researchers examined 98 athletes, most of whom were football players with recent concussions.  Sixty of these students had three or more concussions prior to the one analyzed in the study.  As a result, researchers determined that concussion damage is cumulative, the more concussions one has, the more severe the symptoms and damage.  Three concussions in particular appear to be a sign of trouble. 

A concussion is defined as an injury resulting from a violent jar or shock to the head, causing at least a temporary loss in brain function.  The brain, which floats in cerebrospinal fluid, may be slammed against the inner wall of the skull, causing bruising and possibly bleeding or tearing of nerve fibers when a person is hit or falls down.

Concussions are divided into three different categories: grade1, grade 2 and grade 3:

• Grade 1 - The mild concussion occurs when the person does not lose consciousness (pass out) but may seem dazed.
• Grade 2 - The slightly more severe form occurs when the person does not lose consciousness but has a period of confusion and does not recall the event.
• Grade 3 - The classic concussion, which is the most severe form, occurs when the person loses consciousness for a brief period of time and has no memory of the event.  Evaluation from a health-care provider should be performed as soon as possible after the injury.

The signs and symptoms of a concussion may be slight and subtle at first.  Once they appear, they can last for days, weeks or longer.  If your child has recently taken a hit or fall, watch for the following signs immediately:

• Confusion
• Amnesia
• Headache
• Loss of consciousness after injury
• Ringing in the ears
• Drowsiness
• Nausea
• Vomiting
• Unequal pupil size
• Convulsions
• Unusual eye movements
• Slurred speech

Be sure to watch for the following delayed signs or symptoms:

• Irritability
• Headaches
• Depression
• Sleep disturbances
• Fatigue
• Personality changes
• Poor concentration
• Trouble with memory
• Getting lost or becoming easily confused
• Increased sensitivity to sounds, lights and distractions
• Loss of sense of taste or smell
• Difficulty with gait or in coordinating use of limbs

If you notice any of these signs, it is important that your child see your healthcare provider immediately.  If a concussion is diagnosed, there is a possibility your child may have to stay in the hospital to be closely monitored.  If released, your doctor will prescribe plenty of rest.  Some over-the-counter and prescription medications may be taken to relieve pain.

Since some head injuries and concussions are caused by sports and recreational activities; the Nemours Foundation suggests the following tips for protecting your head – (these apply to adults as well):

• Always wear a seatbelt in a car.  If you are under ten, you probably need a booster seat.  Kids should use a booster seat until they are 58 inches tall, have a sitting height of 29 inches and weigh at least 80 pounds (this is typically when a seatbelt fits properly without a booster).
• When you are walking on the street, always look both ways before you cross, and obey all streetlights and traffic signs.  Always use a crosswalk.  Crossing in the middle of the street where cars may not see you can be dangerous.
• Wear appropriate helmets or headgear and other safety equipment when biking, riding an all-terrain vehicle (ATV), skateboarding, riding your scooter, playing contact sports like football, skiing, and doing other activities.  For example, using a bike helmet reduces a child’s risk of a concussion (and other brain injury) by about 85 percent!
• f you use care and common sense in all of your daily activities, you have a much better chance of avoiding a concussion. Stay safe - the best way to protect your head is to use your head!

References

• Children’s Healthcare of Atlanta
• Mayo Clinic
• Nemours Foundation
• University of Missouri
• University of Pittsburgh

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