The New Do’s and Don’ts of Concussion Care

Once football season ends, the conversation about concussions unfortunately often ends as well.

“People think of fall and winter sports like football and hockey when they think of concussions, but spring sports like lacrosse, year-round sports like soccer, and recreational activities like biking and skateboarding can lead to a concussion, too,” says Christina L. Master, MD, FAAP, CAQSM, a sports medicine pediatrician and brain injury expert at CHOP. 

Concussions, caused by a hit to the body or the head that causes the brain to shake and then not work properly, are on the rise in recent years. According to Dr. Master, kids playing sports year-round and the growing intensity of competition are at least partly to blame. Better concussion recognition and detection are also contributing factors.  

Also on the rise, though, are developments in pediatric concussion research and management, including new advice for preventing and treating concussions. We asked Dr. Master and Kristy Arbogast, PhD, co-scientific director and director of Engineering for the Center for Injury Research and Prevention at CHOP, for their best “do’s” and “don’ts” when it comes to concussion prevention and management.

Preventing concussions

• Do know which sports and activities have an increased risk of concussions. For boys these include football, ice hockey, lacrosse, and soccer; for girls, soccer, lacrosse, basketball, and field hockey carry heightened risk, according to a recent large-scale study.  Also remember that concussions can happen in any sport and recreational activity.
• Do trust your parental instinct and remember that concussions can happen outside of sports and recreation as well.   It’s important to be on the lookout for signs and symptoms of a concussion after everyday life events, such as falls or a motor vehicle crash.

• Do talk to your child’s coaches about concussions. “Many coaches for youth athletes are volunteers and may have different levels of awareness about concussion. The good news is that there has been an increase in awareness and education of coaches, particularly in interscholastic high school sports,” points out Dr. Master. Be sure to ask your child’s coaches about the steps they take to minimize the risk of concussions during practice and what their procedure is if a concussion is suspected.
• Do be aware of the recent concussion prevention ruling in youth soccer, and efforts within football to reduce contact in practice.  Two weeks ago Ivy League football coaches banned tackling in practices. Many youth football programs are adopting similar guidelines in the absence of any official rulings for youth football.
• Don’t rely on padded headbands and helmets to prevent concussions, or let headgear give kids a dangerous sense of invincibility. Padded headbands, currently marketed online to parents of youth athletes, cannot prevent concussions. What’s more, “research shows they may spur kids to play more aggressively and in a riskier style because they believe they’re protected,” says Dr. Arbogast. Parents should have a safety discussion with their kids before helmet-wearing activities, so that kids don’t feel “invincible” and wind up putting themselves more at risk.

Concussion treatment

• Do consider seeing someone who has special expertise in concussion as soon as possible if your child has any kind of concussion. “Our understanding of how to diagnose and treat concussions is rapidly changing, and it’s important to have a physician who is up to date on all of the latest developments,” says Dr. Master. One of these developments involves balance and eye tracking assessments. “Proper evaluation and management aid in recovery,” she adds.  Substantial efforts have been underway to ensure CHOP primary care pediatricians are up to date on these advances; if you receive care in the CHOP Care Network, they may be the best bet to get your child seen quickly. 
• Don’t feel badly if your child has not had a “baseline” test. There are popular computerized “neurocognitive” tests that offer a baseline “score” of abilities such as memory, visual motor speed and reaction times. These scores are compared against scores the child gets after a concussion, to evaluate performance after the brain injury and gauge recovery. “These tests aren’t necessary, though,” Dr. Master says, and may even be inaccurate because baseline memory and reaction times are sensitive to testing conditions. Sometimes, baselines aren’t always administered in an optimal test-taking setting during the preseason. In addition, these skills tend to improve over time, as part of normal cognitive development during childhood. So your child, for a variety of reasons, can sometimes wind up with a better score on a post-injury test — which just indicates the baseline was likely not the most accurate.
• Do supervise the initial period of rest recommended for any concussion. Sleep is important, contrary to the myth that says you should wake your child frequently. Research shows that a brief period of immediate cognitive and physical rest for a few days can also support recovery, says Dr. Master. “We usually recommend minimizing computer games, reading, or other cognitive workload taxing your child’s brain in order to give the immediate rest needed to help the brain heal and recover,” she says. But rest shouldn’t last forever; your child’s physician will help guide him in how to ease back into both cognitive and physical activities.

• Do make an extra effort to provide proper nutrition after a concussion. Your child may not be hungry following a concussion, but the brain requires extra energy in the form of nutrition as it works to heal the injury.
  • Offer small, frequent meals throughout the day, instead of three large meals, if she doesn’t have much of an appetite.
  • Encourage healthy power snacks, with a good mix of carbohydrates and protein such as fruit smoothies, and trail mix (dried fruit, nuts, dark chocolate).
  • Keep your child well hydrated with water, since she may be more susceptible to dehydration after a brain injury.