Keeping our kids safe and healthy is a top priority of any parent—and little makes a parent more nervous than when a child hits his head after falling from a skateboard or gets a concussion after being tackled in a football game.
Parents have good reason for their concern. According to the Brain Injury Association of America, 37,000 children between the ages of 0 and 14 years are hospitalized each year with traumatic brain injury (TBI)—most commonly caused by falls, accidents, assaults or sports-related injuries. TBI is the number one cause of disability or death for American adolescents, resulting in nearly 3,000 deaths every year of children 14 and younger.
Falls—usually from a bicycle, scooter or skateboard—represent the most common cause of brain trauma in children younger than age 12, according to a 2014 study published in the New England Journal of Medicine. Children should wear a properly fitted helmet every time they hop on a bike or other wheeled device, even if they’re taking a quick spin around the block or practicing tricks in the driveway, says Dr. Brent Masel, M.D., the national medical director of the BIAA and the president and medical director of the Transitional Learning Center, a brain-injury treatment facility in Galveston, Texas.
Into-everything toddlers are susceptible to tumbles down steps and falls from furniture, bookshelves and even baby gates. A 2014 study published in the journal Academic Pediatrics found the number of injuries resulting from falls from baby gates more than tripled between 1990 and 2010. Most of the injuries led to cuts, bumps and bruises, but 16 percent resulted in concussions, which are mild brain injuries. Many of the injuries occurred after the child either pushed through a pressure-mounted gate or climbed over a pressure-mounted gate at the top of a staircase, causing the gate to collapse and the toddler to fall. Baby gates that are mounted to the wall with hardware are much safer bets for the tops of stairs—as are watchful eyes of parents.
Prevention continues to be the key, says Masel. There is no cure for TBI, nor is treatment clear-cut. “In terms of treatment, we still don’t have anything new,” he says. “Although the ICU, the ER, the neurosurgeons and the technology have all improved, the basic approach to treating a brain injury has not changed significantly.”
Prevention isn’t easy when it comes to sports-related concussion, says Dr. Mark Halstead, M.D., an associate professor of pediatrics and orthopedics at Washington University in St. Louis. “Obviously, if external devices were the answer to prevent them, we would not really see concussion in the sports settings that require helmets,” he says. “Unfortunately, we see concussion at the highest rate in the three sports that require helmets: lacrosse, ice hockey and football.”
Athletes in other sports will take hits, collide with other players or hit balls with their heads. Although not enough research has been conducted to figure out exactly why, adolescent female soccer players seem to be more susceptible to concussions after heading the ball than their male counterparts, Masel says. But football is the biggest brain-injury culprit when it comes to sports, due to continuous, repeated subcussive blows to the head. “It’s below the level that it’s going to cause a concussion or knock you out every time, but the number of subcussive blows in a football practice is enormous,” he says.
Masel’s advice? “Don’t let your kids play football. The literature is now showing that the high school level and even playing Pop Warner football at age 8, 9, 10, 11 is not good for your brain.”
All 50 states now mandate that a child suspected of having a concussion during a practice or game must immediately be removed from play and evaluated by a licensed healthcare provider, Halstead says. When children fall or are hurt at home and their symptoms suggest a possible concussion or other brain injury, they should be taken to a physician or emergency room for evaluation.
“The ‘red flags’ that should certainly be evaluated quickly are a period of time longer than 30 seconds where they have a loss of consciousness,” says Halstead. “If they’re having the worst headache of their life, or a younger kid is uncontrollably crying after their injury and not consolable. Also, repetitive episodes of throwing up, if they’re unable to move an arm or a leg, or are reporting any numbness or tingling in an arm or a leg after a head injury.”
Treatment of a concussion usually requires nothing more than rest at home for a few days. The myth about not letting kids with concussions fall asleep is just that, says Halstead. “We actually encourage kids to have a good night’s sleep after their concussion. Sleep is very crucial to recovery,” he says.
It will likely take a week or more to fully recover from a concussion. “The good news about concussion is that the vast majority are going to get better really quickly,” Halstead says. “About 50 percent of athletes will be better within the first week of their injury. By three weeks after their injury, 80 to 90 percent will be fully recovered.”
Kids should not return to sports play until they are fully recovered and cleared by a physician, but they can usually return to the classroom after a couple of days. Teachers should be informed of the injury so they can monitor the child’s activity and alert parents to any physical, cognitive or behavioral issues that arise.
“There’s good research to suggest that kids should only be held out of school for a few days and then integrated back into the classroom setting,” Halstead says. “Recent research says if you keep kids out longer, they have worse symptoms and actually take longer to get better.”
Still, the effects of concussions and TBI can linger for months—or longer. A small study of 30 children ages 10 to 17 who suffered concussions found changes to the white matter of their brains three months after their injuries.
Masel says that cognitive or behavioral changes might take years to surface following a brain injury severe enough to require hospitalization. “Children will seem to do OK, then they can start to fall behind because their brain isn’t able to make the connections that it would make had there not be an injury,” he says. “The brain doesn’t develop the way it should.”
A silver lining is that parents, coaches and educators are more aware of brain injury, particularly of concussions, which Masel thinks is likely due to increased media attention to concussion and TBI in military veterans and professional football players.
“There’s been a big spike in children being seen in emergency rooms after blows to the head, and yet the number of hospital admissions has remained the same,” Masel says. “What that’s saying is there’s more awareness of the seriousness of brain injury in children. Parents are clearly more aware than they used to be, which is great.”