Concussion Confusion

Concussions seem to happen all the time. I mean, they are absurdly frequent. I remember one, maybe two kids having concussions when I was growing up. These days they are a dime a dozen. 

Some of this is a function of the fact that we have redefined the word concussion. Any head bonk, it seems, can qualify. Back in the 70s and 80s, concussion implied hitting your head so hard you passed out. This may not have been the medical definition back then, but it certainly was a general consensus. Today, 90% of cases do not involve loss of consciousness. They can include a long laundry list of other symptoms, though, including headache, double or blurry vision, ringing in the ears, confusion, personality changes, nausea, vomiting, sleepiness, I could keep going...

Parental worry around concussion is completely legit. So is the confusion. If you are into reading science-y papers, check out this one, perfectly titled Concussion is Confusing Us All. Want something written for a non-scientist? There’s good information here and here. 

Parents of babies and toddlers can be especially freaked out because their kids cannot articulate their symptoms. Plus, babies and toddlers have such large heads relative to their bodies that when they fall, they almost always lead with the head. The best advice I can give you is: when in doubt, call your doctor. But the most useful tidbit I can pass along is that if your kid develops a massive goose egg within minutes, then in all likelihood there’s no concussion. Typically, if there’s swelling on the outside of the skull, the brain underneath was protected. But not always, so use you best judgement and call a doc when you aren’t sure. 

Then there are the older kids who concuss for sports-related and completely-not-sports-related reasons. The sports most associated with concussion include football, soccer, basketball, lacrosse, gymnastics and cheer. Schools have become quite proactive on the concussion front, with many high schools and now middle schools even conducting pre-sports baseline testing. But there’s a massive group who hit their heads off the field or court. Once any of these kids does get a concussion — and by the way, I have seen tweens and teens concussed because of everything from sports injuries to helmetless scooter (or bike or skateboard) riding to crazy antics on a trampoline to texting while walking and then walking straight into a post or tree — what then?

This article provides a great summary of how much the thinking has changed here (no pun intended). While we used to think brain rest was the most important concussion-healing strategy, now there is evidence that getting back to everyday activities and particularly exercise are the way to go. (One piece of advice that hasn’t changed? Minimizing screen time post-concussion really helps healing.) So what gives with all of the conflicting advice? The answer is that doctors and researchers do the best with the information they have at any given time. And when one approach is announced as the new standard of care, there are folks all over the world pushing on that and checking to see if it really is. In the case of concussion, this will undoubtedly change our approach many times. But it’s not a bad thing. Half of what I learned in medical school is already obsolete — that’s not a negative, it’s progress.

My first year in practice, a mom came in with her baby, several months old by then. She told me he was deaf, but her doctor had done a hearing test and it showed the baby could hear. The mom came to me for a second opinion — she knew the test was wrong and she needed another doctor to check him. Turns out, she was right: her baby was deaf. My point is that you know your child best. If you are worried about a head bonk, if your son doesn’t seem to be acting right, if your daughter is complaining of concussion symptoms, go with your gut and have someone recheck. Because concussion science is evolving, and we aren’t quite there yet with a perfect diagnosis or treatment approach.