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Clear kids with concussions before sports: report

NEW YORK (Reuters Health) - Kids who suffer concussions should be cleared by a doctor before they start playing sports again, and parents and coaches should be aware that young athletes take longer to recover than college and professional athletes, according to a new report in Pediatrics.

The recommendations come from the American Academy of Pediatrics’ Council on Sports Medicine and Fitness and emphasize the physical and mental recovery period necessary for all young athletes after a head injury.

The report is published alongside another study, which estimates that each year about 100,000 kids ages 8 to 19 go to the emergency room with concussions - half of those from sports. That survey of U.S. emergency rooms, led by Dr. Lisa Bakhos, from Brown University’s Warren Alpert Medical School in Providence, Rhode Island, also found that more kids are getting treated for concussions suffered during organized sports than in recent years.

But, that “leaves the question of all of the other concussions that may be occurring where the kids are not reporting it and the parents are not taking them to the emergency room,” Dr. Tamara Valovich McLeod, the sports medicine chair at the Arizona School of Health Sciences, who was not involved in the research, told Reuters Health.

The brains of kids and adolescents might be even more susceptible to the effects of a concussion than older athletes, the Council writes. And while some athletes might want to “tough it out” after getting hit in the head, the Council recommends a gradual increase in activity once symptoms go away - and urges that kids who suffer concussions should never return to a game or practice the same day.

Athletes, parents, and coaches need to be aware of concussion symptoms, as well as the harms of not properly treating head injuries, according to the recommendations.

Sport-related concussions often happen after a blow to the head or neck - such as when a soccer player hits her head on the goal post or collides head-on with another player.

The symptoms, which might take a few hours to show up, include headache, nausea, sensitivity to light and noise, or depression and anxiety, the Council says. Some but not all athletes with concussions lose consciousness.

“We’re relying on an athlete reporting symptoms,” Dr. Mark Halstead, director of the Sports Concussion Program at Washington University in St. Louis and one of the report’s authors, told Reuters Health. “There’s obvious (concussions) where a kid gets knocked out.” But, for “the majority, the kid ... may not realize they’ve had one.”

On the field, coaches and trainers should first rule out the possibility of a spine injury, according to the Council recommendations, then should test the athlete’s mental functioning by asking questions such as, “What team did you play last week?” Athletes that do show signs of a concussion should be monitored closely to make sure they don’t get worse.

If a concussion is confirmed, kids need to rest - both physically and mentally, the Council says. Because schoolwork and reading can make symptoms worse, parents should consider taking kids out of school while they recover and discourage their child from any other mental overexertion, including playing video games or watching TV.

Once kids have no more symptoms, they can slowly start being more active - as long as the symptoms don’t return. It might take up to ten days for all symptoms to disappear. Before kids start practicing sports again, they should be checked by a doctor to make sure they’re ready.

When kids return to play before they are healed from a first concussion, they risk second-impact syndrome: when a second blow to the head can mean serious brain injury.

In their emergency room study, Bakhos and her colleagues found that the rate of concussions was highest in kids who played football and ice hockey. According to their data, more than twice as many kids visited the emergency room for concussions suffered during organized sports in 2007 than in 1997 - even though fewer kids were involved in team sports than a decade earlier.

Off the field, the most concussions came from bike riding, skiing, and playground injures.

The rise in emergency room visits for concussion may reflect a mixture of good and bad news, say experts.

Much of the increase could stem from parents and coaches getting better at recognizing and reporting concussions. “Concussions have always been, ‘oh, you’ve just been dinged’ ... they’ve been kind of ignored,” Halstead said. “The awareness is out there a lot more.”

It may also represent some real increase in head injuries. “Certainly it seems possible with the number of extreme sports being played in recent years, that could be playing a role in this, or a more intense style of sports participation for some kids,” Dr. Michael Kirkwood, who studies concussions at The Children’s Hospital in Aurora, Colorado, told Reuters Health.

But he agrees that increased awareness is behind more children going to the emergency room. “For me, even though it might be concerning that these rates seem to be increasing, this is an overall positive step in concussion care,” said Kirkwood, who was not involved with the current study.

Nonetheless, there is still more education and research to be done, doctors say.

“The younger athletes, their brain is still developing,” McLeod, of the Arizona School of Health Sciences said. “We don’t really know any potential long-term consequences. We just don’t know how these impacts may or may not accumulate over time.”

SOURCE: Pediatrics, online August 30, 2010.