Once again I’ve digressed from the five-part series, because spring is in the air! It’s been a very, very long winter for most of the country and when the warmer weather and flowers bloom, we all want to get outside and finally have some fun, whether it be through organized sports or some form of recreational activity. Yet, this is when most concussions occur. We are so eager to just get out and have fun that we don’t think about helmets and other means of playground and recreational safety.  

Thinking About Child's Safety AND Your Own

How many of you have put a helmet on your children to go bike riding, but didn’t put one on your own head? How many of you out riding your horse, skateboarding, or rollerblading have not put a helmet on your head? Recently I was driving around and saw dozens of parents with their children riding their bikes, where the children have helmets on and the parents do not. Just stop and think, what will happen to your family if you have an accident and have a concussion? How does that affect your entire family? When I drive through the various local towns, there is a vast number of children of all ages playing on their skateboards without helmets.

Now if you recall in my very first post, I wrote about the difference between a brain injury and a head injury. In that post, I pointed out that when you exceed the speed of what you could possibly run into a wall or tree, you are likely to have a brain injury. If you are riding a bike, skateboarding, or rollerblading you are going much faster than you could on two feet, and if you hit your head at that speed you are likely to have injury to your brain, even if you were not knocked unconscious.

Playground Injuries: More Than Just Physical

Now let’s move on to the local playground, with swings, slides, jungle gyms, etc. Usually the children who play there are ages six and under, and their brains are still developing. All too often children that sustain a concussion on the playground in the Spring, their symptoms are often ignored or dismissed the focus is on the physical injuries that occurred. Often parents do not connect the ongoing symptoms (e.g. not paying attention in class, being anxious, fatigued, or complaining of headaches) to the injury on the playground. It is usually not until the Fall when school starts and a teacher sees these symptoms in the classroom, then these symptoms are often misdiagnosed and the parents are told that their child is having anxiety, discipline problems or has ADD or ADHD. At this point most parents never make the connection to the root cause, which was from a concussion in the Spring.

It is important to know there are specific tests to evaluate for concussions. One such test done by neuropsychologists is the Haltstead-Reitan. A list of all the tests is available in Chapter 5 of my book, Coping with Concussion and Mild Traumatic Brain Injury. If your school wants to do any testing, make sure this test is included to rule out the cause was a concussion, rather than ADD or anxiety.

Causes of Concussion Among Today's Youth

For even younger children the leading cause of concussion is being struck by a car while walking or riding a bicycle or scooter. Seemingly benign, amusement park rides also increase a child’s risk. The sudden acceleration and deceleration of roller coasters and other rides are known to cause concussion, particularly if this impact is preceded by other concussions.

It is likely that concussions related to riding toys are underreported, because the parent or caregiver may focus on external injuries such as scrapes or bruises. It is easy to overlook a child’s appearing dazed and shaken if her knee is bleeding or his arm is injured. Even when an injury is serious enough to warrant a trip to the emergency room, the focus tends to be on the visible. Medical personnel may overlook that a child seems to be dazed or not thinking clearly, which is why concussion is called “the Silent Epidemic.”

By 10 years-old, most children are in some type of organized sport, whether that be tee-ball, little league, soccer, etc. The rate of concussion a few decades ago were down for two reasons. First is that there was an under-reporting, along with a lack of evidence that a concussion truly existed. It has only been in the last 5-10 years that the technology and science has been available to truly detect and assess a concussion. The second is that children in prior decades were not involved in organized sports, rather the child would play with their friend at the local baseball field. There was not the competitive edge that exists today. Parents and local social acceptance now go from general encouragement to often pushing a child to go beyond their physical ability to play that sport, resulting in the risk of injury. Once again, if the child was injured the focus was on the physical injury to the body and all too often the injury to the brain was totally ignored or minimized.

Pre-teens and teenagers are the highest risk, especially males, for having a concussion from a wide variety of sports and recreational activities, such as enjoying jumping on trampolines. The table below presents some of the leading sports and recreational activities that can cause concussion at any age.   During the teen years, nutrition frequently becomes worse as parental regulation decreases and the temptation increases to use energy drinks, bodybuilding supplements, alcohol, and drugs. All of this puts the developing brain at risk, because the connective myelin in the prefrontal lobe, which helps regulate how we think, behave, and feel, is just beginning to grow. Yet it is during this time of life that many youths are involved in hard-hitting or risky athletic pursuits.

Leading Sports and Recreational Pursuits That Can Cause Concussion

1.   Cycling

2.   Boxing

3.   Football

4.   Wrestling

5.   Baseball and softball

6.   Basketball

7.   Water sports, including diving, scuba diving, surfing, swimming, water polo, water skiing, and water tubing

8.   Powered recreational vehicles, including ATVs, dune buggies, go-carts, gas-powered scooters, mini bikes, and dirt bikes

9.   Soccer

10. Skateboards and nonpowered scooters

11. Fitness, exercise, and health club participation

12. Winter sports, including skiing, sledding, snowboarding, and snowmobiling

13. Horseback riding

14. Gymnastics, dance, and cheerleading

15. Karate

16. Golf

17. Roller and ice hockey

18. Tennis

19. Racquetball

20. Other unspecified ball sports

21. Trampolines

22. Rugby and lacrosse

23. Roller- and inline skating

24. Ice-skating

How Can You Help Prevent a Concussion?

The reality here is that you cannot be with your children 24/7. You can’t protect them from everything, however, you can educate yourself and them about preventative measures. Please wear a helmet, whether it is a state law or not, when you are riding a bike or a horse, playing football, skateboarding, or roller blading. That includes parents too. If your child isn’t quite as physical as others their age, see if there are other activities they can enjoy. Try putting a net around your trampoline, padding on the ground and on the metal strips. If you or your child has had a recent concussion, do NOT go on a roller coaster. If your child is at all bruised or cut up from a slide, playground injury or from sports, please consider they might have hit their head too.  Don’t minimize their dizziness or headaches. The child might need a day or two of just resting. Avoid sugar, drink lots of water and eat protein!  

Having said all this, please be wise, use caution and enjoy the spring days. They go by very fast!

Be sure to read the following responses to this post by our bloggers:

College Football and Traumatic Brain Injury is a reply by Billi Gordon Ph.D.

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