How to recognize concussion in students and athletes with pediatrician Melissa Knudson-Johnson, M.D.

By Melissa Knudson-Johnson, M.D. Aug 31, 2016

With fall sports upon us, the topic of concussions frequently comes up in office visits with my younger patients and their parents.

So, what is it? A concussion is an injury to the brain. Every injury is different, and so every concussion is different. Contrary to what many people believe, a person does not need to lose consciousness in order to suffer a concussion. It is important to seek medical attention after a concussion.

Typically, the injury is with the circuitry of the brain, and there are four ways concussion can manifest:

  • Physical symptoms: These can include dizziness, headaches, balance problems, nausea and sensitivity to light and/or sound.
  • Cognitive symptoms: These are more difficult to identify and have to deal more with reaction time, reasoning and processing information.
  • Emotional symptoms: These may include irritability, sadness or other changes in mood.
  • Sleep disruption: The last subset of symptoms  regard changes in sleep patterns. These can include trouble falling asleep and/or sleeping too much.

Since every concussion is different, each set of symptoms is different. Even for the same person, symptoms may differ from one concussion to the next.

The best treatment for concussion is rest – both physical and cognitive. Physical rest is pretty straight forward. Cognitive rest means taking frequent breaks from things that put a strain on your brain. That includes texting, playing video games, watching TV, reading and doing school work. Switching activities every 20­ or 30 minutes will help with the cognitive rest. The brain heals while resting, so it is also important to get at least eight hours of sleep a night after suffering a concussion. If symptoms return during an activity, it is the body’s way of saying it needs a break and needs to rest.

Concussions must be treated with rest until symptoms are completely resolved. This is important. If the brain has not healed completely and it is injured again, symptoms can become permanent or can take longer to resolve. It could also result in Second Impact Syndrome, a very rare but serious complication from returning to physical activity too soon after a concussion. Second Impact Syndrome may occur in a child who is still recovering from a concussion and gets a second impact to the head. It can cause brain swelling and lead to serious complications, including death.  

The start of fall sports, or even kids playing hard at recess, will likely mean an increase in concussion for young patients.

For coaches who suspect concussion in young athletes

  • Determine whether a head injury has occurred.
  • Do not return a player to the game. Wyoming High School Activities Association rules prohibit players from returning to play if they have or are suspected to have a concussion.
  • Do not return players to the game if they exhibit ANY symptoms of concussion.
  • Seek immediate emergency care if you suspect a neck injury or if a player exhibits deteriorating status or persistent symptoms. 
  • Refer players suffering a second concussion in a single season for medical evaluation. Such players should not be returned to play on the same day.
Melissa Knudson-Johnson, MD

Melissa Knudson-Johnson M.D.

Dr. Melissa Knudson-Johnson is an internal medicine and pediatrics doctor which is called med-peds, a type of medical specialty which trains physicians to be board eligible in both pediatrics and internal medicine. She sees patients of all ages at Mesa Primary Care. She is board certified in pediatrics and is board eligible in internal medicine.

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