This spring, kids will be returning to extra-curricular activities and organized sports in the community, much of which was canceled over the past two years due to the COVID-19 pandemic. As these activities resume, now is a good time to learn what to do in the event of a concussion.
Concussions are one of the most common sports injuries in children and youth. Canadian data show there are nearly 50,000 diagnosed concussions in children ages 5-19 every year, nearly half of which are sports-related.
Concussions occur as a result of a bump or blow to the head, which can jostle the brain. This can result from a bad fall, a soccer ball to the head, or bumping into another child, for example. Concussions can happen even if children are wearing helmets or other protective gear.
So, what should we do if a head injury occurs?
It is very important for children and youth to stop playing after an injury of this nature and get assessed by a qualified health care provider, which involves a physical evaluation and review of medical history. But don’t expect a routine CT scan – because it may not be necessary.
Unfortunately, there are many misconceptions about how to best assess, treat, and manage concussions in kids. The latest evidence shows that doing imaging tests like CT scans does not help to diagnose a concussion, and in fact, might cause more harm than good.
CT scans can expose children to high doses of radiation. Excess radiation exposure in children raises concerns about future cancer risk. The benefits of CT scans need to be weighed with potential risks and harms.
So, when is a CT scan necessary?
CT scans or other imaging tests are only needed when there are worrisome symptoms, such as repeated vomiting, prolonged loss of consciousness or decreased level of consciousness, seizures, worsening headache, or other concerning physical symptoms.
Proper and timely assessment is important. The Canadian Academy of Sport and Exercise Medicine with Choosing Wisely Canada recently released a new recommendation for health care providers on avoiding CT scans for concussion. This includes the suggestion to use a clinical decision rule, which is a set of questions and prompts health care providers can use to assess the severity of the injury and avoid imaging tests if they would not be helpful.
The good news is that the science on concussions has advanced. But this means the research and practice in treating concussions has changed as we learn more about what helps to heal these injuries in kids.
Other misconceptions about how to manage a concussion include the beliefs that children are required to stay in a dark room, avoid screens or reading, and have minimal physical activity for many weeks. In fact, recent evidence suggests the importance of movement following a head injury to enhance recovery and improve outcomes.
It is currently recommended after an initial short period of rest for a day or two following the injury that light physical and other activities can resume so long as children’s symptoms do not get worse. Kids can return to sport, and play can take place, with careful monitoring and through a plan with your health care provider.
Knowing how to play safely and handle injuries such as concussions when they occur will help keep kids active and healthy as they return to team sports this spring.
Laura Purcell and Erika Persson are sports medicine physicians.
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