Baby's First Concussion


The rise in concern for concussion management and discussions about return to play in kids sports have been a hot topic on twitter and facebook over the last few years.


 I followed it with professional and personal interest. My 8 year old son, Zack,  has hit his head more times than I would like to remember. He doesn’t walk, he runs. He doesn’t jump, he launches. Caution is not a part of his vocabulary. He doesn’t just trip occasionally, he hits the deck on a daily basis with veracity. He usually throws himself there in some dance move or imagined pirate battle. He has no balance disorders or sensory issues, he simply moves first, thinks second….or third or fourth. 
Needless to say, he has had some good knocks to his noodle, and some big headaches. So I have searched the concussion literature with interest, looking for a sideline type screen appropriate for a younger kid that I could use as a baseline for Zack. I wanted something I could compare to in order to measure the severity of future blows, which I knew with my boy were likely. Most of the screens are appropriate for older teen athletes: puzzles, higher level reading tasks, math, balance tests, etc. I had toyed with trying to sort of make one up on my own, just so I could have a unique baseline for my ‘baby’.
Welp, I never quite made that happen. And now it is too late. 2 weeks ago, during a soccer game, he got his first concussion, for realz. Severe headache, sensitivity to light, nausea, dizziness, double vision, fatigue…the works. My background as a physical therapist only gave me a piece of the puzzle to care for him. Sometimes, I am just a mom, and I discovered that this mom had a lot to learn. Time to share my lessons with you.
A trip to the ER, confirmed that he likely had a concussion, but no need for a CT scan because the risk of malignancy from the scan was greater than the possibility that he had a much more dangerous “bleed”. The ER doc actually had this algorithm that helped him draw that conclusion (Lesson #1-weighing the risks). His concerns were minimal. I was relieved that Zack’s much more severe symptoms this time around were actually considered a “minor” concussion, and his previous headaches from blows to the head didn’t even rate on the concussion scale (Lesson #2-Phew). The ER doctor downplayed his symptoms, and really communicated few concerns. 
 Based on all that I had read, I understood that the main post-concussion goal is rest. Keep them quiet. Wait for symptoms to clear before a return to sport. So my task, my priority, was to get my very active kid to sit still and rest, and not hit his head again. Not easy. I employed what likely most of you reading would have done. I let him watch more TV and play more video games then I would normally allow and read. You know stuff I would do to “rest”, nothing like a great episode of Modern Family when my brain needs a break. 
 When Zack’s symptoms lingered our pediatrician referred us to a Neurologist for a follow-up. The neurologist was very concerned about Zack’s continued symptoms. Let the lessons really begin. The neurologist, Dr Charles Niesen, informed me that with appropriate care a child Zack’s age should clear concussion symptoms in about 3-4 days. We were already at day 6 by the time we got to the doctor and he still had significant symptoms (Lesson #3-Uh-oh).
 Zack didn’t just need physical rest, he needed mental rest (Lesson #4- Of course, duh!!) . His brain needed a break from congnative work…he needed to not think (Lesson #5-Umm, say what?). But how do you do that? He was not allowed to read, play video games, watch TV, do math, play on my i-phone, or make-up missed work from school. Dr. Niesen joked he was allowed to do whatever was available in 1880. Whittling, fishing, going for walks, and my personal favorite of his suggestions…chores. (Lesson #6- I had done everything wrong in how I defined “rest”).  The doctor also started Zack on a medicine meant for migraines. 
 Within 24 hours of our new regimen of brain rest,  Zack had no headache. Zack was a trooper and gratefully very compliant.  We baked, played pirates, fished, hiked, colored, danced, lego’ed, domino’ed, and played board games. 
 Gradually Zack’s symptoms diminished, but the lessons kept coming. Lesson #7: HA , dizzyness, nausea, etc. clear first, then fatigue, then the ability to concentrate and perform cognitive tasks. Lesson #8: Most concussions clear over the course of a month or more, and even at a month a lag in the delivery of visual information to the brain stem can exist (per Dr. Niesen). That transfer of information is so fast, that a mild lag, like what would occur with a “minor” concussion like Zack’s wouldn’t really be evident. In other words, the problem is subclincial or essentially undetectable.  So a kid might “appear” fine, but issues might persist. 
 Once his major symptoms had eased, Zack was cleared to return to school. Dr Niesen had a plan for gradual return to ACADEMICS and sport (Lesson #9: The brain’s sport IS academics, a test is like a full-contact game). The schedule looked like (shared with permission, copyright Dr Charles Niesen):
Day 1 Attend all classes, no homework. Exercises, running, no scrimmage.
Day 2: 50% homework load. Run plays, no contact.
Day 3: Full homework load. Scrimmage + contact.
Day 4: Full homework load, tests. Games + contact.
Additional restrictions were to give ample time to make-up missed homework and tests to avoid being overloaded. 
 I learned lots on our little journey. But  my last lesson, Lesson #10,was my favorite. The brain of a child Zack’s age heals really quickly and really well. We are grateful, our baby’s back!  

Dr Niesen is a great resource on concussion management! You can contact him through his website
Contributed by Julie Wiebe, PT, Women's Health PT Extraordinaire!

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