Concussions, head injuries and traumatic brain injuries (TBI) are more common than you might think. In fact, pediatricians see kids with these issues all the time.

When the head is involved, it is much harder to figure out the extent of the problem as compared to other sports injuries. Symptoms may take hours to manifest themselves. Most head injuries go unreported - as when two kids bop heads while playing, and just continue on with their game. They are so focused on what they are doing that they may not even notice the injury until long after the game is over, so mom/dad never hear about it.

Head injuries can be mild (a small bruise) to severe (fractures and severe internal bleeding), depending on the type of trauma sustained. Since there is much info available about TBI's, I will keep this article focused on concussions.

The Stats:

  • Children ages 0-4 years and 15-19 years are most likely to sustain a TBI.

  • Almost half a million (473,947) emergency department visits for a TBI are made annually by children ages 0-14 years.

  • About 75 percent of TBI's that occur annually are concussions or other forms of mild traumatic brain injuries.

What is a Concussion?

A concussion is a mild form of a traumatic brain injury - a temporary insult to the brain which disrupts its normal function. Our brains actually float in a protective capsule within the skull, sort of like a fish in a fish bowl. It may sound kind of weird, but this set-up usually works great to protect the brain from direct trauma. However, when a person's head gets whipped around too quickly, the brain hits the inside of the skull, causing a concussion. Some doctors actually describe this condition as a "brain bruise." If there is actual bleeding into or around brain tissue, then the injury is more severe and is not considered a concussion. In this case, it is an emergency, which can require surgical treatment.

Symptoms of a Concussion

  • Confusion

  • Nausea and/or vomiting

  • Dizziness

  • Fatigue

  • Headache

  • Poor balance

  • Not feeling "with it"

  • Amnesia

  • Loss of consciousness (in more severe concussions)

Concussions are graded into three grades: I, II and III.

  • Grade I concussions are mild, and patients recover quickly (5-15 minutes).

  • Grade II concussions are moderate and include some amnesia, confusion or symptoms that last more than 15 minutes. Sometimes the patient may have a brief period of unconsciousness (less than 5 minutes).

  • Grade III concussions are considered severe and are associated with prolonged loss of consciousness (greater than 5 minutes). These patients may also suffer from more severe physical trauma and usually require an E.R. visit. They may take up to a year to completely recover.

Evaluation and Treatment

Anyone suffering from a head injury needs to be evaluated immediately by a person trained in what to look for. Depending on the severity of the injury, they may need to be re-evaluated the next day or sooner, if not already sent to the E.R. Severe concussions may warrant studies like neck x-rays and MRI/CT scans of the head and neck. Treatment in most cases is close observation by a family member for the next 24 hours, and waking the patient up every two-three hours during the night to see how he responds. Most concussion cases will get better by themselves. Symptoms can last for a few minutes to weeks, or even months for severe cases. Until these symptoms go away, the person should avoid strenuous activity. Returning to sports and similar activities too soon could lead to permanent brain damage.

If any person who has had a concussion starts to show a change in personality - including confusion/irritability, worsening headache, numbness or tingling in the extremities, or vision changes - they require immediate medical attention, preferably at the emergency room, where a head scan can be done quickly. This change in symptoms might indicate a more serious brain injury, like an internal bleed.

To date, there are no real medical treatments to fix concussions. All we can do is let time and the body do the healing, and try to keep another concussion from happening.

Complications of Concussions

Although concussions usually are not dangerous, they can have complications. These include:

  • Postconcussive syndrome may persist for up to a year. Symptoms include: decreased mental processing speed, decreased short-term memory and attention span, sleep problems, ongoing headaches and tiredness.

  • Decreased cognitive functioning can be a result of multiple concussions. Experts believe that the effects of multiple concussions are cumulative, like what certain boxers or football players have experienced.

  • Second impact syndrome is severe brain swelling caused when a second injury happens to a player before he has recovered from his first injury.

Other Injuries

It is always a good idea to have your child examined when any accident involves the head. Skull fractures may seem to have few symptoms, or can be confused with concussion symptoms. If straw-colored fluid drains out of a person's nose or ears, they need to be seen immediately in the E.R. This could represent a skull fracture with a spinal fluid leak. Broken bones around the eye socket can cause double or blurry vision and need quick attention. Certain types of skull fractures can also increase the risk of internal bleeds. Any skull fracture that causes a deformity requires hospital observation and possible surgery.

Returning to Sports

Most of the time, kids can return to sports once their symptoms have resolved and after the proper wait time dictated by the severity of the concussion. This might be the same day, one week or one month after the injury - it all depends on the extent of the injury. If a sports player sustains multiple concussions during the same season, he/she will not be allowed to return to contact sports for the remainder of that year. The criteria depends on the combination and severity of concussions sustained. Most coaches today will not let players return to the team until they have been cleared by their doctor.


While we can't prevent all head injuries, steps can be taken to reduce the chances of having one. Kids who participate in sports should be taught to follow the rules, and to respect the proper methods of play (e.g., no spearing), wear the appropriate safety equipment that fits properly and train to play safely. Coaches and parents need to be aware of the dangers of serious and/or repeated concussions.

Head injuries can happen anywhere and at any time, so making sure your child understands the risks in his surroundings will help lessen the possibility of sustaining an injury. I've seen kids get knocked out when they're just horsing around with their friends. Personally, it's likely that I may have experienced a moderate to serious concussion in college without ever realizing it. I was running down the hall in my dorm when I slipped on a wet spot and fell. I remember running, and then suddenly I was looking up at the ceiling and wondering, "Who are all these people looking down at me?" It turned out they were my fellow dorm mates, who helped me up and walked me back to my room. Now that I'm a doctor, I look back and realize I should have been taken to the E.R. Luckily, I'm still here at my computer writing this article today!

It's OK to Let Them Play!

Spring is nearly here, and soon your kids will be outdoors and team sports will be in full swing. Kids don't need to wear helmets while playing at the playground, but make sure to reinforce safe habits that will minimize the chances of bad accidents. Children are resilient and tend to recover better than most adults. If your child does get hurt in the head, have him seen by a medical expert. When it comes to head injuries, the old adage "better safe than sorry" definitely rules.

William "Dr. Bill" Incatasciato is a pediatrician at Capital Area Pediatrics in the Countryside Shopping Center in Sterling. For more information about Dr. Bill and/or his practice, visit