Until recent years, clinical studies of concussions in children focused upon the immediate event. An injured child would be observed until his or her severe symptoms had cleared. At that point, normal activity could be resumed.
Surprisingly little is known about possible long-term consequences of concussions that occur during pre-adolescent years. Most studies have concluded that children recover quickly from injury with few lasting effects. But one report last year used follow-up interviews by telephone to determine that almost 12 percent of children evaluated for concussion in an emergency room still had symptoms three months later. Other recent studies uncovered persistent changes in memory and behavior in children who had suffered a concussion.
A January 2016 report in the International Journal of Psychophysiology provides fresh insights into lasting changes in brain function that occur in children who sustained concussions.
Fifteen children, average age of 9 and each with a carefully documented history of concussions that occurred during recreational activities, were paired with 15 similarly active children without injuries. The concussions took place on average two years prior to testing. Eight of the injured children had briefly lost consciousness at the time they were hurt.
All the children performed a battery of tests that measured attention, decision-making, working memory and impulse control. Tests that measured impulse control and visual attention were supplemented by simultaneous electroencephalographic (EEG) monitoring of brain activity.
Children who had sustained a concussion exhibited subtle changes in learning skills and behavior, and those changes were more prominent in children injured earlier in life. EEGs in concussed children differed from those in the uninjured group.
The study is limited by the small number of children who were evaluated. Nonetheless, it raises important questions about lingering effects of childhood concussion that need further study on larger numbers of children.
The brain of a child undergoes rapid, progressive development that will determine behavior and cognitive skills throughout life. The 2016 study shows that injury during this vulnerable period can have lasting consequences.
The brain of a child is more susceptible to injury because the skull is thinner and may not be fully hardened. Weaker, less-developed muscles may not absorb the shock waves of a collision in a sport or random play. A child may suffer a concussion even if the head is not directly struck. Abrupt deceleration and shock waves from trauma to other body parts can affect the brain.
Acute symptoms of concussion in children may include temporary loss of consciousness, headache, dizziness, confusion, dazed appearance, nausea and vomiting, ringing in the ears and fatigue. Longer-term symptoms may include decreased concentration, irritability, sleep disturbances, unusual sensitivity to bright light and noise, problems completing schoolwork and depression. Treatment involves both physical and mental rest until the symptoms have subsided.
Certain sports, especially football, soccer, ice hockey and lacrosse, pose an increased risk of head injury. In football, injuries can be reduced by assuring that equipment is properly fitted and up-to-date and that all players have instruction in proper blocking and tackling. Some experts in neurology argue that tackling should be banned until age 14.
Whenever an injury leads to any symptoms suggestive of a concussion, the affected player must be removed from play immediately and be evaluated by someone versed in the recognition and evaluation of head injury. Any suspected concussion mandates a full medical evaluation and follow-up, which involves more-detailed testing and may need to be extended for months or even years.