Health Tips & Articles

Concussions: Why all the concern?

by Suzanne F. Malloy, APRN-BC

and Darlene Stone Adair, APRN-BC

Why is there so much concern about concussions? Aren’t they just a part of playing sports? Can they really cause any harm? Yes, concussions cause damage. For that reason, we would like to review what a concussion is and how you can learn more about concussions. We will then look at what the State of Massachusetts says about concussions in high school sports and examine recent national changes to the rules for soccer and football participation. 

The medical term for concussion is traumatic brain injury (TBI). It is the result of the brain being jostled inside the skull, which can be caused by head injuries during sports or accidents. This sudden movement can cause the brain to bounce around, stretching and damaging the brain cells and creating chemical changes in the brain. This can cause several neurological symptoms which can affect how a person feels and acts.

Immediately after sustaining a concussion, a child may show any of a number of symptoms. These may include:

  • a dazed or stunned appearance,
  • confusion about game assignment or position,
  • forgetfulness,
  • clumsy movements,
  • slow responses in conversation,
  • loss of consciousness, or
  • mood, behavior, or personality changes.  

Signs may not appear immediately after the injury and may not manifest until the next day. They may last for days or weeks.

Danger signs of severe brain injury include:

  • one pupil that is larger than the other,
  • drowsiness or difficulty with arousal,
  • headache that worsens and does not go away,
  • weakness or numbness,
  • decreased coordination,
  • repeated vomiting or nausea,
  • slurred speech,
  • convulsions or seizures,
  • increasing confusion, and
  • restlessness or agitation. 

A child who shows any such signs must be provided with emergency medical attention.

After a concussion, a period of physical and mental rest followed by a gradual return to work, school, and physical activity is recommended. We suggest reduced attendance or absences from school as well as the avoidance of TV and electronics use until the symptoms are improving. This may not be easy to achieve given the amount of time most young people spend on technology!

The damage caused by concussions can be cumulative, meaning that additional concussions can significantly increase the damage one receives and can prolong recovery time. It is important to remember that concussions do not show up on imaging studies like x-rays, CT scans or MRIs, so such studies are usually not necessary.

The Massachusetts Interscholastic Athletic Association (MIAA) has a law regarding head injury that governs all public middle and high schools and all students who play sports. This law states that all students with symptomatic concussions may not return to school athletics without medical clearance. Such clearance typically requires several visits with a healthcare provider and then a gradual step by step return to play via a plan coordinated by coaches and medical providers. The state law also mandates that coaches and referees receive concussion training. 

If, in time, a student’s concussion symptoms resolve, he or she may return to practice and, after additional time, may re-join competition. If, however, symptoms return at any time, the student must return to the last level of the program they successfully completed and may no longer play that day, even if the symptoms are mild. 

The Center for Disease Control (CDC) runs a program called “Heads Up”, which can be found on-line at It includes free online training for parents and couches.

How concussions can be prevented?

The proper use of personal protective equipment is the most commonly known strategy for prevention of concussion. Other ways to reduce the chances of a concussion include:

  • Ensuring use of a helmet when
  • playing a contact sport, such as football, ice hockey or boxing;
  • riding a bike, motorcycle, snowmobile, scooter, or ATV;
  • using in-line skates or riding a skateboard;
  • batting and running bases in baseball or softball;
  • riding a horse; or
  • skiing or snowboarding

Buckling your child in the car using an age-appropriate child safety seat, booster seat or seat belt

Making sure the surface of your child’s playground is made of shock-absorbing material, such as mulch or sand

Recently, due to increasing numbers of concussions, many soccer, football and ice hockey programs have changed their guidelines. For example, according to U.S. Soccer, the governing body for the sport in the United States, children under the age of 10 will no longer be allowed to head the ball in practice and games.  According to Pop Warner, the largest youth football association in the US,  no full speed head-on blocking or tackling drills in which the players line up more than 3 yards apart are permitted, and the amount of contact at each practice should be reduced to a maximum of a third of the practice time. These interventions are all designed to decrease the incidence of concussions in our younger children. Even professional sports teams are taking concussions more seriously. Now, the NFL places a designated person in the officials’ box during a game whose sole job is to call for an evaluation of any player who shows signs of a concussion after a play.

If you have any questions about whether your child has sustained a concussion, you can always call your primary care provider to be seen for an evaluation. We will talk to both you and your child, perform a complete physical exam, and have your child answer some questions. An appropriate plan can then be designed for your child to help in his recovery.





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