1. Concussions in Youth Sports
Erin Caffrey, PA-C, ATC
Surf Pediatrics and Medicine

2. What is a concussion? A CONCUSSION IS A BRAIN INJURY!
“Traumatic induced alteration of mental status that may or may not include the loss of consciousness”
-American Medial Society
Avoid referring to concussions as “getting your bell rung”, “ringer”, or a “ding”
A CONCUSSION IS A BRAIN INJURY!

3. Why we should care about concussions
Account for 1.4 million visits to the emergency room yearly
Of those, 47% are kids years old!
Proper diagnosis is required to prevent more serious injury and/or long term effects
Younger athletes are more susceptible to long term effects from concussions
It is thought that the overall number of mTBI is close to 3.8 million to account for the numbers that go undiagnosed or are not seen in the ED
More severe injury as a result of subsequent head impacts prior to the complete resolution of the initial injury; SIS
Long term sequelae: cognitive deficits, learning disabilities, depression, possibly CTE
More susceptible because brain is still developing

4. Ways to obtain a concussion
Hit, bump, or blow to the head OR body that causes the brain and head to move back and forth quickly

5. Signs & Symptoms Physical Cognitive Emotional Sleep Headache
Feeling “in a fog”
Irritable
Drowsiness
Nausea/Vomiting
Feeling slowed down
Sadness
Sleeping more than usual
Balance problems
Difficulty concentrating
More emotional
Sleeping less than usual
Dizziness
Difficulty remembering
Nervousness
Difficulty falling asleep
Visual problems
Confusion
Fatigue
Answers questions slowly
Light sensitivity
Repeats questions
Sound sensitivity
Numbness/tingling
Dazed
Stunned
An “invisible injury.” Onset of progressive symptoms beginning within minutes to hours up to hours post-injury. Bolded symptoms are more common

6. What to do when a concussion is suspected
Tell a coach!
No one should be allowed to return to activity on the day of injury if concussion is suspected
Evaluation by Physician, Physician Assistant, Nurse Practitioner, or Certified Athletic Trainer before returning to activity

7. Red flag symptoms
Take your child to the emergency room IMMEDIATELY if any of the following symptoms are present after head injury!
Loss of consciousness
Worsening headache in a short period of time
Drastic personality/speech/balance changes in a short period of time
Different pupil sizes (bigger, unreactive to light, or unequal sizes)
Blood or fluid coming out of ears or nose
Bruising underneath eyes or behind ears
Repeated and worsening vomiting
Seizures or convulsions

8. Treatment Typical recovery: MINIMUM of 7-10 days
An athlete cannot return to sports until he or she does not have any symptoms!
Physical Rest
Cognitive Rest
Avoiding all sports, PE class, or recess
No screen time: cell phone, tablet, computer, or TV
Scheduled rest breaks during school work
Make sure to inform teachers of injury in case classroom accommodations need to be made

9. Returning to sports Must be completely symptom free for 24 hours
Return to play guided by Physician, Physician Assistant, Nurse Practitioner, or Certified Athletic Trainer

10. Returning to play progression
Stage
Physical Activity 1
Light cardio activity 2
Medium paced cardio activity, body weight resistance exercises 3
Fast cardio activity, interval training, sport specific agilities 4
Non-contact practice drills 5
Full practice participation, controlled contact 6
Full participation in competition
Light cardio: walking, jogging
Non-contact practice: warm-up, sport specific drills without contact
If symptoms return, stop activity for 24 hours and the pick back up with the previous stage completed prior to symptom onset
MUST BE CLEARED BY PROVIDER TO PROGRESS TO STAGE 5
Overall, minimally recovery from symptoms takes 7-10 days and the RTP takes another 6-7 days on top of that so expect a child to be out of full competition for weeks best case scenario
*Each stage is separated by 24 hours. Athlete must be symptom free to progress to next stage

11. Questions?
Check out the CDC “Heads Up” program for more references:
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