Youth concussions becoming more common, doctors say

Concussions are becoming much more common among American kids, especially if they play a team sport.

That's the conclusion of a new study released this week, which found that the rate at which children are suffering the brain injury more than doubled in the five years before 2005.

Most of those concussions are the result of athletic activities, especially ice hockey and football.

The report's authors concluded that about half of the concussions suffered by kids between the ages of eight and 13 years were caused during an ice hockey or football game.

For children between the ages of 14 and 19, about 60 percent of the concussions could be attributed to participation in those two sports.

The researchers found that, during that period, about four out of every thousand children between the ages of eight and 13 years visited an emergency room for treatment of a concussion.

Six out of every thousand children between the ages of 14 and 19 sought such care between 2001-2005.

"Our data show that older children have an overall greater estimated number of [emergency room] visits for sport-related concussion compared to younger children," Dr. Lisa Bakhos, a co-author of the study who was, until recently, a pediatric emergency physician at Hasbro Children's Hospital in Providence, Rhode Island and now practices pediatric medicine in New Jersey, said in a statement. "Younger children, however, represent a considerable portion of sport-related concussions, approximately 40 percent.”

The researchers examined admissions data for emergency rooms across the nation. They found that children between the ages of eight and 19 years made 502,000 visits for treatment of a concussion during the five years reviewed.

About half of those ER visits were the result of participation in sports. About 95,000 of the patients came to the ER after experiencing a brain injury in ice hockey, football, baseball, basketball or soccer games.

Football- and ice hockey-related concussions appeared to dominate the number of concussion admissions caused by athletic activity.

For kids between the ages of 14 and 19, the number of ER visits for team sports-related concussions increased by more than 200 percent between 1997-2007.

The number of children who visited an ER after suffering a concussion in a team contact sports game doubled during the same period.

Meanwhile, participation by children in team sports dropped by about 13 percent between 1996-2005.

The study's authors did not reach a conclusion about why the number of concussions increased.

Bakhos thinks that it's possible that the increase may reflect both increased awareness of the injury and other trends affecting children in the United States.

"Everybody agrees that sports, especially for young people, are getting more competitive at a younger and younger age," she said. "A nine year old used to go out there and have fun, now it’s 'win, win' and be more aggressive. Also, children as a whole are getting bigger, with the obesity epidemic in this country, and they’re getting stronger and bigger. When you put big kids with a lack of maturity in a game they’re going to get injured."

Athletic competition is not the only culprit for the concussions suffered by American kids.

The report indicates that traditional and common causes of concussion - playground falls, bicycle accidents, and similar childhood mishaps - continue to account for a significant proportion of the injuries.

"Most modern playgrounds are very safe," Bakhos said. "As a parent, you have to look at the playground and ask if it’s concrete and is the equipment safe. When kids are on the playground, we tend to say kids will be kids. But a lot of injuries happen when kids use the equipment in ways it wasn’t intended for. They climb on top of the monkey bars. We can’t keep kids 100 percent safe all the time, but we can guide them."

The American Academy of Pediatricians has long emphasized the importance of helmets as a way of protecting children from suffering head injuries in bicycle accidents.

Physicians also urge parents to require their kids to wear a helmet when they skate, ride a scooter, or participate in winter sports such as skiing and snowboarding.

It is accompanied by a report from the AAP implicating football as the team sport most likely to cause childhood concussions.

The report also indicates that, among participants in the same sport, girls are more likely to suffer a concussion than are boys.

Medical researchers aren't sure what accounts for that disparity.

"Different people have different theories," Bakhos said. "Number one, girls sports as a whole have really taken off over the last fifteen years and they’re getting more competitive and have more contact. It may be that, although the popularity and competitiveness has increased, our attitude that 'they’re just girls, how hurt can they get' really hasn’t changed."

Concussion is caused the acceleration and deceleration of the skull. The brain experiences movement,  which results in a physical injury as the tissue impacts the interior of the skull.

Common symptoms of concussion that are likely to appear shortly after the injury include headache, dizziness, confusion, fatigue, nausea, ringing in the ears, and slurred speech. Some victims also experience amnesia and loss of consciousness.

Delayed symptoms can include sleep problems, inability to concentrate, light and noise sensitivity, memory loss, irritability, and depression.

Doctors are not able to say how long the injury's effects will linger.

"There’s no rhyme or reason to it, and there’s no rhyme or reason to the severity, either," Bakhos said. "It can be a day, it can be months. It all just depends on the child or the adult."

Bakhos said that parents, teachers, and coaches should look for situations where a child appears to be confused or is showing a pattern of behavior markedly different from the norm.

"If a child falls and hits their head, and they cry for a while and get back up and they’re normal otherwise, the chances they’ve suffered a concussion are extremely low," she said. "If they’re complaining of headaches for an hour or, if they’re asking the same question over and over again, they don’t know what time of day it is, if they’re not acting like themselves, you should take them in."

The AAP recommends that children who have suffered a concussion be forbidden from returning to the playing field until a physician has cleared them to play.

Bakhos emphasized the importance of that advice.

"Sport is so important for everyone’s well being, but we have to put things in perspective a little bit," she said. "This is fun, it’s for exercise, but it’s not win-win all the time. I think that’s not getting across in a lot of places. People just need to know that if an injury happens, they should seek medical attention and follow the advice we give them."

The organization also suggests that any child who has suffered more than one concussion, or who has suffered symptoms of a brain injury for more than three months, refrain from continued participation in contact sports.

Kids who have suffered a concussion should also refrain from cognitive exertion while recovering.

“Children need not only physical, but cognitive rest, and a slow-graded return to play and school after such injuries," Dr. James Linakis, another Hasbro Children's Hospital physician and the study's lead author, said in a statement.

Bakhos acknowledged the difficulty parents and physicians may have in convincing teachers to give an afflicted child a break from homework.

"That’s something, I think, that will have to be mandated by the AAP or the American Academy of Neurology," she said. "It’s going to be hard for individual doctors to write a note that the kid needs to be given a break from his or her homework without authority from a higher power."

She urged parents to keep a child recovering from a concussion away from video games and exposure to digital devices.

"They shouldn’t be playing their video games or playing on their phones or taxing their brains in any additional way," she said.

The study appears in the Aug. 30 edition of Pediatrics.