Concussion

All head knocks are serious

Crowther Centre June 24th, 2021 · 7 minute read

What is a concussion?

A concussion is a common injury caused by an impact to a person’s head that results in a temporary disturbance or loss of brain function. Often arising during a sporting match, concussions most frequently transpire from a collision with another player or impact with the ground. It can also happen from an impact that is not directly to the head.

Concussions are not always immediate. The symptoms do not always cause a loss of consciousness and may not present themselves until hours (or even days) after the initial impact. Where a loss of consciousness has occurred, an ambulance must be called immediately.

The impact of a concussion

Short term effects

After experiencing a concussion, your child could experience some or all the following symptoms:

Loss of consciousness upon impact
Drowsiness or fatigue
Headaches or migraines
Pressure in the head
Forgetfulness or memory problems
Vomiting
General unwell feeling or feeling a bit ‘off’
Dizziness
Confusion, slurred speech or unusual behaviour
Sensitivity to light
Blurred or double vision

Short term effects in small children may be harder to recognise, as children are not always able to properly describe how they feel. For small children, you should watch for non-verbal indicators of a concussion, such as:

Appearing dazed
Listlessness
Tires easily
Irritability, crankiness
Excessive crying
Loss of balance
Unsteady walking
Changes in eating or sleeping patterns

Longer term effects

Not all symptoms of a concussion are experienced immediately. Some possible symptoms that your child could develop hours or even days after the injury include:

Trouble concentrating
Memory problems
Irritability and other personality changes
Sensitivity to light and noise
Sleep disturbances
Depression and other psychological problems
Disorders of smell and taste

Most long-term effects of concussion are rare. The impacts of most concussions are temporary, with the majority of people completely recovering when managed correctly. The recovery time is typically up to 4 weeks for children and adolescents.

In about 20% of cases, however, symptoms and effects can be experienced up to 6 weeks after the injury. The more concussions experienced by an individual, the more likely the possibility of suffering long term consequences.

This is why it is so important to manage a head injury properly and give the brain enough time to heal before returning to usual activities.

Role of the parent

To reduce the risk of short or long-term effects associated with a concussion, it is imperative that you manage your child’s injury appropriately and report it to the relevant people.

Disclosure

All head injuries should be treated as a serious injury, regardless of the circumstance. Head injuries, particularly in children and adolescents, must be managed immediately and correctly in order to guard against further brain trauma, complications or ongoing symptoms.

Medical evaluation should be sought as soon as possible after the event, to ensure proper management and care. Even in instances where emergency care is not needed and your child is not obviously symptomatic, it is still important that you visit your doctor within 1-2 days of the injury for proper assessment. As symptoms do not always present immediately, or are not noticeable, your child must have a proper medical evaluation to ensure their health and wellbeing.

Where an injury is sustained out of school hours, it is important that parents inform the school as soon as practically possible, but no later than the first school day after the event. This is to ensure that relevant school staff can look for any signs or symptoms that may develop in time, and so that adequate precautions can be taken to avoid repeat injury.

Management recovery

Immediately after medical treatment is sought and a concussion is diagnosed, the first step to recovery is usually rest. Rest should be both physical and mental, for at least 1 day, or until symptoms subside.

Once symptoms have subsided, it is good for your child to start moving again, albeit slowly and in line with your doctor’s guidance. Light physical activity is appropriate at first, with monitoring for any symptoms reappearing. After this, your child can usually resume a graduated return to regular play/sports (with the guidance of their coach and Student Health Officer), but avoiding body contact for a period of time deemed appropriate.

School policies and requirements

When an injury occurs at school or during a school event/activity, it is recommended that any student with a suspected concussion:

Withdrawal from playing and/or training immediately
Careful monitoring for possible symptoms such as confusion or headache after a knock to the head;
Referral for medical evaluation
Proof of medical clearance before a return to school, sport or physical activity.

A Student Health Officer will provide follow up support and liaise with parents on behalf of the school after a student head injury that has occurred during school time or at a school sporting event.

Return to School

Following a concussion, a student should not return to school until a doctor’s medical clearance is provided.

Return to Sport

Many schools have concussion return to sport guidelines which are modelled on the AFL concussion policy and the SMJFL guidelines. Sport played at school must adhere to the concussion return to sport requirements within this policy.

A student who has a suspected or confirmed concussion should not be able to return to school/study without a medical clearance from a GP, sports doctor or neurologist. For any student participating in Rugby, exclusion from training or play is 19 days, which is in line with the Rugby Australia concussion procedure.

For all suspected or confirmed concussion cases in all sports (except Rugby), training without a full medical clearance from a medical practitioner (GP, sports doctor or neurologist) should not be permitted.

The student will not be permitted to participate in any training or a match for minimum of 12 days after the initial injury, and until they are s symptom free and has completed at least one full training session.

If symptoms persist or re-occur after the 12 days, then a follow up medical clearance will be required.

Schools should always take a cautious and conservative approach to return to play which may involve a graduated return and increase in activity over a few days or weeks. This should be undertaken in full consultation with the player and parents as well as in conjunction with any medical recommendations.

What the experts and others are saying

AFL General Counsel, Andrew Dillon:

The updated guidelines reflect the AFL’s ongoing commitment to the health and safety of all players at each level of the game. Concussion is a serious issue and we will continue to treat it as such. The updated concussion guidelines for community football represent a significant step in the AFL’s existing record of ongoing improvements to its concussion management strategy that reflect medical research and other learnings over time.

AFL Chief Medical Officer, Peter Harcourt:

The focus must be on ensuring that players pass through each of the steps safely (i.e. rest, recovery and a graded return), without a recurrence of symptoms, rather than simply progressing through a schedule. A player who shows symptoms or any signs of concussion during a match or training must be removed from the field of play and assessed, and must not return to that match or training session. The next step is that the player must be assessed by a medical professional, then move through each of the steps in the guidelines,
and finally receive medical clearance prior to returning to full-contact training. Children and adolescents (aged 5-17) require a more conservative approach from adults because their brains are developing. The priority is not just player welfare and return to sport, but a critical element is return to school and learning.

Source: HeadCheck Concussion

APS (Associated Public Schools of Victoria) Policy

The management of sport-related concussion in children (aged 5 to 12 years) and adolescents (aged 13 to 18 years) requires unique considerations suitable for the developing child.

Children have physical and developmental differences including less developed neck muscles, increased head to neck ratio and brain cells and pathways that are still developing. Children and adolescents may have greater susceptibility to concussion, they may also take longer to recover and they may be at risk of severe consequences such as second impact syndrome. Managing concussion in children and adolescents therefore requires different standards and a more conservative approach.

Resources

Parents

RCH Kids Health Info – return to sport factsheet
The Raising Childrens Network
Holland Bloorview Concussion Handbook
Guidelines for diagnosing and managing paediatric concussion
Centers for Disease Control and Prevention

Healthcare Professionals

Guidelines for diagnosing and managing paediatric concussion
Centers for Disease Control and Prevention
Consensus statement on concussion in sport
What is the difference between concussion management in children as compared with adults?

Schools & Community Sporting Organisations