Regardless of how a brain injury happens, it’s important to know what symptoms to look for and how to proceed. Downplaying or ignoring symptoms can be counterproductive and prolong recovery time. And in certain cases, symptoms may be severe enough to warrant a trip to the emergency room.
How Doctors Diagnose a Concussion
According to the CDC, there were 2.5 million trips to the emergency room in 2013 that resulted in a TBI diagnosis. Although not every hit to the head requires a visit to the ER, there are certain “red flag” symptoms to watch for, according to Christopher Giza, MD, professor of pediatric neurology and neurosurgery at the David Geffen School of Medicine and director of UCLA’s Steve Tisch BrainSPORT Program in Los Angeles. These include:
Persistent confusionWorsening nauseaPersistent headache or vomitingLoss of visionWeakness of any part of the bodyInability to speakSeizuresSlurred speechAmnesia
“If you or your child has any of these, it’s time to go to the ER to get evaluated and possibly have a CT scan,” Dr. Giza says. “These could signal a more severe injury, such as a bruise on the brain, skull fracture, or brain bleed. “ For a concussion, by contrast, the signs include headache, nausea, difficulty concentrating or thinking clearly, vomiting, sleep issues, and sensitivity to sound or light. The CDC, which has a list of common concussion signs and symptoms on its site, recommends that anyone with a suspected concussion be evaluated by a healthcare professional.
Considerations for Kids Who Might Have a Concussion
In the case of very young children who can’t describe their symptoms, closely observing how they behave after falling or otherwise hitting their head is critical. In addition to the concussion symptoms listed above, be on the lookout for behavioral changes, difficulties with balance or coordination, and any loss of consciousness, Giza says. Additional serious warning signs that signal it’s time to go to the ER include if the child is inconsolable, doesn’t want to nurse or eat, or can’t be awakened. Soon after a head impact, youth athletes may show behavioral changes, such as being very emotional or crying on the sideline after being taken out of a game, Giza says, noting that these can be additional indicators of a concussion. All 50 states and the District of Columbia now have “return to play” laws designed to raise awareness and improve treatment of concussions for youth athletes, and in most states these laws require that kids be removed from play if a concussion is suspected. Although the specifics vary by state, most also include mandatory concussion education for coaches as well as for players and their parents, and also require that athletes be cleared by a licensed health professional before being allowed to return to play. A study published in December 2017 in the American Journal of Public Health examining the effectiveness of these laws found that even though the number of reported initial concussions went up — likely due to increased awareness both about symptoms and about reporting — the number of repeat concussions went down. For youth athletes, this is good news: In addition to the cumulative risks from repeat concussions, kids who return to play before they’ve fully recovered prolong their symptoms and their recovery time. As noted in a study published in August 2016 in the journal Pediatrics, kids who didn’t come out of the game after being hit in the head took twice as long to recover as those who were immediately removed: 44 days, on average, compared with 22.
Recovery From a Concussion
The best approach after being diagnosed with a concussion is to rest for at least a couple of days. But too much rest is unnecessary, Giza says, and being socially isolated isn’t helpful either. The same goes for cognitive tasks: Concentrating can be difficult at first, but after an initial period of rest it can actually help you recover, he notes. He also recommends light physical activity, such as riding a stationary bike or taking a walk around the neighborhood. “It’s good for the brain, because it strengthens the connection between brain cells,” he explains. “And it also makes natural endorphins, which are the body’s natural painkillers.” As part of a list of recovery tips, the CDC notes that having previous symptoms return can be a sign of pushing yourself too hard. Adults who are recovering from concussions may want to ease back into work activities. And when it comes to activities such as driving, the CDC recommends getting cleared by a healthcare professional, given that reaction times can be slower. Multitasking may also be difficult. And so can flying in an airplane: The CDC notes that some people find that this worsens their symptoms during early recovery. For kids going back to school, the CDC has developed a fact sheet for parents and recommends a short-term plan that includes more frequent breaks, less homework, and additional time for tests. Youth athletes should focus on returning to school before returning to sports, and even then, they should build up the intensity in several stages, as outlined by the CDC as part of Heads Up, series of educational initiatives about kids and brain injuries. Kids take an average of four weeks to recover from a concussion, compared with two to three weeks for adults, according to Giza, but recovery time can vary for each person. “If you’re getting better and you’ve been checked out by a medical provider to make sure nothing else is going on, you can gradually ease back into your normal activity,” he says. “But if your symptoms aren’t improving or you have new symptoms, it’s time to see a medical provider with more specialized knowledge in concussions.”
