Concussions Are Not Child's Play
By Lily Tung Crystal
Patrick Liang, 11, loves to play baseball. He’s played pitcher and second baseman for a variety of teams, from local travel ball to Little League. But in April 2011, he collided with another player while trying to catch a pop fly. Although Patrick can’t remember the actual incident, he says, “It felt like my head was cut open.”
Patrick’s mother Tina, on the other hand, remembers that day like it was yesterday. “Patrick was on the ground, and he started screaming in pain,” she states. Tina rushed her son to the pediatric emergency room at CPMC, where doctors told her and Patrick’s father Jerry that Patrick had suffered a concussion.
Not Just a Bump on the Head
A concussion often follows a head injury and can occur with or without the loss of consciousness. Immediate symptoms include headaches, dizziness, nausea, and vomiting. Children who suffer from concussions might look vacant, slur their speech, or become disoriented. They may also have delayed verbal and motor responses and difficulty following instructions.
Other symptoms that can start hours or weeks later include anxiety, irritability, memory problems, low-grade headaches, sleep disturbance, poor attention or concentration, difficulty at school, intolerance to light and noise, and low frustration tolerance.
“On rare occasions, the symptoms might last up to four weeks, so it’s important to observe athletes over a period of time to see how they’re doing,” explains Farhad Sahebkar, M.D., director of the Pediatric Neurology Division and the Headache and Concussion Clinics at CPMC. “That’s especially true with children. Because their brains aren’t fully developed, they may be more vulnerable to injury than adults.”
Patrick was able to leave the hospital three days after his accident, but Sahebkar recommended that he go on cognitive and physical rest. Only when his headaches subsided a month later was he cleared to return to the baseball field.
A Cumulative Effect
Patrick felt good for nearly a year, until two more head injuries set him back this past spring. In May, Patrick was warming up for a Little League game when a baseball accidentally hit him near the eye, causing another concussion. The resulting headaches kept him home for the last three weeks of school.
Then two months later, another fluke accident occurred. Patrick was at a pool party when a wet Nerf ball hit him in the head. It appeared to be a minor incident, but “concussions have a cumulative effect,” explains Sahebkar. “In Patrick’s case, the third hit caused a disproportionate response.”
Patrick’s headaches worsened and kept him out of summer camp. He has since returned to school, but Sahebkar has recommended that Patrick stay away from baseball until his headaches have completely stopped.
Sahebkar is taking an especially cautious approach because people with multiple concussions have an increased risk for more serious conditions, like chronic traumatic encephalopathy, or CTE, a progressive, degenerative disease.
With another condition called Second Impact Syndrome, patients suffer a concussion and then go back to playing before they fully recover. “If a second concussion occurs, it can cause devastating injury,” says Sahebkar.
How do doctors determine when a child is well enough to return to the field? “It can be challenging,” muses Sahebkar. “A lot of athletes say, ‘I’m okay. I want to play.’ They may have major memory loss, but they’re so eager to return that they’re not going to tell you about it.”
Get a Baseline
Doctors urge all parents to get their child athletes a computerized ImPACT baseline test. If a head injury occurs, doctors can better evaluate the concussion and determine when the player can return to the field.
It’s also important that injured athletes let their care providers guide them through the step-by-step process of recovery. At CPMC’s Concussion Clinic, the team works together to provide a multidisciplinary approach to patient care and support for families like the Liangs.
“We feel lucky that we have CPMC,” says Jerry. “Without them, we may have pushed Patrick into activities before he was ready, like going back to school or baseball.”
For now, Patrick is taking things slow. The headaches come and go, but he continues to do well in school and still gets to play catch with his dad and younger brother. He’s hopes that he can return to the playing field in the spring. “I still want to play baseball,” Patrick admits. “It’s my favorite thing to do!”
Immediate Concussion Symptoms Can Include:
- Vacant look
- Slurred speech
- Delayed verbal and motor responses
- Difficulty following instructions
For more information on the Concussion Clinic, visit cpmc.org/pediatrics.