Traumatic Brain Injury
Do you know the signs of Mild Traumatic Brain Injury?
While I was there another girl on the squad arrived with an injury as well. I used to do well in school, but now I can’t keep up with the work and all the bright lights give me a headache. It’s hard to focus. I feel more clumsy than I used to, in fact, I fell in my driveway and hit my head again, which I’m sure didn’t help!”
This was the story of one teen who came to our office seeking help for attention, focus, and anxiety following a head injury. Unfortunately, she is not alone in her experience. Read on to learn what are the riskiest sports, signs and symptoms of TBI, and how to protect your child.
Nearly a half million sports-related head injuries annually according to estimates by the American Association of Neurological Surgeons (AANS). You may be surprised at the sports with the highest incidences of head injuries for children 14 years old and younger. Cycling is #1, followed closely by football, baseball, basketball, skateboards/ scooters, water sports (diving, swimming, water skiing) and soccer. Powered recreational vehicles, winter sports, ice hockey, and trampolines are responsible for injuries as well. I’d like to add cheerleading to the list.
What is TBI?
A traumatic brain injury (TBI) can result when the head suddenly and violently hits an object, when an object pierces the skull and enters brain tissue, or when the brain is subjected to concussive or shearing forces such as an explosion or whiplash. It is important to note that brain injury can occur without unconsciousness or injury to the skull. Symptoms of a TBI can be mild, moderate or severe, depending on the extent of damage to the brain. Mild cases may result in a brief change in one’s mental state or consciousness, while severe cases may result in extended periods of unconsciousness, coma or even death. Mild TBI is the terminology replacing “concussion.” New research into the cumulative effect of head injuries has been spawned by the spotlight on football players who sustain repetitive mild TBI.
Signs and symptoms of TBI
How do you recognize if your child may have had a mild TBI? The Brain Injury Association of America (BIA) notes that you may notice one or more of the following changes:
Physical changes or symptoms
These may be common immediately after a head injury, such as speech, vision, hearing changes/problems; headaches; nausea; difficulty with motor coordination; trouble with balance; sensitivity to loud noises, bright lights; and fatigue/change of sleep/wake state may be common. Immediately report any of these symptoms to your paediatrician for further evaluation or contact with your physician or paediatrician is delayed in any way take your child to the Emergency Room or Urgent Care. If your child cannot be awakened with a nudge or loud call of their name, call 911 immediately.
Changes in the way your child thinks or communicates can be associated with TBI. This may include short-term memory problems (forgetting their address, phone #, or familiar names), impaired concentration (difficulty keeping their attention on one thing at a time); slowness of thinking (trouble putting their words into thoughts); and a limited attention span. As well, changes in how their five senses are working (hearing, touching, seeing, smelling, tasting) can alert you to a problem. Communication problems (difficulty getting their ideas in words) may start to show and difficulty planning things that were always easy for them, e.g. their free time, remembering their usual routines. Difficulty in your child’s writing (in school or during homework) or judgment (e.g. they forget to look both ways when they cross a street when it has never been a problem before) are other problem signs to watch for.
Mood swings or trouble controlling emotions can occur after a TBI as well. These include denial of their expression of strong emotions; crying at the smallest of troubles; laughing at strange things; more restlessness with increased anxiety (nervousness) and over-focus on worries and fears may become prominent. Overly sad or depressed states about their troubles, lack of motivation to do normal “kid things” may also be present. Again, please contact your physician if you identify any or many of these behaviours after a head/brain injury. It is imperative to their long-term functioning. Even if your child has not had a head injury that you’re aware of, if they show any of the previous behavioural changes, please contact your physician as soon as possible.
Children are especially at risk
For children, cognitive (thinking and communication) changes after a head injury may not be immediately obvious, but may only become apparent years later as the child gets older and faces increased cognitive and social demands. The BIA reports that a brain injury actually has a more devastating impact on a child, than an injury of the same severity on a mature adult. The old thinking was that a child, due to the young brain’s greater neuroplasticity, would “grow out of it.” The new thinking is that the child “grows into” or adapts to the brain injury they sustained. Depending on the where and what of the brain injury, it may become harder and harder for the child to keep up with their peers in terms of the demands of development. Your child may have done well in the lower grades, but as the teaching material becomes more abstract it is harder for the child’s injured brain to keep up with learning needs. You may also see more of the emotional problems (stated above) in your child, due to their inability to adapt to the demands of growing up and the resulting sense of being different than others or damaged. These emotional changes will also present the injured brain with continued difficulty in doing its job.
What can a parent do?
Helmets are a must. Buy your child the right size helmet and insist on its use for high-risk activities. Yep, with increased awareness and concern, helmets are even being considered for soccer, although there is still much debate around their use. In general, helmets are becoming more comfortable, accepted and hipper, with Olympic and professional athletes lending their endorsement and upping the cool factor. If the prices of helmets are too costly, and/or you have a number of young children, ask your School Nurse if she can help you out. Often, they have access to free or low-priced safety equipment.
Schools are encouraged to alert parents when their child has any level of head injury while in their care. Please take these notifications seriously, even if you think the injury was minimal. Call the school nurse for further information and direction. Also, let your paediatrician’s office know and get direction. If you still have a nagging feeling about your child’s reactions take your child to an urgent care centre. Also, always keep track of your child’s health diary, when head injuries occur and the behaviour that follows.
Helmets are only part of the answer, estimates from the Quebec Trauma Center note that wearing a helmet only reduces the risk of head injury by 35% for certain sports. Make sure your child learns how to do a high-risk activity safely and is well supervised by coaches, who are well informed on head injury prevention. Help educate yourself, your child’s coaches, and other parents with the Center for Disease Control’s Heads Up Concussion in High School Sports. Learn how to respond if a concussion occurs and get lots of free videos, online training and brochures. Their biggest advice is not to assess an injury yourself, but to pull the student from play and seek the advice of a healthcare professional. A player who has sustained a concussion is 3-6 times more likely to sustain another if not removed from play for an appropriate amount of time.
Sports are a great way for kids to stay, healthy while learning important team-building skills. Let’s help them do it safely.
Note: This article is intended as educational material only and is not medical advice. Consult a medical professional if you have any medical concerns.