Concussions are among the most widely reported injuries in young people who participate in sports and recreational activities. The Centers for Disease Control and Prevention (CDC) has estimated there are as many as 3.8 million sports and recreation related concussions in the United States every year. 
Classified as traumatic brain injuries, concussions are caused by a bump, blow, or jolt to the head that causes the soft, gelatin-like substance of the brain to move rapidly back and forth inside the hard, bony skull. Concussions can change the way the brain normally works.
Although most of us associate concussions with “contact” sports like football, soccer, ice hockey, or basketball, they can occur in any sport or recreational activity. A concussion can occur from a fall on the ground, tennis court, squash court, or even from falling against a wall or goal post. Furthermore, you don’t have to be “knocked out” or lose consciousness to suffer a concussion.
Most young people make a good recovery from a single concussion that is recognized and treated appropriately. However, mounting evidence shows that repetitive head injuries can cause serious, permanent brain damage. Every year, children in the United States suffer serious injury or death as a result of a concussion in sports and recreational activities.
Youngsters who experience multiple concussions may take longer to recover after each concussion. They may also endure prolonged post-concussion symptoms and suffer cognitive impairment.
Perhaps more alarming, however, is a medical condition seen only in children, Second Impact Syndrome (SIS). Although rare, it may occur when a child sustains a second (perhaps minor) trauma to the head before he or she has recovered from a prior concussion. This re-injury can lead to a series of medical events that causes rapid brain swelling, a dangerous and sometimes life-threatening condition.
Given the risks associated with cumulative concussions, coaches and parents must take the lead in protecting children from these injuries. Coaches, athletes and parents all want their team to perform well, but the safety of the players must be the paramount concern. Often it can be difficult to determine how soon after a blow to the head it is safe for a child to return to play. The following guidelines, suggested by the CDC , can help.
- Keep an eye on your players or children at all times. Watch for blows to the head and falls during practice, games, and other activities; look closely for signs and symptoms of concussion after these events.
- A coach should immediately remove from play an athlete who displays or reports the signs or symptoms of a concussion. He should ensure the player is evaluated promptly by an appropriate health care professional. If the coach does not follow this protocol, a parent should intervene whenever possible. A coach has an obligation to inform the athlete’s parents or guardians about a possible concussion and to recommend prompt and proper medical care.
- Keep in mind the athlete himself may not be a reliable source of information. He may not want to report his symptoms for fear of being taken out of a game or letting his team down.
- Do not allow a youngster who has suffered a concussion to return to any physical activity or sport until he has been cleared to do so by a doctor familiar with the American Academy of Neurology guidelines regarding prevention of SIS and cumulative brain injury.
Most concussion symptoms disappear within a week or so. After multiple concussions, however, symptoms can persist for weeks or months. What general signs and symptoms should a parent look for?
- Headache, which is a common symptom
- Nausea or vomiting
- Dizziness, problems with balance
- Sensitivity to light or noise
- Fatigue, a change in sleep habits like sleeping more or less than usual
- Inability to concentrate or remember
- A “foggy” feeling
The CDC suggests that, in addition to the above symptoms, a coach should be alert for subtle signs and symptoms in the minutes following an event that might cause a concussion:
- The athlete appears dazed or stunned after a hit or fall.
- He appears confused about his game assignment or position.
- He forgets sports plays.
- He is uncertain of the score, game, or opponent.
- He moves clumsily or is unsteady on his feet.
- He answers questions slowly or with hesitation.
- He loses consciousness (even very briefly).
- He exhibits changes in his behavior or personality.
- His memory is affected – he doesn’t remember events before or after a hit or fall.
The CDC is a helpful resource for parents and coaches who want to protect young athletes from the dangerous effects of cumulative  concussions. Although many parents want their children to participate in sports for all the many benefits such participation brings, we all have a responsibility to help children do so safely.
 See CDC Archives 2009, at April 22, 2009, at http://www.cdc.gov/media/subtopic/heard09.htm.
 For more information, see CDC website “Heads Up: Concussion in Youth Sports” at http://www.cdc.gov/concussion/HeadsUp/youth.html. See also other injury prevention topics at the CDC’s National Center for Injury Prevention & Control website at http://www.cdc.gov/injury/.