Concussions: When in Doubt, Sit Them Out!

Concussions happen! They are often an unavoidable risk in many youth sports. Unfortunately, concussions can have long-term impacts on young athletes in areas such as memory, health, learning, and even their survival. Young athletes—especially kids and teens—often do not recognize their own limitations, especially when they have a concussion. It is your responsibility as a parent or coach to help recognize the signs and make the necessary call to pull an athlete out of the game if you think that he or she might have a concussion.

A concussion is a type of traumatic brain injury caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This jarring movement of the brain causes the damage and creates chemical changes in the brain, increasing its vulnerability to further injury.  It is this fact that makes recognizing and responding properly to a probable concussion vital to the athlete’s long-term health. Remember, you cannot see a concussion like you can see a broken arm, and there is no one single indicator for a concussion. Recognizing a concussion requires being observant for multiple signs and symptoms. Listed in the table below are the “Danger Signs” that require immediate medical attention at the closest Emergency Room:

One pupil larger than the other Convulsions or seizures Drowsiness or inability to wake up Inability to recognize people or places A headache that gets worse and does not go away
Increasing confusion, restlessness, or agitation Weakness, numbness, or decreased coordination Unusual behavior Repeated vomiting or nausea Loss of consciousness

If any of the Danger Signs are observed in a player, he or she should be immediately removed from play and taken to an Emergency Room to be seen by a qualified physician.  The next table lists signs and symptoms that are indicative of a concussion in a player following a possible blow or jolt to the head:

Signs observed by coaching staff/parents Symptoms reported by athletes
Appears dazed or stunned Headache or “pressure” in head
Is confused about assignment or position Nausea or vomiting
Forgets an instruction Balance problems or dizziness
Is unsure of game, score, or opponent Double or blurry vision
Moves clumsily Sensitivity to light
Answers questions slowly Sensitivity to noise
Loses consciousness (even briefly) Feeling sluggish, hazy, foggy, or groggy
Shows mood, behavior, or personality changes Concentration or memory problems
Can’t recall events prior to hit or fall Confusion
Can’t recall events after hit or fall Just not “feeling right” or “feeling down”

Imagine now that you have just observed a sign or have been told a symptom indicative of someone suffering a concussion. What should be the immediate and long-term plan?

  • Supervision: First and foremost the athlete needs to be removed from play and put under supervision to monitor for further signs/symptoms.
  • Evaluation: Next, the athlete should be evaluated by a healthcare professional experienced in evaluating concussions. Coaches need to inform parents/guardians immediately following concussion-like signs/symptoms, especially if they were not present for the game.
  • Clearing for play: The athlete should remain out of play until cleared by a healthcare professional.
  • Continued Assessment: Continuing to assess the athlete over time is vital because the full effect of the injury may not become noticeable at first, and some symptoms may not show up for hours or days.

“Toughing it out” is not strong; it is dangerous and foolish.  This stigma is wrong, and it can put a young athlete at risk for serious injury. Coaches and parents should not let others (fans, parents, or teammates) pressure you or the injured athlete to continue playing. Let the doctor decide when the athlete can return to play. He/she might advise following the 5 step “Heads Up Protocol” which can be found on the CDC’s webpage:

Being informed is the best defense. Parents and athletes should sign a concussion policy statement at the beginning of each season, (forms can be found on the CDC’s website). Before each season, time should be spent explaining the seriousness of concussions and how to recognize and deal with them accordingly as a team, (meaning a team of players, parents, and coaches). The CDC site has an excellent parent/athlete information sheet to download and to be signed by both parents and students. The sheet helps all involved to acknowledge the risks, signs and symptoms, and to make a plan for when a concussion is suspected.

In Beijing, in an emergency, go to a facility with board-certified physicians whom you trust. Not all head injuries need medical imaging performed, but it is preferred to go to an institution with immediate CT scan capability and with physicians trained in the appropriate indications for deciding whether to perform a CT scan. If assistance is needed with an emergency, call the United Family Emergency Department at (010) 5927 7120.

Remember, when in doubt, sit them out!