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Concussions are a problem in spring sports, too, pediatrician advises

Spring sports such as lacrosse, baseball and volleyball carry the potential for traumatic brain injury, writes a pediatrician who says about 10 percent of cases that come into his urgent care clinic are concussions.

Avrahom Gurwitz, MD, is a pediatrician and medical director of the Holy Redeemer Pediatric UrgiCare Center in Meadowbrook, Pa
Avrahom Gurwitz, MD, is a pediatrician and medical director of the Holy Redeemer Pediatric UrgiCare Center in Meadowbrook, PaRead moreHoly Redeemer
    by Avrahom Gurwitz, For the Inquirer
    Published 

Football may get the lion's share of attention when it comes to concussions, but spring sports at the high school and collegiate levels see more than their share of traumatic brain injuries, too.

Our pediatric urgent care clinic is awash in boys and girls complaining of dizziness, nausea and other symptoms as a result of contact sustained in lacrosse, baseball and volleyball, three popular sports this time of year. I personally see five or six head injury cases each day, and the vast majority are concussions. Overall, about 10 percent of cases that come through our doors during the spring are concussions, when kids become more active … and sometimes more reckless.

Symptoms to watch for

While mild concussions aren't life-threatening, there are no specific treatments to make their effects go away, and kids might need to miss a few days of school, and possibly a few more days off the athletic field or court. The problem is, symptoms are very subjective, and young people who are often reticent to begin with may simply complain they're "not feeling well."

Nor can concussions be diagnosed with a CAT scan or MRI unless there's bleeding or swelling. So the burden often falls on parents to look for red flags, and take seriously any specific complaints. These include:

  1. Severe headache and/or dizziness

  2. Persistent nausea, including vomiting

  3. Neurological symptoms, such as restricted movement of an arm or other body part

  4. Blurry or double vision

  5. Lack of focus or concentration

  6. Seizures

  7. Confusion or the appearance of drunkenness (don't know the day or who the president is, for instance)

Medicine can treat most of the symptoms, but can't heal the concussion. Sports therapies — such as physical therapy or feedback therapy —may help, depending on the patient, but the only sure cure is time. The average concussion will last a week or two, but the severity is worsened if there have been prior incidents. A student who was concussed before and struggled last time is going to struggle again. And someone who is prone to migraines is  also going to have a much harder time with even a first concussion. 

Establish a baseline

High schools are increasingly ramping up their concussion protocols when players are hit. That baseline test?  Make sure your child completes it, and doesn't try to game it or breeze through it. How he or she responds after a suspected concussion, compared with the response before the start of the season, will be the most important determinant of whether brain damage has occurred.

If a concussion is suspected, sports have to be stopped immediately, as a second brain injury while recovering from a concussion can lead to devastating "second impact syndrome." During this time, the brain is already vulnerable so a second hit can now cause swelling. The exit point is down the spinal canal, where the brain stem is, and that can be fatal.

What else can parents do?

Parents have no control over what occurs on the athletic field, but they can take steps to ensure their child's well-being should brain injury occur.

  1. Ask the school to do pre-concussion baseline testing, if it isn't doing that already. Ensure your child completes it diligently.

  2. Know your child. After an injury occurs, ask yourself "Is he/she walking and talking OK?" If something is off, if your child doesn't seem "appropriate" after an hour or two, get an evaluation.

  3. Follow up. If after one week your child isn't turning the corner, return to the doctor, possibly a neurologist or one skilled in sports medicine.

Science is working to make diagnosing traumatic brain injuries easier, through techniques such as blood markers or analyzing eye movements. Until the research catches up, it's up to parents and doctors to rely on their best instincts, and coaches and school staff to err on the side of caution – even over protests from the student athlete.

Avrahom Gurwitz, MD, is a pediatrician and medical director of the Holy Redeemer Pediatric UrgiCare Center in Meadowbrook, Montgomery County.