Concern about concussions and how these brain injuries affect children's health has never been higher, and rightly so, says neurosurgeon Robert Cantu, one of the nation's leading concussion experts.
According to the Centers for Disease Control and Prevention, emergency department visits for sports and recreation-related traumatic brain injuries (TBIs), including concussions, increased by 60% among children and adolescents (from birth to 19 years old) over the past decade.
In his new book, Concussions and Our Kids, Cantu, chief of neurosurgery at Emerson Hospital in Boston and medical director of the National Center for Catastrophic Sports Injury Research, offers parents advice on keeping kids safe from this "silent epidemic."
Q: You say that physiologically, kids and teens are more vulnerable than adults to concussions. Why?
A: They don't have fully myelinated brains, so the nerve cells and their connections don't have the coating and insulation of adult brains. In addition, they have disproportionately weak necks compared to adults, and disproportionately large, heavy heads, so they're like bobble-head dolls. This sets them up for brain injuries that are more serious than those sustained at a later age from the same amount of force. Girls appear more susceptible to concussions and post-concussion symptoms than boys and are often slower to recover, which is why I recommend that helmets be required in field hockey and girls' lacrosse.
Q: One of your goals is empowering parents to play a role in detecting concussion symptoms that coaches and trainers may have missed. How?
A: I'm not asking them to be a doctor or asking them to make the diagnosis, but asking them to have their antennas up for the subtle mood and behavior changes that could signal a concussion. They know when their kid is "off." When the kid is off, is it necessarily a concussion? No, but you might ask, "Did you get whacked in practice today? Did you have a fall?" or whatever. If they say yes, in those situations the parent should bring the kid to the doctor to be checked out.
Q: Most kids will recover from a concussion, but how long does it take for symptoms to disappear?
A: Properly managed, roughly 80% of people will recover within seven to 10 days; 20% will go on and have symptoms that last beyond that time. Somewhere between 5% and 10% will go on to have post-concussion syndrome, in which symptoms last beyond a month. Most of those with post-concussion syndrome will recover, but some will take even over a year to recover, and a very small number will never recover.
Q: Short of preventing your child from participating in any collision-type sport, what's a parent to do?
A: I don't want to stop sports from being played. I do want people to be very well aware that no brain trauma is good brain trauma. No hit to the brain is a good hit. If your child is going to play a sport in which brain trauma is inherent with the activity, please start at a later age. Arbitrarily I say 14 because that's when high school starts, and if you're going to play at the next level, you've got to start somewhere. Ideally, I wouldn't have them start until 18, because it would have them taking less brain trauma over the course of their lives.
Q: So suggesting kids play no football or hockey until age 18 has no chance of flying?
A: From a practical standpoint, I say don't start until 14. It has got a little chance of flying, but mostly it has a very big chance of putting in place another recommendation: making rule changes in sports that will reduce the amount of contact allowed in practice and the number of hits that kids take in a game. I've already seen Pop Warner (youth football program) dramatically reduce the amount of contact allowed in practice and eliminate certain drills that involve head-to-head hitting. That's great. It's not good enough, but it's a great start.
Q: You also say young athletes, boys and girls alike, should work to strengthen their neck muscles to help prevent brain trauma.
A: They should be working on strengthening their core musculature, especially their necks, so if they receive a blow to the head and see it coming, they can at least tense their neck muscles and reduce the acceleration forces the brain will receive. And by strengthening their core muscles, if they get knocked down, they have a greater chance of not having their neck snap back and suffering whiplash. Girls working to strengthen their neck exercises should remember that they don't produce enough testosterone to build big, bulging necks, but they are going to be stronger and that will help protect them.
Q: Is rest the most effective therapy for a concussion, even for patients who have long-lasting post-concussion syndrome?
A: Both physical and cognitive rest is needed until the symptoms clear. Traditionally, people have been aware of the need for physical rest and understood that when you physically exert yourself, you greatly exacerbate your symptoms. People have not been so aware of the need for resting the brain. Individuals with cognitive concussion symptoms who exert their brain by doing computer work, reading, doing lengthy homework assignments, playing video games or texting will exacerbate their symptoms in almost every instance.
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