Concussion advice for young athletes

As kids and parents prepare for summer sports, Stanford neurosurgeon Gerald Grant, MD, thinks it’s important for them to know what to do if a child or teen shows concussion symptoms.

Grant is a professor of neurosurgery at the School of Medicine and chief of pediatric neurosurgery at Lucile Packard Children’s Hospital Stanford. He treats children and teens with concussions and is conducting research to understand how brain injuries happen during high-impact sports so we can prevent them. He spoke with Stanford Medicine News about how to recognize concussion symptoms and how to help young people recover from one.

Q: Your Stanford research team is collaborating with three local high schools to study concussion risks among football and lacrosse players. What do you hope to learn? 

Grant: We’re eager to better understand how these injuries occur on the field. For every practice and game, the athletes wear an instrumented mouthguard developed in the lab of my collaborator, David Camarillo, PhD. Each game and practice is videotaped; we can correlate hits on the field with forces measured by the mouthguard. We can then reconstruct how the head moved in three planes of acceleration during the hit to understand how the brain moved. It’s pretty amazing.

Trying to interpret these hits is the hard part. Some kids are having concussions we know about, and others may have events that are sub-concussive or that the athlete doesn’t report. It might take several cumulative smaller hits to lead to a concussion. We’re trying to learn whether we can predict when those smaller hits are adding up to pose a danger to the brain so we can pull a player off the field before a concussion occurs. It’s tricky because it has to be individualized for each player since everyone’s threshold is likely different.

Q: Stanford researchers have already done similar studies in college players. Why are you focusing on high school students?

Younger athletes are not as experienced about skills such as how to tackle, and there’s so much more variability in their size and speed than at the college level. There’s also a lot of brain development going on between ages 13 and 18; in my concussion clinic, this age group is very vulnerable and has the highest risk for health issues that may accompany a concussion, such as depression, PTSD and anxiety. In light of those vulnerabilities, we think it’s really important to extend the work to this age group.

Q: Stanford scientists have made several other recent discoveries about concussion. What are a few of the most intriguing findings?

Camarillo’s lab has used the mouthguard technology in Stanford athletes to understand which motions inside the brain contribute most to concussion. They’ve found that impacts to the side of the head can shake the corpus callosum, which connects the two halves of the brain and helps with coordination and problem solving. They have also learned that tensing one’s neck muscles during a high-impact hit does not seem to protect against concussion. We hope these findings can help us develop ways for players in high-impact sports to tackle and handle collisions more safely.

Q: For children playing soccer, baseball, football and other high-impact sports, what precautions can parents and coaches take to safeguard their brains?

Kids need to be educated about concussion symptoms and know to tell someone if they have symptoms so they can be evaluated to see if it’s safe to continue playing. Parents need to be on the same page about the importance of pulling an injured child or teen from play. The long-term risks are much greater if an athlete has a second brain injury before the first has healed. When in doubt, we should pull players out of the game.

The most common concussion symptom is headache. Others to watch out for include dizziness, vertigo, difficulty concentrating, fatigue, neck pain and high anxiety. An athlete might have just one of these symptoms or a mixture.

It’s pretty common for me to see kids in my clinic who have had two or three concussions, are symptomatic and are still playing their sport, and I can’t believe I’m the first one to say they really should not be playing. 

Q: After a child is diagnosed with a concussion, what should parents do to help with recovery? 

No. 1, don’t let your child go back to contact activities until they’re cleared by a health care provider to play. That’s the law in California — and it’s important for parents and athletes to know about it.

While they’re recovering from a concussion, the child or teen should slowly start doing something aerobic but with no contact risk. It’s a myth that concussion recovery should be completely sedentary; there are new studies showing that moderate exercise speeds recovery. 

Parents can also advocate with their child’s teachers. We want kids to be at school, but in small doses; if a teacher overloads them, that could backfire. Taking time to recover from a concussion is especially hard for students who have super-high expectations for themselves. When they feel like they can’t perform at their usual level, they can get very depressed. Being supportive and hopeful is really important. Parents can reassure their kids that they are going to get better, and that appropriate recovery time will allow them to heal.

Q: What are the big unanswered questions about concussion in children and teens?

Some of my collaborators at Stanford are working on subtyping pediatric concussions. Their research is showing that these injuries may look different in different people: One kid might have terrible dizziness; another, mostly vertigo; another, bad cognitive side effects such as difficulty paying attention. We are now figuring out how to rehabilitate patients very specifically, focusing on diagnostics that can help us tease out how to classify the concussion and target therapy to help them get better as soon as possible.