what is the appropriate healthcare management of adolescent following concussion?

Question

15 year old soccer goalie suffered broken nose and mild concussion. it is now 2 weeks later and she is still suffering from moderate to severe headaches, some fatigue and difficulty concentrating. Pediatrician is recommending complete rest, including staying home from school for an extended period of time. does this sound too conservative?

Answer 1

Concussions are serious, so it is hard to say that any recommendation is too conservative. Obviously at this point the pediatrician knows the most about her and has the most medical knowledge, so until you see an expert who says differently, stick with your doctors recommendations.

However, I do think it is VERY important that you see a neuropsychologist who specializes in sports concussions, and preferably a pediatric neuropsychologist. Concussions (traumatic brain injuries, TBI's) are very complex and the symptoms that you are mentioning are very common. Unfortunately, these don't always go away quickly. Sure there is usually an initial recovery burst, but some symptoms take a long time to heal and often patients need medication or certain types of therapy in order to overcome specific deficits. Difficulty concentrating (or attention problems) for example are extremely common after head injuries, but often times patients need medication for a little while to get them back on the right track (especially if they have school to worry about). You really need to see a neuropsychologist who can test her and find out EXACTLY what the problem is and then make appropriate suggestions for care. I hope everything works out.

Answer 2

It sounds like your daughter is suffering from post-concussion syndrome. I am an athletic trainer and have delt with many athletic concusssions. Recent studies are showing that younger athletes require more time to recover from a concussion because there is so much development and restructuring going on in the adolecent brain. Post-concussion syndrome is when concussion symptoms linger. These symptoms include: nausea, dizziness, difficulty concentrating, headaches, aversion to light and loud noises, "groggy" or slow reactions, and altered personality. These symptoms may last from 1 week to a month or more. Your pediatrician is correct in recommending rest while there are still symptoms. It sounds funny, but thinking can acutally increase concussion symptoms, especially headache. I have told several of my athletes to stay home from school for several days due to headaches associated with class work. Also, it is imperative that your daughter not return to activity until ALL symptoms have resolved while resting. Once she is symptom free during rest, she can try light, non contact activity. If any symptoms return, she should stop immediately. Then it is a gradual return to play that starts with no symptoms at rest, then with non contact, light activity, then noncontact strenuous activity, and finally a return to full competition. Is your daughter playing for a high school? If so, is there an athletic trainer present for games and practicies? Athletic trainers are trained to treat and monitor such injuires and recommend referrals when appropriate. In the end, the best advice is from a health professional who has actually evaluated your daughter as they can accurately assess her condition. Keep her safe and keep her playing. I played goalkeeper all through college, best position in sports!!

Answer 3

No, it is never too conservative when it comes to concussions- there are new surveys out stating some serious side affects of children suffering concussions and at what age and how many---my daughter had a concussion from soccer- same scenario as yours. she had one from water polo- smacked in the face with a ball, and the worse was at work, a pineapple corer came down and smacked her in the head- the spring mechanism gave way---she was out on workers comp for 6-8 weeks but the worst part was she had to lose her tuition money for that semester of college and her employer Wegmans refused to address her loss which was over $6,000, they did however, get rid of ALL the pineapple corers made by that company and had spring action handles within 1 week after her accident--- a little guilt- but to no advantage to my daughter---it is now almost 7 years since her last concussion and she is having a problem that may be a pituitary tumor---I am praying that it isn't because it has been proven that tumors in the brain CAN BE CAUSED BY CONCUSSIONS---so if your daughter was mine, I WOULD NOT ALLOW HER TO PLAY ANY CONTACT SPORTS- ESPECIALLY MIXED TEAMS GIRLS PLAYING AGAINST GUYS-- NOT FAIR GAME AND THE GIRLS ALWAYS END UP WITH THE SERIOUS INJURIES--

HAVE THE DOCTOR ALSO DO A CAT SCAN OF THE BRAIN OR AN MRI WITH CONTRAST ABOUT A MONTH AFTER THE CONCUSSION AND WATCH HER ABILITY TO CONCENTRATE AND HOW SHE IS DOING IN SCHOOL- MY DAUGHTER LOST HER ABILITY TO CONCENTRATE FOR ABOUT ONE YEAR.

GOOD LUCK TO YOU AND YOUR DAUGHTER

Answer 4

Don't forget a concussion is basically bruising your brain. Can you be too careful with your brain? Rest is the best thing for concussions. She is very lucky those are the only symptoms. My sister in law had a concussion and couldn't manage to get a coherent sentence out for 2 weeks in addition to those symptoms you mentioned. She could write and speak but it made no sense to anyone because she struck her head in the speech center of her brain.

Answer 5

Yes, she needs to see a neurologist. Have them check to see if the pituitary was damaged...that would cause the fatigue and difficulty concentrating as well as the headache.

Answer 6

Not at all. Has a CAT scan been done? If not, why not? The brain needs time to heal. Maybe request seeing a neurologist? Take care.

Answer 7

Must see a Neurologist. They are specialists in this field sweety!!