Q: My son plays sports, and I’m worried about concussion. When an athlete is hit in the head, at what point should they be taken to the hospital or see a doctor?
A concussion is a traumatic brain injury that affects a person's brain function. It is common in contact or action/adventure/extreme sports. Some concussions can cause a loss of consciousness ("blacking out and not remembering what happened"), but most do not. If your son does lose consciousness for any length of time, he has definitely suffered a concussion and I would recommend having him evaluated. If there isn't a loss of consciousness, but you notice any worrisome signs, such as dizziness, nausea, ringing in the ears, vomiting, headache, slurred speech, loss of balance, unsteady walking, irritability/crankiness, listlessness, delayed response to questions, change in your child's normal behavior after the trauma, seizure, or a feeling of being dazed or confused and/or general fatigue, you should have him evaluated by a physician. Symptoms of concussions can occur immediately, or it may be delayed for hours or days. Depending on his age and the severity of the injury, the physician might perform a neurological exam and check his vision, hearing, coordination, mental status, and/or keep your son in the hospital for an observation period. Other tests could include a CT scan or MRI scan of the head and spine to look for signs of trauma.
It is not advisable for your son to return to vigorous activity while signs or symptoms of a concussion are present or until fully evaluated by a physician. Just as it is unsafe for an adult to drive or handle dangerous or heavy machinery while signs or symptoms of a concussion are present. Potential long-term complications of concussion include headaches, dizziness, and thinking difficulties for days to months after the head injury. Repeated head injury is being actively researched right now and was the subject of the 2015 film "Concussion" starring Will Smith who portrayed Bennet Omalu, the forensic pathologist and neuropathologist who inspired the movie. If your son suffers multiple brain injuries, these may have cumulative effects and places him at risk of developing permanent and progressive impairments and limited function for his whole life. The most important thing I can impart to you regarding concussions and brain injury is PREVENTION. Please wear protective gear during sports and other recreational activities, buckle your seat belts, make your home safe from falls by keeping hallways well-lit and floors and stairs free of anything that might cause someone to trip and fall, protect your children by blocking off stairways and pools and installing window guards and checking lanai rails and stair handrails routinely, pay attention to the elderly in the home and community and give them a hand for stability, exercise regularly to strengthen muscles, improve balance and flexibility, and educate yourself and others about injury prevention.