A blow to the head can be serious – here's what parents need to know.

Thirteen-year-old Tim Auton was playing nets for the Suburban FC boys' soccer team in Dartmouth, NS, last August, when an opposing player began to drive toward the goal. Tim challenged, running and sliding to grab the ball first. Witnesses say the attacker tripped and fell with his knee landing on Tim's head, which was on the ground.

"I couldn't move; all I heard was voices in the background. I could barely see… I couldn't move my fingers," Tim, now 14, told a reporter a few days after the accident. "After a few minutes I could feel my fingers and they helped me up, and I had the biggest headache."

Tim's dad, Steve Auton, was at work at a Halifax fire station when a parent called from the field to let him know Tim was down. When he finally reached his wife, Lori, who was still with Tim at the field, she told him the referees and coach had told her to take Tim to the hospital, because he had been knocked out. "I insisted she call 911 and not put him in our vehicle," says Steve. "I knew it would be a concussion at that point. She then told me he was starting to vomit and looked terrible. She hung up and called 911. I arrived at the field as Tim was being loaded into the ambulance."

Auton says the next four hours at the IWK Health Centre in Halifax involved a CT scan and continuous monitoring by staff. "The doctors informed us immediately that there was definitely a concussion and most likely a skull fracture; the concern was for bleeding and brain swelling. Fortunately, neither became a significant reality."

Tim did have a skull fracture, but his memory and motor skills checked out; he stayed overnight at the IWK to ensure that no bleeding or swelling took place and to make sure he could walk, talk, and eat. When he left the next day, it was with instructions to do no physical activity except walking for 12 weeks. He was also provided with a checklist of concussion symptoms, and was booked for several more appointments with a neurologist to follow his progress.

Signs and symptoms

A concussion, simply put, is a brain injury that can be caused by a direct blow to the head or neck, or by a blow elsewhere on the body that causes a severe and sudden movement to the head.

You can suffer a concussion without losing consciousness, says Dr. Kevin Gordon, a pediatric neurologist at Dalhousie University and at the IWK, and an expert in the field of concussions. A loss of consciousness probably indicates a concussion - or possibly a worse brain injury.

In the case of an obvious head injury incurred while playing sports, seek medical help immediately, he says. And if there's a head injury, assume also there's a neck injury. If the injured person is wearing a helmet, let them remove their own helmet. If they can't, don't remove it for them. Wait for the professionals.

Among the concussion signs to watch for are dizziness, nausea, and vision changes. Other symptoms can include feeling like you are in a fog, and a profound sense of fatigue. Symptoms tend to show up almost immediately after the injury, or within the first 24 hours. But the sure sign that you've suffered a concussion is a headache, and it's a unique headache. "It's there when you wake up, it's there all day, it's there when you go bed, and it's ready for you the next morning. Any degree of physical or cognitive activity [like reading or studying] makes that headache worse."

It would be rare for symptoms to appear after a few days, but Dr. Gordon says there are certainly markers to look for in the days following a head injury. If a child is showing any concerning behaviour several days out - irritability, nausea, extreme sleepiness, confusion, anything that draws attention - it's worth a call to your health care provider. Always err on the side of caution, he says.

After a concussion

The good news is that, for the vast majority of people, concussions resolve on their own, Dr. Gordon says, adding that there's virtually no evidence that a single, brief concussion that recovers on its own will show any longer term or lasting effect. "We shouldn't be as fearful as we are now," he says.

Part of this fear has been fueled by recent media attention, particularly as it relates to professional athletes. Sidney Crosby, the star Pittsburgh Penguins hockey player, is certainly among the most high profile of concussion sufferers. After receiving two serious hits to the head just a few days apart, concussion took him out of the game for 11 months; he returned to the ice in spectacular fashion, but was soon sidelined when his concussion symptoms returned.

Dr. Gordon says that, despite Crosby's protracted recovery, most concussion sufferers recover quite nicely. The cornerstone of concussion management, he says, is physical and cognitive rest until symptoms resolve, followed by a graded program of exertion prior to medical clearance. While recovery times vary, most concussions resolve in less than 14 days, although kids can require a bit more time.

It is important, however, to recognize when a concussion has been sustained, and to allow it to heal properly before a return to the sportsfield or to cognitive activity. Evidence shows that sustaining a second concussion before the first one has healed is much worse than suffering a second concussion after the first has healed. The negative effects are not simply added to, but multiplied. Even a seemingly mild blow to the head when post-concussion symptoms are still present can lead to irreversible changes such as memory loss and concentration problems, and can mean a longer time is required for recovery.

Parents should seek medical attention if a child's symptoms persist beyond a couple of days. Dr. Gordon's ultimate advice for parents? Become informed about concussions, but don't be fearful.  

Prevention

Falls from playground equipment are a common cause of serious injuries, particularly in young children, says Sarah Blades, health promotion specialist with Child Safety Link at the IWK.

Such playground injuries are the number one reason children aged five to nine are hospitalized, although these hospitalizations are more for fractures than head injuries. Between 2005 and 2009, the IWK Emergency Department saw 138 children because of a head injury sustained on the playground.

In Canada, public playgrounds must meet standards for surfacing materials that help to cushion falls, but close supervision of young children, especially those under the age of five, can help reduce injuries. Blades says parents should always be within arm's reach of young kids.

It's also important that young children play on appropriate equipment. Children under age five should be on equipment that is less than five feet tall. If a child needs to be boosted or lifted onto something, chances are they're not quite ready for it.

Off the playground, Dr. Gordon's advice is that kids wear appropriate footwear for icy and snowy walking conditions, and that if there are wheels underneath them or they are on horseback, they should be wearing a helmet. Multi-purpose helmets that cover the back of the head are his top choice, but it's worth noting that helmets themselves are not designed to prevent concussions; they are designed to prevent severe brain injury. 

A parent's advice

Today, Tim Auton is back on the soccer pitch, but he now wears a rugby skull cap. His parents say they were very nervous his first time back. Tim says he doesn't remember much of the incident, and his parents say it hasn't changed his style of play.

"All l would say to other parents is that goalkeepers should wear head gear. They spend time on the ground where the kicking feet are," says Tim's father. "Every keeper should have some training at least in how to dive, slide, and protect him or herself."

He says coaches, clubs, and field supervisors should have basic training in head injury recognition, and all clubs should have a mandatory "sit" rule - meaning that a player should be taken off the field and watched for a period of time by coaches - whenever a head bump is sustained by a player at the youth level.

Take it seriously, he says, and get a professional's opinion.

Signs and symptoms of a concussion

• headache
• pressure in the head
• neck pain
• dizziness
• balance problems
• nausea and vomiting
• vision problems
• hearing problems
• ringing in ears
• confusion
• drowsiness
• fatigue or low energy
• irritability
• difficulty concentrating
• difficulty remembering
• feeling dazed
• feeling slowed down
• feeling more emotional than usual
• feeling "in a fog"
  

Preventing playground injuries

Atlantic Canadian children aged five to nine are hospitalized more often for an injury from a playground fall than for any other cause. Active supervision is your child's best defense against playground injuries, especially if your child is younger than five years old.

• Children under five should play on equipment that is less than five feet tall
• Parents should survey the equipment before children begin to play, and should be aware that weather conditions can impact safety
• Older children should be taught playground rules - including what is safe and appropriate behaviour