At Nationwide Children’s Hospital, our pediatric sporting activities medicine professionals offer other adult care providers can’t – a finish understanding that children and adolescents. Together you know, concussions are a potential peril to athletes in any sport. So how do you save your athletes safe? By understanding what a concussion is, what to do if one athlete is injured, and how to assist him or her recover and get ago to sporting activities safely.

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What is a concussion?

A concussion is an invisible injury the disrupts just how the brain works. It might be caused by a blow, bump or jolt come the head or by any type of fall or hit the jars the brain. A concussion might sometimes involve ns of consciousness (being “knocked out”), yet 90 percent that concussed athletes execute not lose consciousness at time of injury. Ultimately, all concussions space serious due to the fact that they are mind injuries!

How carry out I phone call if among my athletes has sustained a concussion?

An athlete may complain of numerous different concussion symptom that have the right to be grouped into 4 general categories:physical, cognitive, emotional and also sleep.


Cognitive emotionally Sleep


Feeling holy ghost foggy


Trouble fallout’s asleep


Feeling slowed down


Sleeping an ext than usual

Balance problems

Difficulty concentrating


Sleeping much less than usual


Difficulty remembering

More emotional than usual


Difficulty focusing

Sensitivity come light

Sensitivity to noise

Furthermore, here are some indicators that might be observed by the coaching staff: The athlete…

shows up dazed or stunned answers questions slowly Is confused about assignments or position Loses consciousness/gets “knocked out” (even briefly) Forgets an instruction shows mood, behavior or personality changes Is unsure that game, score or adversary Can’t recall events prior come hit or autumn Moves clumsily Can’t recall events after fight or fall

While a blow to the head may not constantly seem like a huge deal in ~ the time, concussion symptoms can build immedi- ately or up to 48 hours after the incident. Ignoring any type of signs or symptoms of a concussion is putting the child’s health at threat – in both the short and long term.

Is that dangerous because that an athlete come play sporting activities with a concussion?

YES. Second impact Syndrome is a catastrophic event that can occur in athletes 21 years of age and also younger. This condition occurs as soon as a 2nd blow to the head happens prior to an athlete has totally recovered indigenous a concussion. This second impact, which may be also a young blow, have the right to cause mind swelling, leading to severeconsequences, together as brain damage, paralysis and also even death. Therefore, no child must be enabled to get involved in any physical activity if he or she has possibly sustained a concussion OR prior to he or she is cleared by a qualified medical experienced after sustaining a concussion.

Will mine athletes be ethical with me around their symptoms?

Even despite concussions are an extremely serious and also potentially life-threatening to the young athlete, studies display that less than 50 percent that high school athletes will report your concussions. Even after being diagnosed, plenty of athletesfeel pressured come say they do not have actually symptoms (when they tho do have symptoms), therefore they deserve to return come play sooner. Nearly all athletes who have passed away or suffered severe complications from repeated concussions did not reporttheir continued concussion symptom to your parents, strong trainer or doctor. That is vitally important that coaches recognize the signs and also symptoms that concussions and encourage honesty in report them.


If one of my athletes sustains a feasible concussion, what should I do?

First, the athlete should be gotten rid of from play and not be allowed to return to any type of physical activity that day even if they say their symptoms have gone away. If you’re not sure if a concussion has occurred, err top top the side of caution. When in doubt, sit them out!

Second, monitor for worsening signs and also symptoms. If any kind of of the followingDANGER SIGNSpresent themselves, the child have to be evaluate by a physicianIMMEDIATELY(sent to the emergency department via ambulance).

major or increased headache double vision unlike pupils Convulsions Unusual/increased drowsiness Bleeding/clear liquid from the ear/nose Projectile or repetitive vomiting unexplained stiffness in the neck area major personality transforms Weakness in either arm(s) or leg(s) Numbness in the face/extremities

Third, educate the athlete’s parent/guardian the the concussion. Instruct them to have their son evaluated by a medical skilled educated in concussion evaluation and also treatment. Ask lock to lug you a doctor’s note with diagnosis and information top top their restrictions after their visit. Note: If girlfriend have access to an strong trainer, he or she may manage this step. Make sure to produce a communication plan that is agreed top top by all parties, so that correct information is ceded in a fashionable manner to the parent and back to you.

Fourth, do not enable the athlete to return to play without a keep in mind from a medical skilled stating that he/she is clearing to start participating. Also with a note, if one athlete tho complains the symptoms, host him/her out of every activity. Speak come the parents and have castle re-visit their health treatment provider.

A legal Note

Keep doctors’ note on record and organized. If over there is question about a decision girlfriend made with an injured athlete, friend will want the note proving that you were following doctor’s recommendations. If friend cannot create a keep in mind in this situation, it opens you approximately liability.

Returning to Play:

What deserve to I do to assist the athlete recover?

Make certain the athlete is complying with the guidelines for both mental and also physical rest.

physical rest: No practice, games, pick-up games, running, throwing, batting, load lifting, gym class, horseplay, etc. Mental rest: avoid computers, video games, texting, extreme TV and listening to according to music, particularly with headphones border exposure to light and noise: use sunglasses and also avoid parties, concerts, games, etc.

When deserve to an athlete who has sustained a concussion for sure go ago to participating in sports?

The child need to be completely complimentary of symptoms and also participating in school totally (if applicable) prior to beginning to play sporting activities again. When released by an appropriate health care provider, the child have to participate in a gradual progression ago to activity.

What is the Return-To-Play progression back to activity?

The Return-To-Play progression is crucial because a return of any type of signs or symptoms of concussion throughout mild physical activity signals that the mind has not healed and that boy is not all set to return to activity. IT have to NOT be SKIPPED, abbreviation OR changed WITHOUT THE written CONSENT that THE HEALTH treatment PROFESSIONAL.

Each stage should take a minimum that 24 hours, so an injured athlete will take roughly one mainly to proceed through the complete rehabilitation protocol, assuming that the athlete stays asymptomatic in ~ rest and with provocative exercise. (Note the this timeframe might be extended by the health treatment provider in younger athletes, those with specifically severe or long-lasting symptom or those that have suffered previous concussions.)

If symptoms are provoked at any type of stage, the athlete have to stop exercising and rest till all symptoms have actually resolved for at the very least 24 hours. The athlete may then attempt to resume the development at the ahead level that did not cause symptoms.

An instance of the progression endorsed by concussion experts throughout the many recent worldwide conference on concussion is displayed below.

Graduated return to Sport (RTS) Strategy




Goal of every stage

Stage 1

Symptom-limited activity

Daily activities that perform not provoke symptoms.

Gradual reintroduction to work/school activities

Stage 2

Light aerobic activity

Walking or stationary bike at slow-moving to tool pace. No resistance training.

Increase heart rate

Stage 3

Sport-specific exercise

Running or skating drills. No head affect activities.

Add movement

Stage 4

Non-contact maintain drills

Harder training drills, eg. Happen drills. Might start gradual resistive training.

Exercise, coordination and increased thinking

Stage 5

Full call practice

Following medical clearance, take part in regular training activities.

Return confidence and assess functional an abilities by coaching staff

Stage 6

Return to sport

Normal video game play.

How have the right to I save my boy from gaining a concussion?

Are there long-term results from a concussion?

Most young athletes will certainly heal from a concussion if it is regulated properly. If a human has had actually multiple concussions, especially within a short duration of time, the symptom may become chronic and may jeopardize the person’s capacity to participate in certain sports or activities. Later on in life, human being with multiple concussions may be much more likely to suffer from depression, dementia, and also other diseases and illnesses that have a huge impact on quality of life.

How deserve to I store my athletes from obtaining a concussion?

There are a couple of things you deserve to do to decrease your athletes’ opportunities of acquiring a concussion.

Ensure the your athletes wear effectively fitted equipment and also that the is checked and maintained frequently (if applicable). Encourage great sportsmanship and following the rules. Teach great technique.

How deserve to I re-publishing this source with others?

Nationwide Children’s Hospital sporting activities Medicine provides an in-service ~ above this topic cost-free of charge. The length of the presentation and also content can be tailored come fit the particular needs of the group. Please contact (614) 355-6000 for an ext information.

What if I desire to learn more?

We provide further educational resources, presentations and print products on concussion management and also other sports-related injuries and fitness well-being. Visit or speak to (614) 355-6000.

Theconcussion clinicat Nationwide Children’s Hospital utilizes the field of expertise of pediatric sports medicine specialists and physical medicine and rehabilitation specialists, along with neurologists, neurosurgeons, radiologists, neuropsychologists, physics therapists and also athletic trainers to finest manage pediatric concussions.

Nationwide Children’s Hospital sports Medicine additionally offersbaseline neurocognitive (concussion) testingto advice a healthy athlete’s decision make ability, reaction time, attention and memory.

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Centers for condition Control and Prevention

The Centers for an illness Control and also Prevention gives informational materials around concussions because that athletes, parents, coaches and teachers, consisting of a free Heads Up! tool kit.