By Dr. Allan Shefrin
A few years ago, I was having dinner with a friend who plays professional hockey. Then, as now, concussions were a hot topic in both our professional worlds. He asked me how I talk with kids about head injuries when I see them in the emergency department.
As I thought about how best to answer, I had to consider that for a professional athlete the calculus is different than for almost every patient I see.
My friend knows well the physical risk that comes with his job. He grew up in the sport at a time when people were just becoming sensitive to the need to treat head injuries in young athletes properly. There was a time that if my friend got a concussion while playing, he might still head back out on the ice. The culture encouraged it, and once he made the NHL, it was also what he would be paid to do.
But for the rest of us, sport is exercise, escape and recreation.
When kids get a head injury while playing sports, the decision of what to do next needs to be rooted in reality: regardless of our sincerest hopes, most, if not all, of our kids are not going to be pro athletes, making millions of dollars that will help them live well the rest of their lives.
So, we need to balance our desire for them to play and engage in sport and physical activity against the crucial need to protect their developing brains.
The Canadian Hospitals Injury Reporting and Prevention Program tracks every injury and its outcome. It’s how we know car seats and helmets are effective.
Yet, how many times have you seen – or been – the parent not wearing a helmet on a bike ride while you force one on your kids?
I can relate to the thought process of “I didn’t need one when I was a kid, why do I need one now?, but with all we know now that we didn’t three decades ago, I think it is crazy not to wear one. This has rubbed off on my eldest daughter who, in her car seat from the backseat of my car, will yell at cyclists to wear a helmet. We didn’t have car seats in the ‘80s either, I know. Would you drive your child without one?
To help our kids, we must first lead by example. Put on your own helmet!
A helmet will not always prevent injury, but it can reduce it. The worst head injury, besides death, is an intracranial bleed. A helmet can turn an incident that would have caused that into something far more minor.
So what happens if your kid does get a head injury while playing sports?
The first, and most important, step is to get them out of the game. The risk of worse injury is greater. Sidney Crosby, arguably the best player in hockey for the last decade, kept playing after he was concussed and as a result missed almost a year.
Sometimes it is hard to know immediately whether it’s a minor head injury or a concussion. A minor injury is often free from symptoms other than a headache. A concussion presents differently. Symptoms include a headache, but also light or sound sensitivity, troubles concentrating and nausea, to name a few. It may take a few days to really know how severe the injury is.
When it comes to whether to see a doctor, the general rule of thumb is to see a professional after the injury, and then again before returning to full activity.
Give pain meds. Symptoms which improve with Tylenol or Advil are generally less worrisome than those that do not.
Rest is important, but recent research led by colleagues at CHEO, has suggested moving away from complete rest. Light activity and school should be OK.
If your child cannot tolerate that, then they should definitely be seen by a professional.
A great resource is the Ontario Neurotrauma Foundation which helps with symptom recognition and management. Check it out at www.onf.org.
So in answering my friend, I said the reality is that my patients are a long way away from your job, and will likely never get there. And even for those who might – they’ll get there stronger if they take time out to heal. A healthy, protected, brain is the most important organ we have, we can’t get another.
Dr. Allan Shefrin is an emergency room pediatrician at the Children’s Hospital of Eastern Ontario.