5 things parents should know about concussions in children

Concussed athletes should not return to play until they

Leading causes of concussion seen in emergency departments

About one-third of concussions occur at sports practice, not in a game

Less than 10 percent of concussions result in loss of consciousness.

Source: choa.org/concussion

For every kid who can't wait to get on the gridiron, there is a parent worried about what could happen to that child.

For a time, kids who "got their bell rung" would shake it off and return to a game. In recent years, however, parents and sports enthusiasts have become much more aware of the dangers of concussions.

Dr. David Marshall, director of sports medicine at Children's Healthcare of Atlanta, said he has never let a fear of concussions detract from his son's pursuit of sports, first in football, then in lacrosse and wrestling. In fact, he is encouraged that more knowledge about concussions will allow for children and adults to pursue sports with less fear.

"I would never hold him back from a sport because of the risk of a concussion," Marshall said.

Allowing a kid to fully recover from a concussion will make a difference in the long-term outcome, Marshall said. "That will change things for athletes."

Here are five things to know about concussions.

When do concussions happen?

Football players were the focus of the Will Smith movie "Concussion," but they aren't the only athletes who face this risk, Marshall said.

In the fall, football players most often get concussions, but Marshall said he has also treated cheerleaders. In the spring, soccer and lacrosse players get concussions. In the summer, the injuries are common from bike riding — especially when kids don't wear helmets — and on playgrounds.

"Of the total number of kids who play sports, the number of kids who get concussions are extremely low," Marshall said.

He said kids can get a concussion when they play any sport and their heads are hit by the ground, a piece of equipment, another head or body part, or even when they aren't hit but their head is jarred.

» Why you should see the movie "Concussion."

» Atlanta is home to the consequences of football concussions.

When is it an emergency?

The symptoms of a concussion include confusion, headache, nausea, sensitivity to light or noise, and tiredness. Sometimes, those symptoms can be pretty extreme.

If a person loses consciousness, then he or she should be taken to the emergency room. Many times, though, you can wait until the morning to take your kid to a doctor. Marshall added that many primary care doctors are more comfortable treating concussions, so a specialist may not be necessary.

But parents should keep an eye on their child and watch to see if the symptoms get worse, he said, because that can be a sign of a brain bleed and require a trip to the E.R.

» Tips to keep your child's trip to the ER from being too traumatic

How long does it take to recover?

Concussions take time to heal, and it is hard to predict how long it could take. Some kids are fine within an hour, but some might take a few days or even months to get better.

Marshall said 95 percent of people with a concussion are fine within two or three weeks, but there are exceptions.

Doctors used to stress keeping kids home from school to let them rest, but Marshall said he prefers to get kids back in the classroom earlier. Faculty will likely have to modify the child's schedule and workload, however. Frequent breaks at the nurse's office can help, as can preprinted class notes. If a child is sensitive to light, sunglasses might be a good idea. For the most part, Marshall said, local schools have become educated about these kinds of modifications.

But, Marshall added, kids shouldn't return to practice until they are symptom-free.

Can a buddy help?

At the 36 high schools that partner with Children's for trainers, Marshall and his colleagues have implemented the buddy system for football players. Every kid on the field has a partner who can check on him between plays.

The biggest issue with concussion, Marshall said, is under-reporting. Too often, a kid is reluctant to tell a coach how they are feeling for fear of leaving the game, but a buddy might see the signs and let the coach know.

"You can't rely on a coach 40 yards away," he said, adding that the buddy is also key for recognizing symptoms of dehydration or heat illness. "You might not notice until a kid collapses, but a buddy can help. The buddy system can help on a lot of different levels."

How many concussions are too many?

Marshall said parents will ask him for a "magic number." Should their child quit after two concussions? Three? Five?

"There's really no data or literature that supports a number," he said. "It's truly a family decision."

Doctors don't immediately assign grades to concussions anymore, Marshall said, explaining that how long it takes to recover is a better barometer of the severity of the injury.

If it takes a few months to recover from a concussion, then that might be the time to have a talk about retiring, he said.

"As long as they make a good recovery," a kid can still compete, he said. "We're trying to make sure that athletes nowadays are managed properly while the brain is recovering.

"We need to keep educating each other," Marshall said, adding that coaches, schools, parents and athletes seem to be getting the message and are making sure that kids are safe.