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Column originally published Apr 6, 2010

Repeated Concussions Can Be Dangerous For Children

Question: Our fourteen-year-old son is a good hockey player. Last week, he suffered a concussion when he collided with another player who was much bigger than him. He was out for at least a few minutes. Fortunately, he has recovered and seems to be fine now. This is his third concussion in the last four years playing hockey. We are wondering whether he should play some other sports. He is very athletic and he plays intramural in school as well as baseball and soccer in summer. We want to know how big a risk it is if he continues to play hockey.


As parents, we worry about our children, whether they are playing sports or going for a drive with their friends. We always worry about their safety. It must be scary for you to see your son being hit and collapse on the ice. I am not surprised that you are wondering whether he should continue to play hockey or not. The older he is, the bigger he gets, and so would his opponents. As they get older, the collisions get more severe, and the chance of injury also increases.

Concussion is a medical condition caused by significant injury to the brain. Some of the signs and symptoms include loss of consciousness, confusion, loss of memory, and headaches. There can be nausea, vomiting, difficulty with balance, blurry vision, sensitivity to light and noise, mood changes, irritability, difficulty with concentration, and other problems that can last for days to weeks, and sometimes months, after injury.

The severity of symptoms and how long they last often correlate with the degree of injury that led to the concussion. However, this correlation is not quite exact, which means that for some, the injury may seem to be minor, but the athlete can continue to have headaches or blurred vision for a long time.

In order to make it easier for health professionals as well as coaches and others to gauge the severity of head injury and to decide what to do, experts have classified concussion into three grades. In grade 1 (mild) concussion, there is no loss of consciousness, but there is headache, dizziness, ringing noise or brief memory loss.

In grade 2 or moderate concussion, there is loss of consciousness for less than 5 minutes, or loss of memory for greater than 30 minutes. In grade 3 or severe concussion, there is loss of consciousness for more than 5 minutes or loss of memory after injury for greater than 24 hours.

What to do when doctors diagnosed concussion varies. Some guidelines recommend those with mild or grade 1 concussion not to return to competition until they have no symptom with exertion. For those with grade 2 concussion, they should not return to play after one week of symptom-free exertion. For those athletes with severe concussion, it is recommended that they should not return to contact sports until they have a neuro-cognitive test by a trained psychologist to make sure the brain is functioning normally.

There are others who recommend a more gradual approach. The most important thing is for coaching staffs to recognize that a player has suffered head injury, even without loss of consciousness. If a player gets hit and fall, and then become unsteady, that can be a sign of head injury. He should be taken off the game and should be monitored by staffs experienced in head injury. If there are signs of confusion, nausea, or vomiting, the athlete should be taken to hospital for assessment.

Not everyone with head injury should have a CT scan. Minor head injuries is unlikely to cause skull fracture or bleeding which shows up in the scan. Too much radiation to the head can cause brain tumor later on in life.

After a head injury, the athlete should have complete rest from sport-related activities, which means that he can walk around in the house and he doesnʼt have to stay in bed unless if he is dizzy, but he should not run, for at least 24 hours. Afterwards, if there are no symptoms, he can start exercise with walking and then running, followed by training drills but without physical contact with other players. If at any time there is recurrence of symptoms, he should rest for 24-48 hours before going back to the previous level of activity.

The danger of returning to contact sports too early is a condition called ʻsecond impact syndrome.ʼ It means that if a person has a concussion and still has some remaining symptoms (this can be mild like dizziness or blurred vision), and get a second concussion. This can lead to more severe damage to the brain and even death. That is the reason why it is so important to make sure that the athlete has completely recovered from concussion before resuming sports.

Some athletes are so competitive they want to go back before they are ready. Sometimes parents or coaches are the ones that push physicians to clear a star athlete back to the game. The result can be disastrous.

There is recommendation that if an athlete has three severe concussions, he should not return to contact sports. There is increasing evidence from professional athletes that repeated head injuries can lead to long-term damage of the brain.

If your son has had three fairly severe concussions, it is probably worthwhile for him to consider other sports with less physical contact, therefore, less likely to cause head injuries. These can include team sports like baseball and volleyball, or individual sports like running, swimming, badminton and tennis.