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My son had a severe concussion, should we pull him out of sports?

A test dummy performs an impact test at the Neurotrauma Impact Science Laboratory at the University of Ottawa.

Dave Chan/The Globe and Mail

The Question: Our family was recently in a car accident where our 15-year-old son suffered a severe concussion. He has recovered, but we're worried about his extracurricular activities as he's an avid hockey and soccer player. What precautions can we take to be sure he doesn't suffer a second, worse concussion? Should he even be playing?

The Answer: Concussions are surprisingly common in children. Half of all childhood concussions are sports-related but, as your case demonstrates, many head injuries occur in other settings as well.

If your teenager has suffered a concussion it is imperative that he be medically cleared – before returning to sports – by a physician who is experienced in concussion management. The need for a medical evaluation is critical since your son's preferred sports, hockey and soccer, both carry significant risk of concussion.

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It's important to seek a thorough assessment and follow-up because the signs and symptoms of pediatric concussion can be subtle and may be easily overlooked by coaches, parents, physicians, and even your child. A concussion can be triggered not only by a direct blow to the head or neck, but also from trauma sustained elsewhere on the body as the force of the impact can be transmitted to the brain. While wearing an approved, properly sized helmet is an important part of injury prevention, helmets alone won't protect you against concussion.

In my clinic the most common concussion symptoms are headache, nausea, and dizziness. Severe symptoms can include amnesia and loss of consciousness, while more subtle ones may include irritability, difficulty concentrating, and changes in sleep patterns.

A child or adolescent suspected of sustaining a concussion during a sporting event must be removed from the game or practice immediately, even if the symptoms are mild. This often goes against the instincts of the athlete who may want to continue playing, and the desires of the coach who may be reluctant to lose a player. Fortunately coaches are increasingly aware of concussion symptoms, risks, and management on the field.

Once a child has been medically assessed, the best treatment is rest. I cannot overemphasize the importance of rest, both physical and mental. Physical rest includes avoiding any and all exertion while mental rest involves avoiding activities that require sustained concentration such as reading, school work, and all but minimal time in front of the television and computer. My tongue-in-cheek advice to children suffering from a concussion is "Just don't think!" Mental rest is often the most challenging part for families and teens who don't want to fall behind at school.

Fortunately for most, concussion symptoms dissipate over a period of days. For those with a more severe injury, the symptoms can last for weeks or even months. Once a child has been symptom-free for several days, I develop a plan with the family to gradually increase both physical activity and mental exertion. Typically this starts with a gradual return to school and light activity, such as walking. Children who remain symptom-free can then resume a full academic workload and participate in non-contact training.

Eventually athletes can return to full-contact sports and resume competition. Athletes who try to return too early increase their risk of re-injury, and the development of chronic symptoms that can impact not only their ability to return to sports, but may also impact learning and function in the long term.

Dr. Michael Dickinson is the head of pediatrics and chief of staff at the Miramichi Regional Hospital in New Brunswick. He's a staunch advocate for children's health in Atlantic Canada through his involvement with the Canadian Paediatric Society.

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