Playing Through Pain? Not for Kids
Tuesday, October 10, 2006
After a nasty collision on the field, a face-first dive and a fierce somersault, soccer player Kerry Aldrich went home three weeks ago with a post-scrimmage concussion. Had it happened several years ago, her coach might have told her to rest through the weekend and report for practice Monday.
Today, however, the Vienna 10th-grader remains on the sideline. A doctor still has not cleared her return to the game.
Research is rewriting the rules for the treatment of juvenile concussions and for the hundreds of thousands of young athletes who get "dinged" annually in the United States. What was once considered "a relatively benign condition," as a recent commentary in the journal Pediatrics noted, is being recognized as a critical medical issue with distressing, potentially permanent consequences.
Growing evidence indicates that youth is not a plus with concussions. When jolted violently from a hard hit or fall, a juvenile brain may be more vulnerable to harm and slower to heal. It also seems in greater jeopardy of subsequent damage. Yet many pediatricians and frontline practitioners are only beginning to adjust what they tell patients.
"It can be a very serious injury," said Gerard Gioia, director of the sports concussion clinic at Children's Hospital, one of the few programs on the East Coast that focuses on such cases. "And with what we know about the developing brain, it can be an even more serious injury."
The risks explain why 15-year-old Kerry is on inactive status while her school and touring teams play major fall games.
"It's very, very important that you give yourself a break," Gioia emphasized when Kerry returned to the Rockville clinic last week. He went over the latest blue-and-red test results showing how well she was retaining and reacting to information. All the bars had moved the right direction, back toward normal, just not far enough yet.
"That's the good news," he told her. "The stinky news is that we've still got some handcuffs on you."
Concussions in children have long been underestimated, misdiagnosed and poorly managed, Gioia and other specialists say. They do not cause bleeding or swelling in the brain, so they do not show up on X-rays or usual diagnostic scans. Until recently, there have been few ways to measure the effects, from headaches, dizziness and double vision to sluggishness, confusion and poor concentration.
Doctors have had to depend largely on their patients to describe the severity and duration of symptoms. In a sports-driven culture that celebrates the competitor who pushes through pain, some coaches, parents and young athletes have minimized or overlooked warning signs. Most likely, few understood that those could lead to lasting learning problems or personality changes.
The burgeoning ranks of children in competitive sports -- and heightened awareness of the danger -- have helped propel the focus on concussions. With some of these athletes experiencing difficulties long after their ostensible recovery, recommendations about managing such mild brain injury became suspect.
"We've learned more about this injury in the past five years than in the past 50 years," said neuropsychologist Michael Collins of the University of Pittsburgh Medical Center. The center has been the leading researcher of sports concussions in the country, designing computerized testing dubbed ImPACT that takes the guesswork out of assessments. Its list of hazardous endeavors: not just football, soccer and basketball, but ice and field hockey, skating, wrestling and cheerleading.