It Takes a Village to Manage Concussion Symptoms in Kids

As a social worker in the De Soto School District in Kansas, Joe Kordalski has learned a lot about concussion symptoms in kids. He sets up academic accommodations for students who have experienced head injuries.

"I've given a lot of advice to other families," says Joe. "But it's a little different when it's your own kiddo."

In February 2020, Joe's 10-year-old son, RJ, was playing point-guard for his 4^th grade basketball team, the Westwood View Pythons. A loose ball caught RJ's eye. He dove for it, as did a member of the opposing team. Their heads collided and RJ fell to the floor.

"Everyone caught their breath and ran over to make sure he was okay," says Joe, who was keeping score. RJ didn't lose consciousness, but he didn't feel good. He sat on the bench for the rest of the game.

On the way home, RJ told his dad he had a horrible headache and just stared out the car window. He didn't eat dinner and was not his usual active self. Joe suspected his son had suffered a concussion.

That night, Joe and his wife, Adrienne, discussed their options. They didn't think RJ's symptoms warranted a trip to the emergency room, but they decided to keep him home from school the next morning.

Joe was familiar with the partnership between The University of Kansas Health System and his school district. The health system provides certified athletic trainers to assist with athletic injuries, including concussions.

Trusting the health system's expertise, Joe contacted the Sports Medicine and Performance Center at Indian Creek Campus. The next day, RJ met with David Smith, MD, a primary care sports medicine physician and concussion specialist.

"It's important to be seen by a physician who's trained to evaluate concussion symptoms in kids within the first 48 to 72 hours. If you wait a week or 2, it's more difficult for us to make an appropriate diagnosis and tailor an individualized treatment plan," says Dr. Smith.

Diagnosing a 10-year-old is not easy. For concussion patients over 11, Dr. Smith uses a computerized neurocognitive test. Although the tests are available for children under the age of 11, our sports medicine and concussion specialists do not routinely use them.

"Instead, I relied on RJ to help me understand what had happened. He's a cool kid, quite mature and analytical for his age. He was able to describe the injury, what it felt like and what symptoms he had been experiencing," says Dr. Smith. "His dad allowed him to answer the questions in his own words, which had a positive impact on our treatment plan and his recovery."

When devising a treatment plan for child concussion recovery, Dr. Smith considers many factors. The location and intensity of the injury. The patient's personality and health history. The patient's ability and willingness to follow orders. The level of intervention from the family. And finally, the degree to which the school's teaching staff and coaches will support the child.

"Every concussion is unique. We do whatever we can to expedite the brain's healing process," says Dr. Smith.

RJ and his dad appreciated Dr. Smith's undivided attention during their appointment. "Dr. Smith helped RJ understand how this impacted him and what to look for," says Joe. "He also explained the level of supervision my wife and I needed to provide."

At home, Adrienne kept the lights low and noise to a minimum. RJ's younger sister, Brooklynn, did her best to watch TV or play on the iPad when RJ was not around.

"We really had to slow life down. Everyone made small sacrifices to make sure RJ had the opportunity to heal," Joe remembers.

Acclimating to the new normal was especially hard on RJ. "At first, my head hurt so bad that doing basic stuff was difficult," he says. "Later, it was tough to follow the doctor's rules. He told me not to participate in sports, gym class, running or jumping. Those are the activities I love to do. I was really bored."

One factor that complicated RJ's diagnosis and treatment plan was a history of significant motion sickness. For years, RJ had suffered dizziness and nausea while riding in cars. In fact, the family had traded in one car for another to alleviate his motion sickness.

"Unfortunately, concussions often cause motion sickness in patients who have never experienced it before. It's called vestibular dysfunction," says Dr. Smith. "And for patients like RJ, who are naturally sensitive to motion, studies have shown that concussions are likely to increase those unpleasant symptoms."

After 2 weeks of rest and inactivity, RJ returned for a checkup. He described some lingering dizziness and vision problems. Dr. Smith recommended another 2 weeks of limited activity.

"Adults often recover from concussions in 3 weeks," he says, "but child concussion recovery usually takes longer. Around 4 weeks or so."

Once Dr. Smith cleared RJ for activities, he was still a bit reluctant to participate. He worried the pain and dizziness would return. "It was pretty overwhelming and stressful to not know when I was going to get better," says RJ. "Sometimes I didn't really know what to do next and I'd get confused."

In his experience managing concussions, Dr. Smith has seen the huge role anxiety plays in child concussion recovery – the same is true for adults. "The injury itself stirs up the emotional center of the brain and changes the brain's function. Emotional responses are extremely common," he explains.

After nearly 5 weeks, RJ confidently resumed his normal activity level, including basketball practice and games. RJ's coaches, teachers and family monitored him closely to ensure continued success.

"Because of his early evaluation and excellent compliance with the concussion management plan, RJ was able to recover from a youth sports concussion without any major issues," says Dr. Smith.

RJ's parents have no plans to restrict his athletic pursuits. "We see the pleasure he gets out of playing," says Joe. "We also see other rewards. He's learning to be a good teammate who values communication and respect. We think those benefits outweigh the risk of concussion."

For anyone dealing with concussion symptoms in kids, RJ has some expert advice. "Take it easy, get good sleep and limit a lot of your activities," he says. "Doing those things helped me get better."

Patient testimonial: As with all treatments, individual patient results vary. It is important to discuss your treatment options with your healthcare provider.