Silly question? Maybe not presently or during the recent past.   

With all the 'negativity' about serial TBI and the potential long term damage in particular to kids' brains, the question is a little more weighty than   

in generations past.

Certainly untreated concussions may be an issue.1

​  

​However, as a whole the benefits of exercise and sport far outweigh the argued potential problems.  

Some of the many benefits of sport participation for children (indeed for most of us) include2:​ 

 

· reduced risk of obesity     

· increased cardiovascular fitness      

· healthy growth of bones, muscles, ligaments and tendons     

· improved coordination and balance     

· a greater ability to physically relax and, therefore, avoid the complications of    chronic muscular tension (headache or back ache)     

· improved sleep     

· mental health benefits, such as greater confidence      

· improved social skills     

· improved personal skills, including cooperation and leadership.

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What is an issue however is UNTREATED TBI. Generally, in the form of Mild TBI (mTBI), the sufferer does not show any obvious signs as we would expect from the movies; seeing stars, head spinning, blackout, spasticity, etc.

Like any other injury, if untreated problems will occur.3 

Unfortunately if signs are not indeed obvious, sufferers may slip through the cracks with potentially disasterous , long lasting effects.

​Asymptomatic children and adolescents with a history of concussion showed a distinct performance decline for a prolonged period of time (2 years) following their last concussion, a finding which is highly important for future discussion about current return to play (RTP) guidelines and reducing the risk of re-injury in this age group. We suggest that examining performance requiring the integration of biomarkers, cognition and action is a useful and important approach to comprehensively assess brain function following concussion.4.


Many young athletes in competitive sports, such as ice hockey, may try to minimize or hide their concussion symptoms from coaches, parents, and clinicians.5.Thus, standardized patient assessment tools can be helpful in identifying concussion. Although none of these tools are particularly well validated, their use is recommended.

The Centers for Disease Control and Prevention (CDC) "Heads Up" initiative provides many tools and resources for parents, schools, coaches, and clinicians to prevent, recognize, and respond to concussions and other TBI's.

                                                                           https://www.cdc.gov/headsup/index.html


These tools/resources include information sheets, posters/infographics, stickers, and palm cards, as well as free online applications (apps), embeddable microsites, and training.

Removing athletes from play following a concussion or other TBI is crucial, as they are more susceptible to repeat head (or other) injury due to slowed reaction times. Repeat concussion prolongs symptoms, and there is growing concern that postconcussive symptoms are associated with long-term cognitive dysfunction and other neurologic sequelae.5-7. The American Medical Society for Sports Medicine (AMSSM) indicates that athletes should be free from concussion symptoms before being cleared to return to play.8.

Emerging evidence suggests that early return to physical activity may be helpful in reducing the severity and chronicity of postconcussive symptoms. The activity should not be one that is high risk for repeat head injury.

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The signs and symptoms of mild traumatic brain injury(mTBI) may include9.:

Physical symptoms

     ·  Loss of consciousness for a few seconds to a few minutes 
      · No loss of consciousness, but a state of being dazed, confused or disoriented 
      · Headache 
      · Nausea or vomiting 
      · Fatigue or drowsiness 
      · Difficulty sleeping 
      · Sleeping more than usual 
      · Dizziness or loss of balance 

Sensory symptoms

      · Sensory problems, such as blurred vision, ringing in the ears, a bad taste in the mouth or changes in the ability to smell 
      · Sensitivity to light or sound 

Cognitive or mental symptoms

      · Memory or concentration problems 
      · Mood changes or mood swings 
      · Feeling depressed or anxious 

Children's symptoms

Infants and young children with brain injuries may lack the communication skills to report headaches, sensory problems, confusion and similar symptoms.

In a child with traumatic brain injury, you may observe:

      · Change in eating or nursing habits 
      · Persistent crying and inability to be consoled 
      · Unusual or easy irritability 
      · Change in ability to pay attention 
      · Change in sleep habits 
      · Sad or depressed mood 
      · Loss of interest in favorite toys or activities 

When to see a doctor

Always see your doctor if you or your child has received a blow to the head or body that concerns you or causes behavioral changes. Seek

emergency medical care if there are any signs or symptoms of traumatic brain injury following a recent blow or other traumatic injury to the head.

The terms "mild," "moderate" and "severe" are used to describe the effect of the injury on brain function. A mild injury to the brain is still

a serious injury that requires prompt attention and an accurate diagnosis.


Sport-related concussion is a health risk to our children and adolescents and, therefore, requires accurate diagnosis and appropriate management by providers. Information on sport-related concussion in children and adolescents currently found in textbooks is typically not enough to prepare practitioners to diagnose and manage these patients. Research will ultimately provide evidence that will support standard practice guidelines that can be published for provider education. However, until this occurs, it is essential that educators provide the essential information for accurate diagnosis and the most up-to-date recommendations for appropriate management.10.


Sporting codes have also been slow to recognise and indeed admit there may be issues in and around concussion recognition and treatment. The flow down effect, 'weekend warriors' and kids don't receive the care they need post a head knock.

You as mums and dads are the true gate keepers when it comes to; 

1. Deciding what sports your kids play, 

2. What happens re your kids returning to play post concussion. 

However, it is ultimately up to sporting administrators, researchers, clinicians, and team trainers to provide all the most relevant up to date information for you to make these potentially 'life changing' decisions.


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TBI can be a concern for children even more so than for professional adult athletes. Unlike other injuries where the young body seems to heal more rapidly than the adult one, brain related trauma can heal more slowly and be longer lasting.11 Beyond the current neuropsychology, balance/dexterity and other clinical indicators, researchers are working on a blood based test that will assist with diagnosis and most excitingly prognostic outcomes.

 They are our future. Let's protect them.

References

1. Matthew Eisenberg, M.D., division of emergency medicine, Boston Children's Hospital; John Kuluz, M.D., director, traumatic brain injury and neurorehabilitation, Miami Children's Hospital; May 12, 2014, Paediatrics.

​2. Department of Health & Human Services, State Government of Victoria, Australia, website

​3. Lind Li, et al.  The effect of pediatric traumatic brain injury on behavioral outcomes: a systematic review. Dev Med Child Neurol. 2013 Jan; 55(1): 37–45.

4. Marc Dalecki, et al. Concussion May 12, 2016.

5. Ling H, Hardy J, Zetterberg H. Neurological consequences of traumatic brain injuries in sports. Mol Cell Neurosci. 2015 May;66(pt B):114-22. 
6. Mckee AC, Daneshvar DH. The neuropathology of traumatic brain injury. Handb Clin Neurol. 2015;127:45-66. 

7. Harmon KG, Drezner J, Gammons M, et al, for the American Medical Society for Sports Medicine. American Medical Society for Sports Medicine position statement: concussion in sport. Clin J Sport Med. 2013 Jan;23(1):1-18. 
8. Grool AM, Aglipay M, Momoli F, et al, for the Pediatric Emergency Research Canada (PERC) Concussion Team. Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents. JAMA. 2016 Dec 20;316(23):2504-14. 

​9. Mayo Clinic website

​10. Sport-related Concussion in Youth. A Curriculum for Advanced Practice Nurses. Pamela Mapstone

​11. Bond Chapman, S. (2006). Neurocognitive Stall: A paradox in long term recovery from pediatric brain injury. Brain Injury/professional 3(4), 10-13.