Hard Knocks

When we were kids playing Pop Warner football, we used to take to heart the words emblazoned on our coach's shirt: "No pain, no gain. No guts, no glory." If you didn't feel well, you sucked it in. If you were injured, you taped it up. If you took a hit on the head--got your "bell rung," as we used to say--you just shook it off and got back on the field.

It's surprising how many players and coaches still feel that way about sports-related concussions and other head injuries--surprising because we now know the internal swelling and other damage caused by repeated concussions can be additive, making the brain susceptible to further injury. Returning to the field after a mind-altering blow to the head might win football games, but it can also permanently impair development and lead to serious brain damage or even death.

Each year more than 300,000 American athletes sustain brain injuries of varying degrees of seriousness. The younger children are when they take part in contact sports, the more dangerous these blows to the head become.

The human brain is particularly vulnerable as it develops through childhood and into the teenage years, finally maturing when we reach our 20s. As the brain develops, windows open up and the mind has its best opportunity to acquire knowledge and easily learn new skills, such as speaking a foreign language. If the window closes--either with the normal passage of time or because the brain has been damaged--learning that language can be much harder.

So how do you know when a child with a banged head should return to competition? There is no simple answer. The American Academy of Neurology, however, has developed a new system that can be used as a guideline. Concussions are divided into three categories: Grades 1, 2 and 3.

A child with a Grade 1 concussion does not lose consciousness but may experience a range of symptoms that include headache, mild dizziness, ringing in the ear, confusion and blurred vision. The symptoms typically resolve in less than 15 minutes, but the child should be removed from the contest, examined immediately and then re-examined at five-minute intervals. If the symptoms clear within a few minutes, the child can return to play.

In a Grade 2 concussion, there is still no loss of consciousness, but the other symptoms may last more than 15 minutes. A child with such symptoms should be examined by a physician, and if still symptom free after a week, can return to competition.

A Grade 3 concussion, the most severe, occurs when a player loses consciousness for anywhere from a few seconds to several hours. An injured child should be transported off the field in a neck brace to protect the spinal column and taken immediately to a hospital. Returning to competition depends on how long the child was unconscious and how long it took for the other symptoms to resolve.

What's most important to remember is that a person with a concussion may look fine and speak clearly but still be suffering severe injury to the brain. Before getting back into contact sports, one should be examined by a trained professional. There's always another game, but we're never going to have another brain. Dr. Ian appears on WNBC-TV in New York. E-mail him at ianmedical@aol.com . To learn more about concussions, visit www.aan.com