Most organized athletes in North America are children and youth. According to the recent NCBI published report “The Pediatric Athlete: Younger Athletes with Sport-Related Concussion”, (William P. Meehan, MD, Alex M. Taylor, PsyD, and Mark Proctor, MD) about 25% of the pediatric concussions in America presenting in the Emergency room occur during some athletic activity. There is now a large amount of data for high-school and college aged youth, but little recorded data on pediatric athletes with concussion.
A recent study in the Journal of the American Medical Association (JAMA) reports that up to 20% of youth athletes suffer at least one concussion. These concussions are caused by sudden movement of the brain from a blow to the head or body. TBI is most frequent in contact sports. While most concussions are not immediately life-threatening they are a TBI and we know that in children they pose a much greater risk than in adults.
Pre-high school aged athletes with concussion pose a serious concern as we are aware that the child brain is continuing to develop into young adulthood. Concussion injury on the brain is not well understood for any age group, however we have clinical evidence that TBI in children is different than in adults. From the Study:
Concussion is caused primarily by a rotational acceleration of the brain. Clinicians have hypothesized that increasing both the cervical muscle strength and tone at the time of impact can reduce the risk of concussion by increasing the effective mass of the head, which becomes more of a unit with the rest of the body as the neck muscles strengthen. This, in turn, reduces the resultant acceleration for a given force.
This difference in neck strength has biomechanical effects, shown both experimentally in animals and clinically in children. Recent evidence supports this hypothesis. Given the relatively weak cervical muscle strength compared with their older counterparts, younger athletes might be at increased risk for concussion when hit with the same magnitude of force. Of course, as other investigators have pointed out, this same decrease in muscle strength may result in less force delivered by the striking athlete at the time of injury, thereby decreasing the risk of injury.
Countering this hypothesis, biomechanicians have demonstrated that greater force is required to cause similar concussive injury in smaller brains than in larger brains with greater mass. Thus, it has been suggested that children symptomatic after a concussion have sustained greater force than an adult with similar postconcussive symptoms. This would suggest that the weaker neck muscles and larger head may be a more important issue than the overall small size of the athlete because these weaker forces are disproportionately applied to the brain.
Clinically, the different effects of age on head injury have been investigated. An analysis by Berney and colleagues revealed that children younger than 3 years sustained head injuries associated with lower energy mechanisms and more skull fractures, subdural hematomas, and early seizures than their older counterparts. They were also less likely to lose consciousness than older children. Those children aged 3 to 9 years sustained head injuries after higher energy mechanisms, were more likely to lose consciousness, were more often comatose, had less subdural hemorrhages, and had more significant cerebral edema. Injuries sustained by children older than 9 years were more like adult injuries with high energy mechanisms and more extradural hematomas. These age-dependent injury patterns warrant further investigation into the possible differences in concussive brain injury between patients of varying ages.
This study underscores the importance of seeking medical attention immediately for children who have received a blow to the head, or who are considered to be at risk of having sustained a TBI.
Symptoms of concussion include:
For more informatino on the study read here.