Questions and Answers About Concussions

The recently released movie Concussion, starring Will Smith as the Pittsburgh coroner who sounded the alarm on chronic traumatic encephalopathy (DTC), brought increased attention to the problem of concussion in sports, especially football.

The magnitude of current information on concussion can be overwhelming and confusing to parents. Some are deciding to forego football for their children, while others are allowing them to play, trusting better equipment, better understanding by coaches to protect players and better protocol to minimize the risk of sports-related concussions to keep their kids safe.

We asked Patrick Mularoni, M.D., medical director of Pediatric Sports Medicine at All Children’s Hospital Johns Hopkins Medicine, to answer a few questions about children and concussion. You can also see a video about concussion on, provided by All Children’s Hospital.

TK: What is the best protocol for a player (youth – high school age) to follow to return to play after suffering a concussion?

Dr. Mularoni: Every state has its own specific protocol but most follow a five-day return to play protocol with gradual return to sport while increasing physical activity each day until a full return to sport is started. I presently advocate for a five-day return to play protocol where day one is light exercise, day two is heavy cardio exercise, day three is non-contact practice, and day four is full-contact practice with day five being a return to contact or games.

TK: Who is the best medical health professional to diagnose concussion? Can a trained coach, for example, tell when players can return to play?

Dr. Mularoni: Recognition of concussion falls on athletes and the adults that are at the field. A parent, athletic trainer, or coach can recognize concussion but a physician who is comfortable managing concussion should be the one to make the diagnosis. For parents at the field, we use the mantra “when in doubt sit them out.” If you question whether concussion has occurred, pull the player and do not let them return until they have seen a physician who is comfortable treating concussion.

TK: What are the symptoms of concussion that coaches, teachers and parents should watch for?

Dr. Mularoni: The most common symptoms are headache, dizziness, a feeling of slowness, a foggy type feeling and emotional changes. Other children may describe nausea, sensitivity to light, or sensitivity to sound.

TK: What can adults do to combat the tendency for children and youth to hide symptoms?

Dr. Mularoni: Children want to play but when they understand the consequences of playing with concussion,  many of them make the right decision.

TK: Are children’s concussions different from adult’s? If so, how?

Dr. Mularoni: Concussion seems to be the same condition in children and adults. The major issue is that children have the stressors of organized sports and the urge to get them back for their team. In addition, children have the stresses of school with a regimented schedule and testing. Many of the symptoms of concussion get worse with use of smart boards and computer screens. Today’s children suffer more because the use of multimedia devices causes exacerbation of symptoms.

TK: Do individuals completely recover from a concussion? Can kids continue to play sports after having a concussion?

Dr. Mularoni: With our present understanding of concussion, most experts will agree that if a child has completely resolved from concussion and is symptom free, they can go through a five-day return to play protocol and then they are safe to return to sport.

TK: Can young people develop brain injury from repeated hits (as in football practice) without actually suffering from a recognizable concussion?

Dr. Mularoni: Research has yet to answer this question. There are many questions about whether sub concussive hits are causing damage, and we should have more information on this as research in this field increases and progresses.

TK: What can be done to minimize concussion in children and youth?

Dr. Mularoni: Teaching proper technique is key. Coaches and parents need to stress proper tackling techniques in football and proper hitting techniques in sports like hockey and lacrosse. In sports like soccer athletes need to play by the rules, which do not promote contact.

TK: Should children play football? Should high school students play football? If you have a child or if you did have a child, would you allow that child to play football?

Dr. Mularoni: The decision whether to let your child play football is a personal one. In our concussion clinic we have seen over 600 youth athletes with concussion in the past year. These concussions occur in all sports including swimming, gymnastics, ice skating, soccer, and contact and collision sports. Football is the most common sport where males suffer concussion and soccer is the most common sport where females suffer concussion. I have three children and I allow them to play contact sports. If my son who is 4 chooses to play football, lacrosse, or hockey, then I would allow him to. I feel that the games are getting safer and that under proper supervision the benefits that the sports provide outweigh the risks.

TK: What is the most important thing that parents should know about concussion?

Dr. Mularoni: The most important thing that a parent should know is that their child should not play with concussion. There is no minor concussion and every one of them should be treated the same. Athletes should not be allowed on the field with concussion symptoms. So often I see athletes who have gone back out on the field with concussion and it’s often the second hit after a concussion that does the most damage. We should continue to teach our children what the signs of concussion are and encourage them to report those symptoms so that they can get off the field and heal before returning to play. “When in doubt sit them out.”

Categories: Health