Concussion in children and its effects

One mother's story as statistics reveal worrying number of people with 'hidden injury'.

Rachel Halliwell for the Daily Mail After her four-year-old daughter Lucy tumbled down the stairs, Laura Halls was most concerned about the fact that she had a small skull fracture. That doctors told her Lucy had also suffered concussion barely registered. Yet within a couple of months the 1cm fracture had healed without treatment. The consequences of the concussion, though, are still present six years on. It altered Lucy’s personality and continues to affect her memory and communication skills. ‘After the accident Lucy lost her appetite — and having always been a very placid child, she began to throw tantrums,’ says 30-year-old Laura, a full-time mum who lives with husband David, 34, a civil servant, Lucy, now ten, and their other children James, 11, Keane, eight, and Dawson, two. ‘She also seemed to regress — she wanted her milk out of a bottle, which she hadn’t had since she was a baby. At first I put it down to the crack in her skull, but after we met her paediatrician a month later we realised it was the concussion. ‘I started reading up on concussion and began to realise I should have been far more worried about that.’ A Canadian study published this month found that even mild concussion can have a direct effect on a child’s personality, development and communication skills. Find a list of concussion symptoms here. Researchers monitored 130 children aged five and under — a third of them had previously been concussed, another third had suffered a minor orthopaedic injury, such as a fracture or sprain, and the rest had sustained no injury at all. Six months after the injuries they found significant differences in communication skills and interaction with parents among those diagnosed with concussion. Miriam Beauchamp, senior author of the study, concluded: ‘The quality of parent-child interactions following concussion was significantly reduced compared with non-injured children.’ The results are alarming, given that concussion is so common. More than a million people in the UK go to hospital with a head injury each year and 75-80 per cent will have some degree of concussion.
It is defined as a sudden but temporary impairment of consciousness — but actually you don’t need to have blacked out or even hit your head to have it. According to the brain injury charity Headway, only 10 per cent of people who have concussion lose consciousness. Concussion can be caused by a relatively innocuous blow to the head, and even violently moving your head back and forth may cause it. Think of your brain as a blob of jelly inside a box, says Colin Shieff, a consultant neurosurgeon at the National Hospital for Neurology and Neurosurgery, in London. ‘If you bang on that box (your skull), the jelly (your brain) will bump around inside it. This can stretch, deform and even cause microscopic tears in the fibres that connect nerve cells in the brain.’ Communication between different parts of the brain is then interrupted, the immediate result being a brief loss of consciousness or general disorientation. ‘This is when you feel shaky and perhaps see stars,’ says Mr Shieff. ‘The damaged or torn connections need a little time to start working properly again.’ For many people, any confusion, poor balance, nausea, headaches and dizziness will resolve within a fortnight. But the effects of concussion can be long-lasting. For most it is a mild, temporary condition. ‘But occasionally the damage is permanent,’ says Mr Shieff. ‘Cognitive ability might be impaired; you can see changes in personality, even depression and anxiety.

‘You may become a risk-taker or suffer general cognitive fogginess.’ The impact of concussion on a pre-schooler tends to be more severe than on an adult because their brain ‘wiring’ is immature and connections are still being made. ‘Also, they are more prone to concussion because their head is big compared with the rest of their body,’ says Mr Shieff, ‘and their muscles are weak, making them less resistant to external forces. ‘That a child grows up clumsy or not so good at spelling might well link back to when they whacked their head when they tumbled off their bike aged five.’ Yet according to Headway, persistent concussion problems can be overlooked by GPs. ‘Symptoms are often misdiagnosed as stress or depression,’ says spokesman Luke Griggs. There are many long-term issues now linked to concussion. A 2013 study of Canadian ice hockey players who suffered concussion found there was abnormal brainwave activity for years afterwards, which can lead to attention problems. Another study, by researchers at the University of California, looked at data from 164,661 patients and found a link between concussion and increased risk of dementia. In another study, researchers scanned the brains of 589 people aged 70 and older and found that those with memory impairments and a history of head trauma had, on average, 18 per cent more amyloid plaques in their brains — the hallmark of Alzheimer’s — than those with no history of concussion. Resting after concussion can help to speed recovery. That means avoiding taxing mental or physical activity and alcohol (for an adult) while the brain recovers. Katy James, head of brain injury community services at children’s brain injury charity The Children’s Trust, adds: ‘Rest for 48 hours is very important — that means resting the brain, not just the body. ‘So no reading, puzzles or computer games; just lots of sleep and peace and quiet.’ Yet a diagnosis is needed first — and this is far from an exact science. It is normally based on symptoms, some of which might not develop for up to 48 hours.
Spotting the problem can be especially hard in children. ‘With a child it will manifest as subtle changes in personality,’ says Katy James. ‘Are they irritable or off their food? Is their mood different, or have you noticed changes in their concentration and emotions?’
Mr Shieff says it is important to apply common sense. ‘If a child takes a knock in the playground but doesn’t even pause to rub where they bumped their head, then they’re not concussed. ‘The biggest indicator in anyone is a change in their behaviour. ‘If someone says: “Johnny knocked his head playing football and he hasn’t been himself since,” you must seek medical advice.’

It is, he warns, much harder to recognise it in yourself. That is because concussion can damage the brain’s Reticular Activating System (RAS). This is a set of interconnected nerve cells deep inside the central part of the brain that regulates consciousness and helps you keep aware of danger. ‘It’s the part of the brain which alerts you to signs that the house is on fire even when you’re in a deep sleep,’ says Mr Shieff. ‘If that isn’t working properly, you’ll be confused, clumsy and will have lost the protection that nerve centre gives. You could end up wandering into the road, perhaps, or walk straight into an obstacle.
‘Perhaps you’ll notice that you’re doing daft things, like forgetting to turn the gas off.’ Yet not all of those with suspected concussion are warned what to watch for or what to do. A Headway study found that just 8 per cent of hospitals in the UK were providing written discharge information that met guidelines set by the National Institute for Health and Care Excellence (NICE), with 53 per cent failing to give even half the information required. Laura, from Greater Leys, in Oxfordshire, says she was not warned of possible long-term implications when Lucy was released after an overnight stay in hospital.
Yet within hours, it was clear that all was not right. Initially Lucy was just drowsy. ‘But when she started speaking we noticed a lisp and that she struggling to pronounce some words,’ says Laura. ‘Over the next two days she appeared to have lost a large chunk of her vocabulary. At a follow-up appointment a month later, her paediatrician said she was almost certain it was due to the concussion. ‘She suggested language therapy. It did help — after four sessions Lucy could form words properly but she still had to work hard to find them. Even now you can see the concentration she has to put in.’
It was four months before Lucy was anything like her old self. ‘But I think she’ll always have problems finding words and her short-term memory is very poor,’ says Laura. ‘When you ask what she did at school today and she says she can’t remember, she is telling the truth.’
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