Ask the Pediatrician

by Jim Raelson MD

football player

Q: My son suffered a concussion 2 weeks ago playing Pop Warner football, is it OK for him to go back to play?

The sad reports of permanent brain damage in professional football players has led to all of us being more careful about concussions. A concussion is a brain injury; the delicate brain has been slammed against the inside of the skull. There is usually some element of brain tissue edema. Concussions can vary in severity and are graded 1 to 3 based on symptoms. Concussion symptoms include headache, confusion, drowsiness, memory loss, irritability, difficulty concentrating, fatigue, feeling “out of it” and in more severe cases; vomiting, loss of consciousness, and disorientation. Any child with a more severe or grade 3 concussions should go to the ER immediately.

No child with a concussion should ever return to play the same day. Your child’s doctor should evaluate less severe concussions the next day. Guidelines have been developed by expert organizations to guide doctors, coaches, and schools in deciding when a child can return to their sport. A child should first have 24 to 48 hours of cognitive and physical rest. Cognitive rest means no homework, no intense videos, no games. After 24 hours the child with no symptoms the child can return to school and normal light daily activities. After another 24 hours of no symptoms while going to school the doctor can clear the child to begin 6 step gradual return to full sport participation. Each step is more intense physically, the child is allowed to progress to the next step if she or he has no symptoms for 24 hours; if symptoms return then the child goes back a step.

Most children recover this way in 7 to 10 days so your child may be OK but really needs to be cleared by your doctor and this step program. I have found our coaches on Kauai to be very knowledgeable and well trained in concussion management.

Also, some general rules are 2 concussions in one season means no further play that season; a 3rd concussion may require sitting out for a year. A severe concussion means the player is out for the season and 2 severe concussions might lead a parent to take their child out of contact sports.

soccer player

Q: My girl wants to play soccer but every time she runs hard she coughs and gets easily winded, she had asthma when she was younger, wouldn’t it be better for her to not play?

Asthma unfortunately affects 18.6% of children in Hawaii; almost 1 in 5! Asthma changes as your child grows older and often children who wheezed with colds when little develops exercise asthma in middle school. But remember: take control of your asthma don’t let asthma take control of you! Exercise is very important for your child, it helps build lung capacity and decrease the effects of asthma. Fortunately there are safe effective medications your child can take and still play sports. In the last 5 Olympics, 8% of athletes had asthma, many of them in running and endurance sports. They took control of their asthma and didn’t let it slow them down. See her doctor soon and get her into soccer!