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Concussions On or Off the Playing Field: What Parents Need to Know

Hassenfield Children's Hospital

From the real experts at Hassenfield Children’s Hospital at NYU Langone:

A concussion is an injury to the brain caused by sudden head movement – from either a jolt or blow to the head or body. While many people think of football and other contact sports as the most common cause of concussion, playgrounds and bicycling or scooters are the leading cause of concussion in children. It is critical that children play safely and that kids, parents, and guardians know how to spot the signs and symptoms of concussion. Symptoms from a concussion can take minutes or hours to develop, so if a concussion is suspected, it is important to book an appointment with a doctor trained in concussion management for a thorough evaluation after a blow to the head or body. Concussions typically resolve on their own within a month of injury, but recovery is faster for children who see a specialist right away.

A few simple precautions can help keep you and your children safe:

  • Use age-appropriate playground and cycling equipment
  • Ensure that equipment is properly maintained for safety
  • Use guardrails to prevent falls
  • Wear a helmet when bicycling, skateboarding, or using a scooter
  • Look out for hazards that can cause trips or falls
  • Talk with kids about the importance of playing by the rules to avoid unintentional injury

Concussion identification:

Signs or symptoms of concussion may include:

  • Headache
  • Dizziness
  • Balance problems
  • Nausea
  • Mood changes
  • Difficulty sleeping
  • Difficulty concentrating or remembering
  • Sensitivity to light or noise

You should immediately seek medical help or call 911 if there are signs of:

  • Loss of consciousness
  • Severe or worsening symptoms
  • Sudden changes in speech or walking
  • Bruising around the eyes or behind the ear
  • Facial deformity
  • Vision changes


Children can begin to return to their normal, non-contact, non-strenuous activities a few days after suffering a concussion as long as their symptoms do not increase with activity. Promoting good sleep and nutrition can help the child feel better. The child can also gradually return to school as tolerated under guidance from a physician, so communication with school administration is important. Children should not return to sports or strenuous physical activities until they are in school full-time and have been cleared by their physician.


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Elizabeth Barchi, MD, is a clinical assistant professor in the Department of Orthopedic Surgery and sports medicine specialist at NYU Langone Health. She sees children and adults at NYU Langone Orthopedic Hospital and the Joan H. and Preston Robert Tisch Center at Essex Crossing, and her main interests include injury prevention, cross-training, nutrition and energy availability, and optimizing recovery.

The 4-1-1 on Concussions During School Sports


Participating in sports can be an important part of kids’ social and physical development, but school athletics are not without risk of injury.

That’s why New York City’s Public Schools Athletic League (PSAL) both encourages students’ participation and promotes safety in athletics. One of PSAL’s primary health concerns is concussion, a common injury in contact sports, such as football, lacrosse, wrestling, basketball, and soccer.

What is a concussion?

A concussion is a traumatic, usually short-lived brain injury that can result from either a direct blow to the head or a hit to another part of the body that causes whiplash-like motion in the neck and head. Imagine the brain as Jello being forcibly shaken back and forth within the confined space of the skull.

Concussion symptoms

Contrary to popular belief, less than 10 percent of concussions involve any loss of consciousness. Classic symptoms include:

• Headache or pressure in the head;
• Confusion or fogginess;
• Nausea;
• Sensitivity to light or noise;
• A delay in response when questioned;
• Glassy-eyed stare or dazed appearance.

How do NYC school sports programs handle concussions?

Guided by the New York State Concussion Management and Awareness Act, PSAL’s concussion policy calls for student-athletes suspected of sustaining a concussion to be removed from the field immediately—there’s no reason to wait for a definitive diagnosis. Students may not return to athletic activity for a minimum of 24 hours and until they have been evaluated by and received written clearance from a licensed physician.

It is important for parents to seek appropriate medical care from a doctor experienced in treating concussions.

How long do symptoms last?

Recovery times differ. It typically takes 10 to 14 days for all symptoms to clear. However, some kids may take longer, especially younger athletes; girls; students who have had one or more previous concussion; those with a learning disability, attention-deficit/hyperactivity disorder (ADHD), or mood disorder like depression or anxiety; and those with a history of headaches. The severity of injury or time since it occurred doesn’t predict the duration; some of the mildest concussions cause symptoms lasting for weeks to months and vice versa.

Concussion treatment and recovery

As difficult as it may be for active young people, the main treatment is cognitive and physical rest.

Cognitive rest includes limiting TV, computer, and texting time, as well as class time, studying, papers, and exams until symptoms begin to resolve. Some children need to avoid school for several days to a week or two, or attend half days until symptoms start to subside. As kids feel better, they should progress gradually to normal levels of activity.

Physical rest means no strenuous physical activity until symptoms have completely resolved. However, there is usually no reason for complete bed rest. Light aerobic activity, such as walking or stationary bicycling, may speed healing and help keep kids’ spirits up.

Rest times may vary, and a concussion specialist can help determine the best treatment course.

When is it safe to return to sports?

Even if a physician has cleared a student to return to athletic activity, parents and coaches should have the final say, as they know the kids better than anyone. Once symptoms have disappeared completely and athletes have been cleared, school sports programs follow a step-wise “return to play” protocol where kids gradually increase physical exertion over five to seven days, watching for any recurrence of symptoms. Depending on the number of previous concussions a student has sustained, the return to play may be slower or curtailed for the season.

For more information

To learn more about concussion in sports, start with this informative PSAL PowerPoint presentation about everything from identifying, diagnosing, and managing a concussion to PSAL guidelines.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Dennis A. Cardone, DO, is Director of Primary Care Sports Medicine in the Department of Orthopedic Surgery and Co-Director of the Concussion Center at NYU Langone Medical Center, and Chief Medical Officer for the New York City Public Schools Athletic League.