Sports Concussions Vary for Boys and Girls

It was just another after-school soccer practice when 13-year-old Ava James bent down to retrieve a ball and another player’s shot on goal smacked her on the side of the head, slamming her head against the goalpost. Dizzy and a little nauseous – classic concussion symptoms – Ava sat down. Fifteen minutes later, feeling better, she resumed practice.

After practice, her head began hurting again. When the pain persisted through the next few days of school – and soccer practice – Ava told her mom, Alexandra. Ava’s pediatrician referred her to Paul Fisher, MD, at Lucile Packard Children’s Hospital at Stanford.

As soccer, lacrosse, and other popular “incidental contact” girls’ sports – including cheerleading – have boomed, so has the concussion rate for girls like Ava, rising about 21 percent each year over a recent 11-year stretch, according to a 2011 study in The American Journal of Sports Medicine. For boys, the increase has been 14 percent.

With these trends in mind, we sat down to talk with Fisher, chief of pediatric neurology at Packard Children’s and professor of neuro-oncology at the Stanford University School of Medicine; and pediatric neurosurgeon Gerald Grant, MD, associate professor of neurosurgery at the School of Medicine, to find out more. Grant, a U.S. Air Force veteran, treated soldiers with blast concussive injuries in Iraq and worked with civilian sports injury specialists in developing military protocols for dealing with concussions.

What are the symptoms?

Dr. Fisher: A concussion is a head injury that causes temporary impairment of normal brain function, such as loss of awareness or alertness. Girls and boys tend to report different symptoms of a concussion and may also describe the same symptoms differently. Boys often report symptoms that are fairly severe – confusion, bad headaches, forgetting – while girls may report milder symptoms, such as drowsiness, malaise, or noise sensitivity. But that doesn’t mean a girl’s concussion is any less severe.

A big problem here is that when a girl reports milder symptoms to a male coach – and a lot of coaches in girls’ sports are male – her concussion could be missed if the coach isn’t alert to the differences in how boys and girls report symptoms.

We can’t prevent all concussions, but what can we do to reduce their number?

Dr. Fisher: Probably the most effective way to reduce the number of sports-related concussions is just to enforce the rules of whatever game is being played.
That’s particularly important in girls’ sports, because when the level of play and the rules are the same, girls get more concussions than boys. No one knows why.

What can be done to reduce the effects of a concussion?

Dr. Fisher: Spot it early. Everyone should know the symptoms of a concussion. Having coaches and parents keeping an eye out for symptoms isn’t enough – players need to watch out for each other.
A lot of times athletes are reluctant to report concussion symptoms – theirs or another player’s – because they’re afraid of being thought of as wimpy, or hurting the team. But they should understand that the sooner they acknowledge a concussion, the less playing time they will lose.

A kid who gets a concussion has to sit out sports for a while. It’s paramount to keep them from getting a second concussion before the first one has healed.

Kids need to reduce physical activity after a concussion — what about mental activity?

Dr. Grant: After some initial rest – which could be less than a day to a couple of weeks, in severe cases – it’s okay to stimulate kids’ brains. But it should be in short pulses – no more than 30 minutes of any particular activity, so their brain doesn’t get fatigued. That applies to watching TV, playing video games, reading and schoolwork.

If a child has to cut back on schoolwork or attendance at first, it may be best for them to gradually work back to a full school day. The classroom can be very difficult for a boy or girl recovering from a concussion, because there is so much activity going on. They may have trouble listening, their memory may not be up to par, and they don’t have their usual stamina.

When can an athlete get back on the field?

Dr. Fisher: For most kids, one to three weeks after a concussion is when they should be transitioning back to their normal level of activity, rather than resting.

When I saw Ava, it was two weeks after her concussion. She hadn’t played soccer in a week and a half and had taken a few days off from school. After a thorough evaluation, I concluded she had already rested and recovered to the point where she could – and should – resume her normal activities.

What is the take home message?

Dr. Grant: Everyone needs to be on the same page. Coaches, parents and players all need to recognize the symptoms of a concussion and girls should be evaluated if there is any concern.