Concussions and Child Abuse and Neglect

We’re living in a day and age with heightened awareness concerning brain and head injuries. In years past, what was once considered as getting your bell rung, is now seen as something that could cause permanent damage.

This paradigm shift can be seen, for instance, in the changes administered in youth football and other sports. Efforts have been made to remove tackling for 12-and-under leagues, which is already being enforced in Canada.

However, when such a topic finds itself at the forefront of mainstream media platforms, it tends to fall victim to misinformation. It’s as though everybody’s child has suffered a concussion and is doomed to a life of CTE.

That isn’t to say being cautious about the health of our children is a bad thing.

Still, when these fears are leveraged to falsely accuse someone of child abuse, the sensationalizing of concussions becomes a serious issue.

Is a concussion any blow to the head?

Given the information being spread these days, one might think the answer is yes. Furthermore, in California, there’s something called the “concussion return-to-play law.” If there’s even a hint that a child is concussed, they should be sat out.

As discussed in a published research paper called “When in Doubt, Sit Them Out,” coaches are expected to be educated on the signs of a concussion. Though, curiously, they aren’t obligated to take CPR training that outright teaches concussion protocols (though they’re still expected to be trained in CPR). See Josh Hunsucker, “When in Doubt, Sit Them Out”: Chapter 173 Effectively Supplements California Concussion Law and Raises Awareness Among Coaches, 44 McGeorge L. Rev. 600 (2013).

But I digress—we need to give a more precise definition to concussions.

According to medical professionals, mild head trauma lacking in neurological symptoms is known as a head injury. If symptoms are involved, it’s commonly called a brain injury. Concussions are a mild injury that can lead to momentary unconsciousness up to a minute or two. Conversely, consciousness might not be lost after being hurt, and a concussion can still have occurred.

With head injuries, the pathophysiology is yet to be fully grasped in the medical community. There is the assumption that there is impermanent brain cell damage occurring in the surrounding axon glia and blood vessels.

It’s believed by field professionals that these effects are a result of rotation-acceleration forces.

According to the Minneapolis Clinic of Neurology, a concussion injury in very young children can be different from concussions in grown men and women. This is because a child’s skull is flexible and the consistency of the brain is softer. When you add those two factors to the fact that very young children have larger heads relative to the bodies and have a difficult time controlling their head movements, young children are more prone to minor injuries. Many doctors believe toddlers may experience brain swelling more easily than older children for these reasons. After two years old, the skull and brain start to develop and mature at a faster pace. By ten years old, children’s brains and skulls likely respond to outside forces more similarly to adults.

First and foremost, abuse is the #1 cause of deaths due to brain injuries in children between 0 and 4 years old. Statistics show that there are 150 of these mortalities per year.

For something to be classified as abuse, it can’t be an accident and can be avoided without question. The swelling and bleeding that could lead to a child’s death are caused by physical trauma to the head or shaking of the brain.

Even if a child survives this kind of abuse, there’s a chance that they’ll be dealing with permanent damage. Symptoms can be seizures, learning impediments, paralysis, and blindness, just to start.

In milder instances, it can lead to permanent changes in personality and behavior.

While throwing a child back into a football, soccer or other athletic competition with apparent concussion symptoms could be construed as negligent, the signs of concussion aren’t always visible.

Once a coach is in doubt, they’re expected to sit the child out. Also, the injured individual can’t play again until they’re cleared by medical personnel.

While concussion-specific CPR training isn’t mandatory (at the time of this writing), there is a wealth of resources offered on the topic, such as free online courses.

There’s a failure to establish a statewide standard in concussion training, which leads to coaches only learning the standard care methods. These are perceived to not be up to the rules of governing bodies such as the CDC that would ensure child safety.