A Hockey Mom’s
Intuition

A Hockey Mom’s Intuition by Dr. Andrea Lazosky Chisholm

We all shouted encouragement as my son raced neck and neck with the other team’s player to be first to the puck. He was just ahead of the other player as he triumphantly got to the puck, just before it hit the boards. My heart suddenly sank as we all watched the other player, unable to stop his momentum, run into my son from behind and push him headfirst into the end boards.

In those seemingly endless minutes that he lay on the ice with the trainer over him, I questioned whether it would ever be worth the risk of having him continue to play hockey. What were the chances he would be okay? Had he just suffered his first concussion?

After a few moments, he was able to get up off the ice and skate unassisted to the bench. I watched to see if he would go out on his next shift, but he did not. He sat to the side and continued talking with the trainer.

Another few shifts went by and I saw him leave for the dressing room with the team staff. Something was not right. I went back to meet them in the dressing room, and my son looked fine aside from a few uncharacteristic tears. I thought he might be frustrated or mad he was not back in the game, but he said he was sore at the back of his head and neck.

The trainer said my son was being a bit vague in answering his questions. However, he seemed okay to me, just a little upset. I expected him to go back on the ice with the rest of the team after the second-period intermission, but the trainer then said my son had become more confused and did not know where he was.

It is a moment like this when parents may have a pivotal role in the identification and management of a possible concussion in their child. Parents often believe that they do not have the experience or training to manage their child’s injuries, and so they defer to others. After all, the trainer has taken a course that has certified them to be responsible for the well-being of each player on the team. But often the only advantage the trainer has is access to a series of standard questions that may be used to guide decisions about whether a player has sustained a concussion.

Concussions are relatively easy to identify when there has been a loss of consciousness, or when any of the common symptoms are apparent. However, some of the very early signs of concussion can be missed, or “symptoms” can be misinterpreted as significant when they are really normal characteristics of some individuals. Take headaches, for example. According to the University of Saskatchewan’s College of Medicine, chronic headaches are common in children and adolescents. About 50 percent of seven-year-olds and 85 percent of 15-year-olds report such headaches. There are also many causes of recurring headaches in children.

They can be a symptom of a recent cold or flu. They can also be caused by school- or home-related stress conflicts with friends or bullying. Strong smells from cigarettes and perfumes can trigger headaches in children, as can a number of foods, including milk products, eggs, luncheon meats, hot dogs, chocolate, oranges, and tomatoes. Noise, sun, changes in the weather, heat, fatigue, and hunger may all cause headaches, in addition to irregular sleep, fluorescent light, or video games. Some headaches only occur during physical activity. When a player becomes upset or cries because an injury leads to them being dismissed from the game, it could provide enough stress to trigger a headache.

Trainers use questions like the date, the score of the game, what happened leading up to the injury and where the game is being played to identify cognitive symptoms of concussion (for example, confusion, poor attention or concentration, and memory problems).

Certainly, the answers to these questions can vary in their difficulty. Knowing where you are playing is an easier question when it is a home game than when it is an away game. It is relatively easy for children to know the date on a school day, but they are less likely to pay attention to such details on the weekend.

Mental tasks such as counting or spelling “world” backward are often used to judge concentration, as well. Here, knowing the child’s background can make a significant difference. Parents know their children best and have a vast knowledge about them even before the moment of injury. This unique knowledge provides an essential context within to understand any changes that might have occurred as a result of any incident. Parents know their children’s temperament, personality, strengths, and weaknesses, what motivates them, and what upsets them. This individual knowledge can provide helpful information to the trainer or other health care provider using injury guidelines or criteria, as these guidelines are based on information about groups of people with similar injuries.

For example, some children have difficulty counting backward by 7 from 100 because of poor arithmetic skills. Children taking medication for attention deficit hyperactivity disorder (ADHD) sometimes take a weekend holiday from their dosage. Consistent with a diagnosis of ADHD, they might have difficulty with tasks of attention or concentration. Children with dyslexia have difficulty spelling words correctly forward let alone backward. Thus, standard questioning can be misleading without information about each unique child that only a parent can provide.

When diagnosing and managing concussion, it is essential to have an idea of what is referred to as an individual’s baseline. That is, what the person was like before the injury. Everybody has a different baseline, and the goal of treatment is to return the person back to their “normal” self.

Ideally, the best baseline is obtained by having players complete formal cognitive testing before ever having been injured.

The more comprehensive the assessment, the more helpful it will be if an incident does happen. However, if you choose not to have your child complete a formal cognitive assessment, you as a parent can record important information about your child that can be used for comparison in a concussion injury. Information about your son or daughter can be organized into three broad categories:

Cognitive:

Record any diagnosis of attention-deficit hyperactivity disorder (ADHD), a learning disability in language or arithmetic, or a developmental disorder that might affect how your child performs cognitive tasks. Copies of any psychological or educational assessment reports, or Individual Education Plans (IEP), would be particularly useful to have on hand.

Physical:

Any relevant medical history that might affect the occurrence or frequency of concussion symptoms should be recorded.

Emotional:

Know your child’s mood or temperament. Have there been any recent stressors in your child’s life that could affect how he or she is able to cope with an injury or handle the stressors of a game? Life changes such as a move, an addition to the family, or the loss of a family member or pet may affect how your child manages stress.

All children are different and unique in their own way. Thus, it is important for each child to be treated as an individual. After a possible concussion, you as a parent should be watching for any change from your child’s usual way of being. You cannot assume something is wrong just because the behavior of your child is different from what is expected. However, at the same time, you need to be aware that even subtle changes in your child can signal other difficulties.

So what about my son? Well, we were in a small town far from any major centers. I spent about five minutes getting directions to the nearest emergency medical services. By then, my son just wanted to go back in the rink and watch the game. He was calm and reasonable and did not want to miss seeing how his team did. We decided to take a breather and sit down with him to watch the game and talk. He spontaneously communicated what happened before and during the play in which he was hurt. My son knew the score was close. When I asked him about not knowing where he was, he responded that he knew how the name of the town started but mixed it with another close-sounding name.

He did not have a headache but did have pain at the back of his head and neck where the other player ran into him. My son and I were then told the player that ran into him had been looking for us to see if he was okay, and my son seemed to appreciate the gesture. In the end, we did not think he had suffered a concussion after all. He appeared to be his usual self and did not develop any further symptoms over the following 24 hours. Taking some time to sit quietly and talk to him reassured us that he was back to normal.

The most important advice I have for parents is to be prepared and proactive. Know both the obvious and the subtle symptoms of concussion. Know what to do if you suspect your son or daughter has suffered a concussion. In my case, I was comfortable that my son had not suffered the injury. However, if he had any concussion symptoms or did not seem his usual self, I would have certainly taken him to a doctor as soon as possible.

If you are ever unsure or in doubt, always err on the side of caution, and have your child checked by a medical professional. 

The story is taken from Concussed written by Keith Primeau & Kerry Goulet

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StopConcussions is a non-profit company, that aims to bring players, parents, coaches and officials information on brain concussions and their consequences in contact sports.

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