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From the American Academy of Pediatrics

Parental Misconceptions About Concussions Persist Despite Increased Education

With football season in full swing, there's no shortage of talk about young players - from high school down to the Pee Wee levels - suffering from concussions. Yet many parents may lack knowledge about this mild traumatic brain injury, according to two studies to be presented Friday, October 10, 2014 at a pre-conference symposium on pediatric sports medicine at the American Academy of Pediatrics (AAP) National Conference & Exhibition in San Diego.

Brain with post-it notes

Nearly 175,000 children are treated in U.S. emergency rooms each year for concussions due to sports-related activities, according to the Centers for Disease Control and Prevention. Parental knowledge of the signs and symptoms of concussion and recognizing that this is a brain injury is important to ensure children are diagnosed in a timely manner and get appropriate treatment.

Two separate studies looked at parents' knowledge of concussion and common misconceptions. They will be presented as part of the Peds21 symposium, "1, 2, 3, Go! Sports in the World of Pediatrics - Playing it Safe and Making it Fun!" in the San Diego Convention Center.

For the first abstract, titled "Parental Knowledge of Concussion," 511 parents of children ages 5-18 years who sought care at a pediatric emergency department within two weeks of their child suffering a head injury filled out a 24-item survey. They were asked questions about their demographics, their child's head injury, and general questions related to their knowledge of concussion and its treatment.

Results showed about half of parents correctly identified a concussion as a brain injury that could lead to symptoms such as headache or difficulty concentrating. No parental demographics (age, sex, education or prior history of sports participation) significantly predicted parents' knowledge about concussions.

The survey also indicated that almost all parents (92 percent) were aware that they should stop their child from playing and see a physician if they suspected a concussion. Yet only 26 percent were aware of guidelines on when their child could return to sports and school work.

"Our study showed that the vast majority of parents knew what to do if they suspected a concussion in their child and in most cases understood the clinical importance of this injury as a brain injury," said lead author Kirstin D. Weerdenburg, MD, FAAP, pediatric emergency medicine fellow at Hospital for Sick Children, Toronto, Ontario, Canada.

"The study also highlights that a physician visit shortly after the injury is important to confirm the diagnosis for parents and to inform parents of return to play/learn guidelines to ensure a proper recovery and prevent a second concussion while the brain is still healing," Dr. Weerdenburg said.

The authors of the second abstract, "Parental Misconceptions Regarding Sports-Related Concussion," also surveyed parents to assess their knowledge of concussions. The online survey was completed by two groups - 214 parents whose children were evaluated at a sports medicine clinic for musculoskeletal or mild traumatic brain injuries (group 1) and 250 parents of students at a local private school (group 2).

The survey included questions that gauged their knowledge of and attitudes about concussions as well as demographic information.

The majority of parents in both groups did well overall but had several misconceptions:

"Our study highlights the fact that many parents are still in need of education regarding concussion identification and post-injury evaluation. Even those highly educated parents were prone to misconceptions," said senior author Tracy Zaslow, MD, FAAP, medical director of the sports medicine and concussion program at Children's Orthopaedic Center, Children's Hospital Los Angeles. "False perceptions such as the ones pinpointed by our study may impact when medical care is sought after concussion and lead to less than optimal home care."

Earlier studies: mixed results

Earlier studies of parents' knowledge of concussions have reported mixed results. [1-5]

A 2014 study [1] reporting on the result of a knowledge assessment of sports-related concussion among parents of children aged 5 to 15 years enrolled in a recreational tackle football program, for instance, found that only 13% of parents identified all statements regarding concussion accurately, and no respondent correctly identified all symptoms related to concussion.  

As in the new AAP surveys, parents did not recognize red herring signs and symptoms of concussion, incorrectly identifying numbness in the arms or legs, hearing voices, and weakness in the arms, 92%, 80%, and 95%, respectively. Parents also missed increased irritability or emotional outburst (44%) and sleeping difficulty (28%) as symptoms of concussion.  Two-thirds of parents failed to recognize that a concussion is considered a form of mild TBI, and 42% had difficulty identifying that a concussion can be caused by something other than a direct blow to the head.

A 2010 study of parents of athletes aged 13 to 14 years [2] also found many parents unable to recognize the red herring signs and symptoms, with nearly half incorrectly identifying hearing voices and lower pulse rate as true signs and symptoms of concussion.

A second 2010 study [3] surveying parents of children of children 5 to 7 years old who were seen and discharged from a pediatric emergency department with TBI found that most (69.5%) initially stated that their child was asymptomatic, but when asked about each symptom specifically, 46.6% of these parents identified one or more symptoms.

A 2010 survey [4] by C.S. Mott Children's Hospital and the University of Michigan of parents of children age 12 to 17 years playing school sports also reported a surprising lack of knowledge by parents of concussion risks; more than half of those surveyed did not know if their child's school had a policy about returning to sports after a concussion; only a third (36%) were aware that their child's school had such a policy.

On the other hand,  in a 2014 study [5], researchers at the University of Washington found that, a year after enactment in Washington State of its groundbreaking Zackery Lystedt Law, 96% of respondents (parents, coaches, and other persons involved in athletics) understood that concussion was a form of traumatic brain injury, and that 90% would delay an athlete's return to play when neurological symptoms were present.  Fewer individuals understood return-to-play guidelines, including the requirement of written clearance (73%), or that a parent could not clear the athlete for RTP (88%).    

For the most comprehensive information about sports-related concussions, visit MomsTEAM's pioneering concussion safety center


Source: American Academy of Pediatrics 

1.   Mannings S, Kalynych C, Joseph M, Smotherman C, Kraemer DF. Knowledge assessment of sports-related concussion among parents of children aged 5 years to 15 years enrolled in a recreational tackle football program.  J Trauma Acute Care Surg 2014;77(3) Supp. 1, S18-S22.

2.  Coughlin C, Myles B, Howitt S. The ability of parents to accurately report concussion occurence in their bantam-aged minor league hockey league children.  J Can Chiropr Assoc. 2009;53:233-250.

3. Stevens P, Penprase B, Kepros J, Duneback J. Parental recognition of postconcussive symptoms in children. J Trauma Nurs. 210;17:178-182.

4. C.S. Mott Children's Hospital National Poll on Children's Health, Vol. 10, Issue 1 (June 14, 2010)

5.  Shenouda C, Hendrickson P, Davenport K, Barber J, Bell KR.  The effects of concussion legislation one year later - what we have learned: a descriptive pilot survey of youth soccer player associates.  PM R 2012;4:427-435  

Posted October 10, 2014