Head injuries at school 

As a parent myself, I understand the frustration at being called away from work to collect a child who has had a "simple" knock to the head, especially when the injury ends up being a mild one that doesn't require medical intervention.

The Department of Education policy is very clear on this one.   We will administer a Concussion Screening tool following any bump or knock to the head.  If, in our opinion, there is any chance of a concussion, we will  mandate that the child be collected. We will strongly recommend medical screening.    If your child does not appear to have any signs of concussion, you will be contacted and given the option of collecting your child.  We still encourage you to seek a medical opinion following any knock to the head.  

We are not medical professionals and are not equipped to make definitive concussion diagnosis, and so we must always err on the side of caution and our duty of care to students.  Concussion is not straightforward, and there can be unseen brain injuries resulting from even a simple knock to the head.  

I have reproduced sections of an article from the Community Concussion Research Foundation below which I encourage you to read.  Although this largely references concussions acquired as a result of playing sport, it is applicable to all head bumps.  

Traumatic Brain Injury (TBI), including concussion and CTE, is the leading cause of death and disability in Australia and worldwide. It is a ‘silent’ epidemic as society is largely unaware of the magnitude of the problem. Australia has a national brain injury crisis. We have one of the highest rates of acquired brain injury in the world at 3% of the population. 

Why is it so? In part, due to the massive popularity of AFL and Rugby in Australia, two high risk, dangerous sports which have the highest rates of concussion of any team sports in the world. Worse, they are increasing annually, very rapidly at junior level. This is compounded by the fact that there is very significant under-reporting of concussion in Australian sport. 

In Australia, by age 16, 20% of children will have sustained a concussion (Murdoch CRI).  

Concussion in sport is currently the subject of an Australian Government Inquiry, supported by all political parties. 

The CCRF issued an initial concussion/CTE ALERT to schools in Victoria on 11/11/2022 (An extract from the ALERT: 

• Just because a football player's concussion symptoms have cleared up, it doesn't necessarily mean their brain has recovered from the impact. Lasting damage to the brain can occur if you don’t rest long enough afterwards to let the brain fully heal. Second Impact Syndrome, incurring a second brain injury before recovering from a first, can cause more catastrophic damage. A second impact is more likely to cause severe brain damage than a first, even if the victim does not lose consciousness. Between 10% and 20% of adults who are diagnosed with concussion have symptoms that persist for more than three months. Early return to play comes with an incredible amount of risk.
• There is another type of dangerous head impact that flies under the radar: Subconcussions occur when the head is directly or indirectly impacted, but is not followed by symptoms of concussion — and they can be particularly dangerous long-term because people don't realise they've happened. That means they don't take necessary precautions after the impact. When these less severe sub-concussive head impacts happen repeatedly it may lead to long-term health issues. “Eventually the brain may no longer be able to function properly and you start to see mental-health issues and cognitive problems." This is referred to as Chronic Traumatic Encephalopathy (CTE). CTE is a neurodegenerative disease that, over time, causes nerve cells in the brain and parts of the nervous system to deteriorate and die. There is no treatment for CTE and it can only be fully diagnosed after death. CTE is a preventable disease.
• Research in the United States by NIH and CDC has now proved conclusively that there is a link between repeated sporting concussions and the disease known as CTE, which causes early onset dementia and a range of other issues. 
• TBI is a major cause of death and disability: TBIs affect the lives of people of all ages. Anyone can experience a TBI, but data suggest that some groups are at greater risk of dying from a TBI or experiencing long-term health problems after the injury. Most concussions in teenage years happen playing sport. A TBI during childhood may affect brain development. TBI affects children differently than adults. Children require 2-3 times less impact force to sustain a concussion than adults. Children take longer to recover from concussion .An injury of any severity to the developing brain may:
  • Disrupt a child’s development
  • Limit their ability to participate in school and other activities, like sports
  • As a result of a TBI, children may experience changes in their health, thinking, and behaviour that affect learning, self-regulation, and social participation, all of which are important to becoming a productive adult. 
  • The sooner you start playing and the longer you play dangerous contact sports, the greater the chance you will suffer traumatic brain injury. It is not the level of the sport that was played but how often it was played. It is not how hard people are being hit but how often. The more often you tackle or are hit the more likely you are to suffer permanent brain damage and tragic decline. Concussion protocols (return to play) may help those who are concussed but they are not going to head off the growing prevalence of CTE in sports participants. In these cases it is not concussion but the accumulative impact of ongoing sub-concussive hits that can damage the brain irreparably.
• Why is TBI called The Silent Epidemic? Simply put, many people do not know they suffer from a traumatic brain injury. Since they cannot see the injured area, they assume they are fine. That is why doctors and other professionals refer to it as a silent epidemic. Concussions range from mild to quite severe. A generation ago, most doctors believed that concussions were little more than inconveniences. We now know that a concussion can cause life-long damage.
• “You are not OK to return to your sport once you no longer have symptoms”. Symptom resolution is NOT considered a realistic return to play guide. It does not indicate physiological healing of the brain. Let’s think of it like a fracture – the pain from the fracture is gone after 10 days, but that doesn’t mean the bone has sufficiently healed. Most symptoms go away within 7-10 days. But recovery of the brain can take 4-6 times longer than that. Having a concussion renders you 4 to 6 times more susceptible to having a second one.
• Australian researchers expect that over 90% of AFL footballers who have played 10 years or more will have CTE.
• Dr Rowena Mobbs said head knocks in community sport are the greater cause for concern, particularly when it comes to the impacts on life away from football. “The brain is still developing into the 20s and children are vulnerable to more severe, and more prolonged, concussion. I have seen some devastating outcomes from kids who fail year 12 with concussion two to three years prior.

Recommendation : Have all students, staff and parents at your school watch one of these award-winning short videos on concussion. They are divided into three age groups. Concussion and CTE are not well understood. Education and awareness is a key requirement for better outcomes. Both children and their parents need to understand that repeat head injuries expose their children to the significant risk of progressive brain degeneration.