Parents and coaches need to know signs of concussion – paediatrician

School rugby players with suspected concussion should be taken off the pitch immediately

Prof Alf Nicholson, paediatrician at Temple Street hospital. Photograph: Alan Betson / THE IRISH TIMES

Prof Alf Nicholson, paediatrician at Temple Street hospital. Photograph: Alan Betson / THE IRISH TIMES


A leading paediatrician has said school rugby players suspected of having sustained a concussion during a match should be taken off the pitch immediately.

Prof Alf Nicholson, a consultant paediatrician at Temple Street hospital, said there was a need for parents, guardians and coaches to be aware of the signs of possible concussion.

Prof Nicholson said the most obvious sign of concussion was a loss of consciousness but it occurred only in a small percentage of concussion presentations.

“Best international advice, backed by anecdotal experience, is if there are concerns regarding concussion, the player should be immediately removed from play and should not return if at youth or school level,” he said.

Prof Nicholson said spinal injuries had reduced dramatically since the scrum had been depowered in school and youth rugby but some may still occur following high-impact tackles.

He said a weight grade could be introduced instead of the age group as teenagers differed in weight due to growth spurts.

“Cervical spine injury should be assumed in any player who is unconscious after head or neck trauma in a match. Maintaining adequate cervical spine stabilisation is critical until neurological function in all four limbs is evaluated and found to be intact and the player has no reported neck pain or cervical spine tenderness on palpation,” he said.

Obvious signs

Prof Nicholson said no single sideline tool would make it clear if a child had been concussed or not but there were some obvious signs.

“The visible clues of suspected concussion include lying motionless on the ground, being unsteady or falling over, a vacant or dazed look, confusion or, very rarely, a loss of consciousness,” he said.

He said children who had been concussed should limit activities that required focus, concentration and attention such as reading, studying, texting, videogame play and computer use.

Prof Nicholson said the time a player returned was contentious and some felt pressure to play again before they had recovered.

Protective headgear helped reduce head lacerations and mouthguards prevented dental injury but neither prevented concussion, the professor said.

“The tackle area is where most rugby injuries now occur and application of the laws forbidding high tackles or clearing out at rucks need to be enforced,” he said.

“Strength and conditioning training, higher impact collisions and high intensity games create a very exciting spectacle but do place added burdens and responsibilities on medical personnel on the sideline,” said Prof Nicholson.

Last year an international concussion expert, Dr Bennet Omalu, called for the banning of rugby, MMA and American football among minors.