We have had several children lately in the PICU with concussions, and in talking with their parents I was reminded again how confusing that term can be to non-physicians. A good way to think of a concussion is an injury to the brain, nearly always a self-limited one, that produces symptoms but no objective damage like bleeding or bruising on the brain. Common symptoms include brief memory loss (often of the several minutes of time around the injury), nausea and vomiting, headache, and dizziness. Children with concussions also may have signs later of irritability, difficulty concentrating, or fatigue. It is not necessary to be “knocked out” to get a concussion.

Concussions are very common. For children, contact sports and accidents are the most common causes. In fact, twenty percent of all high school football players will have at least one concussion during their brief football careers.

There is no specific treatment for concussion other than to make sure the child does not have another blow to the head while the brain is still recovering from the first one — if that happens there can be serious consequences. Repeated concussions can cause long-standing brain damage. You can read more about concussions, especially guidelines about when it is safe for athletes to compete again, here and here.

As I write there is a looming battle between Congress and President Bush over reauthorization of the State Children’s Health Insurance Program, or SCHIP. The program ends at the end of the month unless it is reauthorized. SCHIP provides health insurance to children in families with too much income to qualify for Medicaid but too poor to afford healthcare. It is a complicated question, well reviewed in a recent New England Journal of Medicine article here. The controversy boils down to what we think the government’s role should be in providing health care to children. Most support helping the truly poor, those below the federal poverty threshold of an income of $20,650 for a family of four, but many balk at giving public money to families making as much as twice that. Another issue is that the SCHIP reauthorization bill, as with many bills, was quickly laden with extraneous add-ons.

I support SCHIP because, without it, children in families slightly above the poverty line suffer. When these children get seriously ill they will end up in PICUs like mine anyway, and if they have no insurance the government usually ends up with the bill. If these children had insurance for preventative care, they may well have not needed the expensive PICU in the first place. I would much rather see a comprehensive overhaul of our medical system, but I despair of that ever happening until the inevitable time in the future when things really do fall apart. Meanwhile SHCIP is a band-aid, but I think it is a needed band-aid.

Addendum: Here is an update–it looks as if some compromise will pass. Whether the president will sign it is another matter, of course.

Another addendum: Here is another update–a compromise passed both houses. It’s still unclear if the president will sign it.

Update: President Bush has vetoed the bill. It is unclear at this point if Congress will have sufficient votes to override the veto, but most expect that the Democrats will try to do this. They will need to attract Republicans to do so.