Concussion Information Form - Allied Gardens Little League

Concussion Information Form - Allied Gardens Little League
Allied Gardens Little League
CONCUSSION INFORMATION SHEET
​WHAT IS A CONCUSSION?
​A concussion is a brain injury. Concussions are caused by a bump or blow to the head. Even a “ding,”
“getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious. You
can't see a concussion. Signs and symptoms of concussion can show up right after the injury or may
not appear or be noticed until days or weeks after the injury. If your child reports any symptoms of
concussion, or if you notice the symptoms yourself, seek medical attention right away.
​WHAT ARE THE SIGNS AND SYMPTOMS OF A CONCUSSION?
If your child has experienced a bump or blow to the head during a game or practice, look for any of
the following signs and symptoms of a concussion​:
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Appears dazed or stunned
Forgets an instruction
Moves clumsily
Loses consciousness (even briefly)
Nausea or vomiting
Double or blurry vision
Sensitivity to noise
Concentration or memory problems
Does not “feel right”
Can't recall events prior to or after hit or fall
Is confused about assignment or position
Is unsure of game, score, or opponent
Answers questions slowly
Headache or “pressure” in head
Balance problems or dizziness
Sensitivity to light
Feeling sluggish, hazy, foggy, or groggy
Confusion
Shows behavior or personality changes
​HOW CAN YOU HELP YOUR CHILD PREVENT A CONCUSSION?
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Every sport is different, but there are steps your children can take to protect themselves from
concussion.
Ensure that they follow their Manager’s rules for safety and the rules of the sport.
Encourage them to practice good sportsmanship at all times. Make sure they wear the right
protective equipment for their activity (such as batting helmets, catcher’s gear such as shin
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guards, chest protector and helmet; and eye and mouth guards). Protective equipment should
fit properly, be well maintained, be worn consistently and correctly.
Learn the signs and symptoms of a concussion.
​WHAT SHOULD YOU DO IF YOU THINK YOUR CHILD HAS A CONCUSSION?
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Seek medical attention right away. A health care professional will be able to decide how
serious the concussion is and when it is safe for your child to return to sports.
Keep your child out of play. Concussions take time to heal. Don’t let your child return to play
until a health care professional says it’s OK. Children who return to play too soon—while the
brain is still healing—risk a greater chance of having a second concussion. Second or later
concussions can be very serious. They can cause permanent damage, affecting your child for a
lifetime.
Tell your child’s manager about any recent concussion. Managers should know if your child
had a recent concussion in ANY sport. Your child’s manager may not know about a concussion
your child received in another sport or activity unless you tell the coach.
WHAT IS THE PROCEDURE FOR A SUSPECTED CONCUSSION?
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Any athlete who is suspected of sustaining a concussion or head injury in a practice or game
shall be removed from the activity at that time and for the remainder of the day.
Any athlete who has been removed may not return to play until the athlete is evaluated by a
licensed health care provider trained in the evaluation and management of concussion and
has received a written clearance to return to play from the health care provider.
LET YOUR CHILD’S MANAGER KNOW RIGHT AWAY IF YOU SUSPECT YOUR CHILD HAS
A CONCUSSION AND CONSULT YOUR PHYSICIAN!
Adapted from the CDC. For more information you can go to:
http://www.cdc.gov/ConcussionlnYouthSports
Athlete Signature _________________________________Date _______________________
Athlete Name (print)_______________________________
Parent or Legal Guardian Signature_________________________ Date ______________________
Parent or Legal Guardian Name (print)________________________________________________
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