Stanford Medicine Newsletter Updates For the Local Community


Sports concussion symptoms vary for boys and girls

Girls’ sports are booming, leading to a rise in the number of concussions. For young athletes like Ava James, spotting the symptoms can lead to timely treatment.


Ava James was picking up a ball at soccer practice when another player’s shot smacked the side of her head, slamming it against the goalpost. Dizzy and a little nauseous — classic concussion symptoms — Ava, 13, sat down. Fifteen minutes later, feeling better, she resumed play.

After practice, her head began hurting again. When the pain persisted through the next few days, Ava’s pediatrician referred her to Paul Fisher, MD, chief of pediatric neurology at Lucile Packard Children’s Hospital Stanford and professor of neuro-oncology at the School of Medicine.

Fisher confirmed that Ava had suffered a concussion, a head injury causing temporary impairment of normal brain function, such as loss of awareness or alertness.

As soccer, lacrosse and other sports have boomed, so has the concussion rate for girls, rising 21 percent annually over 11 years. For boys, the increase was 14 percent annually.

Boys often report symptoms that are fairly severe — confusion, bad headaches, forgetfulness — while girls may report milder symptoms, such as drowsiness, malaise or noise sensitivity, said Fisher. But that doesn’t mean a girl’s concussion is any less severe.

He said one of the problems in organized sports is that when girls report milder symptoms to a male coach — and many coaches in girls’ sports are male — the concussion may be missed, as the coach may not be alert to the differences in how boys and girls report symptoms.

Fisher said the best way to reduce the effects of concussions is to spot them early. “Everyone should know the symptoms. Having coaches and parents keeping an eye out isn’t enough; players need to watch out for each other,” he said.

It’s important for children who’ve had a concussion to sit out from sports for a while to keep from getting a second injury before the first one has healed. It’s also important to reduce mental activity.

“After some initial rest, it’s OK to stimulate kids’ brains, but it should be in short pulses — no more than 30 minutes of any particular activity, so their brain doesn’t get fatigued. That applies to watching TV, playing video games, reading and schoolwork,” said neurosurgeon Gerald Grant, MD, associate professor of neurosurgery at the School of Medicine.

Grant said it may be wise to gradually work back to a full school day, as the classroom may be difficult for a student recovering from concussion. The child may have trouble listening, may lack stamina and may suffer memory lapses that affect his or her ability to function effectively in a classroom setting.

Most kids can transition back to a normal level of activity within one to three weeks after a concussion, Fisher said. Those involved in sports should get a doctor’s clearance before getting back on the field.

When Ava saw Fisher two weeks after her concussion, she hadn’t played soccer in a week and a half and had taken a few days off from school. After evaluation, Fisher concluded that she had recovered to the point where she could resume normal activities. 

Grant said the key is in managing concussions to make sure everyone involved is on the same page.

“Coaches, parents and players all need to recognize concussion symptoms, and girls should be evaluated if there is any concern,” he said.

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