Concussions in children have long been underestimated, misdiagnosed and poorly managed. What used to be considered a common childhood incident can have distressing permanent consequences if not recognized early.
Take 17-year-old Elizabeth Lowman. It's a crucial soccer game, but instead of starting, she's on the bench.
Three weeks ago during a game, Elizabeth collided with another player. At the time, she didn't think much of it.
"Everyone on the sidelines heard the smack, and we all went uh-oh," says Lynn Lowman, Elizabeth's mom. "And we really did think it was her mouth."
But it wasn't. Elizabeth continued playing the rest of the game. But this wasn't just a smack. She had a concussion. A headache was the first sign that she had a real problem.
"I didn't expect that I had a concussion," Elizabeth says. "I mean, I get hit every now and then."
Doctors estimate that 3.8 million kids sustain sports-related concussions in the U.S. every year. The problem is figuring out which kids have been hurt and then preventing the second blow.
It's called second impact syndrome because it may be the follow-up brain bruise that causes permanent damage.
Dr. Gerry Gioia is a neuropsychologist at the Children's National Medical Center in Washington, D.C., who specializes in sports concussions.
"We can look at the speed at which somebody can think and process information, their reaction time and how quick they can respond to things," Gioia says.
Temporary amnesia is a tip-off that the brain has been injured. Doctors are also checking for headaches, difficulty concentrating, irritability, sleep disturbances. In a world of high-tech scans and X-rays, doctors are turning to low-tech ways to test how well the brain is working.
"I'm going to say some numbers, but this time when I stop, I want you to say them backwards," a tester says to Elizabeth.
"4 ... 6 ...," Elizabeth responds.
With the test completed, it's time for the news Elizabeth is afraid to hear.
"We are making progress but not quite there yet," the doctor tells her.
Elizabeth knows it's better to sit out the season than playing with the rest of her life.