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updated 10/6/2011 1:20:08 PM ET 2011-10-06T17:20:08

Emergency room visits by children with concussions and other traumatic brain injuries from sports or other recreational activities have jumped over the last decade, a new government report shows. Doctors are divided whether it means more kids are getting hurt or parents are being more careful about their children's head injuries.

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Between 2001 and 2009, emergency room visits for traumatic brain injuries, or TBIs, in American youngsters under the age of 20 were up a full 60 percent, according to the Centers for Disease Control and Prevention. The CDC found that 153,375 youngsters were seen in the ER in 2001, versus 248,418 in 2009. Bicycling and football topped the causes of head injuries in young people.

"There could be an increased incidence because more kids are getting up off the couch and participating in physical activities,” the study's author Dr. Julie Gilchrist, a pediatrician and researcher at the CDC’s Injury Center said. “But we’re hoping that the increased numbers represent an increased awareness among parents that their children need to be evaluated for suspected brain injuries.”

Story: Q&A: Concussion crisis a game-changer, authors reveal

Either way, Gilchrist hopes parents are even more vigilant about their children’s head injuries. “We aren’t putting out this paper to scare people,” Gilchrist explained. “We certainly believe children need to be active and find physical activities that they can enjoy throughout their lifespans. And we believe parents should encourage this.”

Even if the rise in ER visits reflects increased parent awareness, experts agree the actual number of concussions kids suffer each year is much greater than the number seen in emergency rooms. While some kids are seen by family physicians, many still go undiagnosed and untreated.

Read an excerpt of 'The Concussion Crisis'

“We do know that a large proportion of concussions are not seen in the emergency department,” Gilchrist said. “And that’s appropriate -- if there aren’t any red flags for a more severe brain injury or structural injuries such as a skull fracture or a subdural hematoma.”

Dr. Douglas Smith, professor of neurosurgery and director of the Center for Brain Injury and Repair at the University of Pennsylvania, estimates there could be as many a 3 million traumatic brain injuries each year. “Moderate and severe injuries make up about 20 percent of that; the rest are concussions.”

The new report isn’t the first to find a rise in concussion-related ER visits. A 2010 study published in Pediatrics found that the number of 8- to 13-year-olds seen in the ER had doubled over a 10-year period, while visits among 14- to 19-year-olds had tripled in the same time period.

Brain injury experts were mixed in how they interpreted the new findings.

For Kevin Guskiewicz, a long time concussion researcher, the numbers indicate the injuries are being taken more seriously.

"I think that there has been a culture shift regarding this injury," said Guskiewicz, professor and chair of exercise and sports science and co-director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center. "A lot of that has to do with the amazing job the CDC has done educating the public. I’d also say that the media has done a very good job in helping create awareness about this injury."

In fact, there's a national movement to protect young athletes from concussion injuries. At least 30 states have laws requiring coaches to pull injured kids from games and another 15 have legislation pending. "The laws have three components: education; stipulation that an athlete can not return to play on the same day as a concussion; and a requirement that the concussed athlete must be released back to participation by a health-care provider," says Guskiewicz.

Because kids now realize that a concussion diagnosis could keep them out of a game, they may not report an injury to their parents or coaches and may find creative ways to hide it, Smith warned.

"For them, getting sat out of the game is punishment," he said.

That makes it even more important for parents to be alert to a head injury.

"Symptoms can evolve over time," Gilchrist said. "A child might be having a difficult time on Monday and if the parents don’t know the signs and symptoms they might not recognize this is related to a hit that occurred on Friday."

Symptoms can vary with each injury, but Gilchrist offered some common ones, including:

  • A child looking dazed or confused or forgetful
  • A child who is moving clumsily or who answers slowly
  • A loss of consciousness (no matter how brief)
  • Personality or behavior changes
  • Difficulty recalling events that occurred either before or after the hit or fall

Kids who have sustained a concussion might report any or all of the following: headaches or a sensation of pressure in the head, nausea, vomiting, balance problems, dizziness, double or blurred vision, sensitivity to light or noise, a feeling of sluggishness, haziness or grogginess, confusion, memory problems.

Linda Carroll is a regular contributor to msnbc.com and TODAY.com. She is co-author of the new book "The Concussion Crisis: Anatomy of a Silent Epidemic”

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