In 2014, findings showed emergency room visits for concussion injuries rose by 29 percent in just four years, with the biggest increase among toddlers and seniors. But most often those who suffer concussions are high school athletes in sports such as soccer, basketball and football. Here, Lindsey Carfagna, a former elite college athlete who is now a certified personal trainer with the National Academy of Sports Medicine, a private coach for and a contributor to The Knockout Project, a website created to educate people about the dangers of concussion, talks about awareness and recovery from this injury.

What can parents do to protect their kids who play sports where concussion injuries might be likely?

I think the first thing is being aware and understanding that concussions are a brain injury. The more parents treat it as such, the more seriously they’ll take a child getting knocked in the head and make sure they’re evaluated properly. Also, it’s key that parents understand the leagues their kids play for, their coaches and what protections the sports programs have in place for concussion management, pre-testing and post-testing.

What do you think about protective gear for kids who play sports?

Honestly, this is one of those things that I don’t think we know enough about. I think a lot of manufacturers will tell you that their helmet is the best to prevent concussions. But what a lot of people don’t understand is that when you get hit in the head, it’s not always the immediate force of the blow affecting your head; sometimes it’s the force of your brain bouncing off your skull on the other side of your head; or sometimes it’s your neck flipping around. That’s why, in my opinion, there are too many factors to say what one thing will prevent a kid from getting a concussion. Also, over time, too many hits in a sport can lead to pretty much the same effect as having a major concussion. I’m not sure how a piece of equipment can deter that.

What symptoms of concussion injury should parents watch for?

I think there’s a difference between what you see immediately and what you see later in the day or evening. What happens most of time is the person playing sports has their adrenaline pumping and so they’re not going to want to come out of play. But you should look to see if someone is disoriented or little bit confused. Definitely look at their eyes. But, basically, anybody who is just kind of rubbing their heads, or looking around like something funny happened, get ’em off the field and evaluate it. Later in the day, the person may just become really tired, and nausea is a big sign. But you don’t actually have to throw up. Vomiting used to be one of those markers: If you threw up, the blow must have been bad. But the marker today is if you feel nauseous or dizzy—those types of things.

What do experts advise parents to do to speed up a child’s recovery from concussion injury?

Well, there are two camps. One of them says to wait, rest and recover. Some experts advise for kids to completely shut down, not look at any screens, and to communicate to their teachers what’s happening to make sure they’re not being overloaded with school work. These experts suggest that kids with concussion injuries just shut the brain down, stay in dark rooms and avoid a lot of noise. I think that if these measures are done immediately, they’re absolutely good recommendations. But we’re starting to see that a lot of kids will continue like that for several months, and that’s when they can start to get into what’s called post-concussive syndrome. At that point, some other doctors are saying that the brain becomes maladaptive by shutting down for so long. Some physicians suggest using exercise as a way to reorient people after concussion. They believe that people with concussion injuries suffer certain metabolic changes, so they need to learn how to bring their heart rate up again. These are the things that help to regulate brain function. In my opinion, wait, rest or recover initially. If you’re not seeing recovery in a couple of months, then you need to start considering physical therapy or exertion therapy. These treatments work best when they’re tailored to the individual.

What are some of the major misconceptions that you’ve found people have about concussions?

I’ve read and seen in my own career the misconception that girls don’t compete hard, or girls don’t get hit hard. But actually women in high school soccer show the second-highest rates for concussions, and high school athletes fall right behind professional football players. I think coaches need to take athletes and their concussion injuries seriously, regardless of gender. The other thing is this idea that healing takes place after a couple of weeks, or maybe a month. But some people don’t heal. After a concussion injury, some people won’t heal for another year or two, and might then start to show signs of anxiety, depression or some mental health symptoms. If kids show signs of being different than they were before the concussion, parents should make sure they’re getting them evaluated. Also, they should choose doctors who take concussions seriously. After all, these are injuries to the brain.