Center for Injury Research and Prevention

The Skull Breaker Challenge and Concussions

March 17, 2020

As noted in a recent Research In Action blog post by Dr. Patty Huang, the social media platform TikTok, which describes itself as a “video-sharing social networking service,” has led to several dangerous trends in children and adolescents. Pediatric Emergency Medicine and CIRP Colleague Mark Zonfrillo, MD, MSCE and I have been paying close attention to one in particular: the “skull breaker” or “tripping jump” challenge.

It involves three participants (usually children or adolescents) with one of the participants unaware of the challenge. While being filmed, the three participants stand in a row and the middle participant is tricked into jumping, at which point the other two participants kick out his or her legs, causing the middle participant to fall.

Reports from around the country have noted the following cases and their consequences:

  • A 13-year-old girl in Massachusetts who was hospitalized with a concussion
  • An Arkansas teenager who lost consciousness and was treated for a concussion
  • An Arizona boy who lost consciousness, required facial sutures, and was diagnosed with a concussion
  • An Alabama boy who fractured his wrist and required surgery
  • A 13-year-old boy from Cherry Hill, New Jersey who lost consciousness and was hospitalized with a concussion 

There are likely dozens more cases that exist beyond these local media reports.

An Alarming Challenge

This challenge is alarming for several reasons. Falls from greater than five feet (which would be the majority of these falls) are at higher risk to cause skull fractures and intracranial bleeds. As noted in the cases above, these circumstances are very high risk for concussion. Emerging evidence has shown that concussions that result from assault mechanisms are at higher risk to lead to prolonged symptoms of concussion.

Our Minds Matter Concussion Research team has demonstrated the physical, cognitive, and emotional burden of prolonged concussion symptoms in prior studies:

  • 75 percent of patients with prolonged symptoms require some accommodation to return to school.
  • 25 percent of patients with prolonged symptoms require homebound tutoring.
  • 60 percent of patients with prolonged symptoms experience a decline in grades.
  • The direct costs of prolonged symptoms (therapies, medications, physician visits) are over $3,500 per patient, totaling over $200 million in the US per year.

As noted in Dr. Huang’s post, we strongly encourage parents to engage in conversations with their children regarding the danger of these challenges.

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