Concussions

Concussions in children can happen at any age – it’s just part of being an active kid. It might be a fall, a car crash, or a sports injury. No matter how a concussion happens, the symptoms don’t always develop right away.

It may take days before signs of a problem might appear. That’s why many kids, unaware they’ve been hurt, try to pick themselves up and get back to whatever they were doing, which is dangerous. If you suspect your child has had a concussion, remove him or her from activities and get an evaluation from your health care provider. Concussions in children require medical attention, lots of rest and a slow, careful return to daily routines under a doctor’s care.

More on Concussions in Children & Teens

 
Concussion Symptoms

If you think your child might have a concussion, be on the lookout for changes.

Symptoms of concussions in children that might occur immediately after injury include:
  • headache
  • dizziness
  • nausea and/or vomiting
  • fatigue
  • confusion
  • blurred vision
  • memory difficulties surrounding the injury
  • balance difficulties
Symptoms after the injury might include:
  • balance problems
  • dizziness
  • behavior or personality changes
  • confusion or difficulty remembering things
  • difficulty paying attention
  • feeling foggy
  • double or blurry vision
  • headaches
  • irritability or a change in behavior
  • sadness
  • feeling more emotional
  • nausea and/or vomiting
  • reduced energy level (tiredness)
  • sensitivity to light or noise
  • trouble falling asleep or a change in sleep patterns
  • changes in school performance

Sometimes, concussion symptoms get worse slowly over time.

Seek immediate help if your child develops more severe symptoms like these (even after a visit to a doctor):
  • headaches that get worse
  • extreme sleepiness or trouble waking up
  • seizures
  • weakness or numbness in the arms or legs
  • slurred speech
 
Follow-Up Care
Follow these next steps after your child comes home from the Emergency Department or doctor’s office following a concussion:
  • Follow any instructions provided to you
  • Keep your child home from school for at least two to three days or until cleared by your doctor
  • Bring your child to your Primary Care Physician for a follow-up visit two or three days after the incident. Your doctor should determine when it’s OK to return to school and can help answer your questions about managing any symptoms
  • See the doctor who treated your child’s concussion if your child continues to experience symptoms five to seven days after the incident
Even if symptoms go away, see your neurologist or specialist
if your child has:
  • had a concussion before
  • a history of learning disabilities
  • Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD)
  • headaches
  • mood disorders
 
Concussion Tips
Here are some things to keep in mind about concussion in children:
  • Keep your child from participating in normal activities until you get the go-ahead from your doctor. Normal activities include: school attendance, gym class, sports and extracurricular physical activities, and rough housing with siblings and friends. And that’s even if your child has been seen by a school nurse and even if your child feels ready. It takes time and rest to heal from a concussion. When kids get repeat concussions, the damage can be much more severe and long-lasting
  • Be sure to inform anyone who might be supervising or taking care of your child after a concussion – babysitters, relatives, teachers, school officials, coaches, and child care workers – so they can also make sure your child is following the doctor’s orders
  • Allow your child to ease back into the daily routine slowly, with guidance from your doctor, one activity at a time – never all at once
  • Consider baseline cognitive testing (ImPACT or similar) if your child plans to participate in sports. This provides an objective measure of how your child’s brain functions normally so we can have something to compare to if your child does get a concussion later
 
Preventing Concussions
Here are some common-sense steps you can take to help prevent concussion in children:
  • Have your child wear a properly fitting, appropriate helmet when riding a bike or playing contact sports
  • Make sure your child knows and follows sports rules
  • Childproof your home
  • Follow car seat, booster seat, and seatbelt recommendations for all ages

Trusted Insights from Nemours' KidsHealth

Head Injuries

Head injuries fall into two categories:

  1. external (usually scalp) injuries
  2. internal head injuries, which may involve the skull, the blood vessels within the skull, or the brain

Fortunately, most childhood falls or blows to the head result in injury to the scalp only, which is usually more frightening than threatening. An internal head injury could have more serious implications because it may result in bleeding or bruising of the brain.

External (Scalp) Injuries

The scalp is rich with blood vessels, so even a minor cut there can bleed profusely. The "goose egg" or swelling that may appear after a head blow is the result of the scalp's veins leaking fluid or blood into (and under) the scalp. It may take days or even a week to disappear.

What to look for and what to do:

  • Call the doctor if your child is an infant; has lost consciousness, even momentarily; or if a child of any age has any of these symptoms:
    • won't stop crying
    • complains of head and neck pain
    • vomits repeatedly
    • difficult to awaken
    • becomes difficult to console
    • isn't walking normally
  • If your child is not an infant, has not lost consciousness, and is alert and behaving normally after the fall or blow:
    • Apply an ice pack or instant cold pack to the injured area for 20 minutes every 3 to 4 hours. If you use ice, always wrap it in a washcloth or sock; ice applied directly to bare skin can cause cold injury to the skin.
    • Observe your child carefully for the next 24 hours. If you notice any of the signs of internal injury (see below), call your doctor immediately.
    • If the incident has occurred close to bedtime or naptime and your child falls asleep soon afterward, check in once or twice to also check for disturbances in color or breathing.
  • If color and breathing are normal, and you observe or sense no other abnormalities, let your child sleep (unless the doctor has advised otherwise). There's no need to keep a child awake after a head injury.
  • If you aren't comfortable with your child's appearance (trust your instincts), rouse your child partially by sitting him or her up. Your child should fuss a bit and attempt to resettle. If he or she doesn't protest, try to awaken your child fully. If your child can't be awakened or shows any signs of internal injury (see below), call the doctor or an ambulance.

Suspected Internal Injury

The brain is cushioned by cerebrospinal fluid, but a severe blow to the head may knock the brain into the side of the skull or tear blood vessels. Some internal head injuries — complications of a fractured skull, torn blood vessels, or damage to the brain itself — can be serious and possibly life threatening.

Different levels of injury require different levels of concern. It can be difficult to determine the level of injury, so it's always wise to discuss a head injury with your doctor.

What to Look for and What to Do

Call 911 if your child shows any of these symptoms after a head injury:

  • unconsciousness for more than a few minutes
  • abnormal breathing
  • obvious serious wound
  • bleeding or clear fluid from the nose, ear, or mouth
  • disturbance of speech or vision
  • pupils of unequal size
  • weakness or paralysis
  • neck pain or stiffness
  • seizure

If your child is unconscious:

  • Do not try to move your child in case there is a neck or spine injury.
  • Call for help.
  • Turn a child who is vomiting or having a seizure onto his or her side while trying to keep the head and neck straight. This will help prevent choking and provide protection in case of neck and spine injury.

If your child is conscious:

  • Do your best to keep your child calm and still.
  • If there's bleeding, apply a clean or sterile bandage.
  • Do not attempt to cleanse the wound, which may aggravate bleeding and/or cause serious complications if the skull is fractured.
  • Do not apply direct pressure to the wound if you suspect the skull is fractured.
  • Do not remove any object that's stuck in the wound.

Concussions

Concussions are also a type of internal head injury. A concussion is the temporary loss of normal brain function due to an injury. Repeated concussions can result in permanent injury to the brain. However, it's possible to get a concussion that's mild and doesn't result in long-term damage.

One of the most common reasons kids get concussions is through sports, so make sure yours wear appropriate protective gear and don't let them continue to play if they've had a head injury.

If your child sustains an injury to the head, watch for these signs of a possible concussion:

  • "seeing stars" and feeling dazed, dizzy, or lightheaded
  • memory loss, such as trouble remembering what happened right before and after the injury
  • vomiting
  • headaches
  • blurred vision and sensitivity to light
  • slurred speech or saying things that don't make sense
  • difficulty concentrating, thinking, or making decisions
  • difficulty with coordination or balance (such as being unable to catch a ball or other easy tasks)
  • feeling anxious or irritable for no apparent reason

If you suspect a concussion, call your doctor for further instructions.

Preventing Head Injuries

It's impossible to prevent kids from ever being injured, but there are ways to help prevent head blows.

Make sure that:

  • your home is childproofed to prevent household accidents
  • your kids always wear appropriate headgear and safety equipment when biking, in-line skating, skateboarding, snowboarding or skiing, and playing contact sports. Wearing an appropriately fitting bike helmet, for instance, reduces the risk of head injury by about 85%.
  • kids always use a seatbelt or child safety seat
  • your child takes it easy after a head injury, especially if there is a concussion
  • your child doesn't go back to rough play or playing sports until the doctor gives approval. (If your child reinjures the brain while it's still healing, it will take even more time to completely heal.)

Reviewed by: Kate M. Cronan, MD
Date reviewed: January 2011