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

Preventing Children's Sports Injuries

Causes of Sports Injuries

Participation in any sport, whether it's recreational bike riding or Pee-Wee football, can teach kids to stretch their limits and learn sportsmanship and discipline. But any sport also carries the potential for injury.

By knowing the causes of sports injuries and how to prevent them, you can help make athletics a positive experience for your child.

Kids can be particularly susceptible to sports injuries for a variety of reasons. Kids, particularly those younger than 8 years old, are less coordinated and have slower reaction times than adults because they are still growing and developing.

In addition, kids mature at different rates. Often there's a substantial difference in height and weight between kids of the same age. And when kids of varying sizes play sports together, there may be an increased risk of injury.

As kids grow bigger and stronger, the potential for injury increases, largely because of the amount of force involved. For example, a collision between two 8-year-old Pee-Wee football players who weigh 65 or 70 pounds each does not produce as much force as that produced by two 16-year-old high school football players who may each weigh up to 200 pounds.

Also, kids may not assess the risks of certain activities as fully as adults might. So they might unknowingly take risks that can result in injuries.

Preventing Sports Injuries

You can help prevent your kids from being injured by following some simple guidelines:

Use of Proper Equipment

It's important for kids to use proper equipment and safety gear that is the correct size and fits well. For example, they should wear helmets for baseball, softball, bicycle riding, and hockey. They also should wear helmets while they're inline skating or riding scooters and skateboards.

For racquet sports and basketball, ask about any protective eyewear, like shatterproof goggles. Ask your child's coach about the appropriate helmets, shoes, mouth guards, athletic cups and supporters, and padding.

Protective equipment should be approved by the organizations that govern each of the sports. Hockey facemasks, for example, should be approved by the Hockey Equipment Certification Council (HECC) or the Canadian Standards Association (CSA). Bicycle helmets should have a safety certification sticker from the Consumer Product Safety Commission (CPSC).

Also, all equipment should be properly maintained to ensure its effectiveness. In the United States, the National Operating Committee on Standards for Athletic Equipment (NOCSAE) sets many of the standards for helmets, facemasks, and shin guards. In addition to meeting the NOSCAE standards, all equipment should be properly maintained to ensure its effectiveness over time.

Maintenance and Appropriateness of Playing Surfaces

Check that playing fields are not full of holes and ruts that might cause kids to fall or trip. Kids doing high-impact sports, like basketball and running, should do them on surfaces like tracks and wooden basketball courts, which can be more forgiving than surfaces like concrete.

Adequate Adult Supervision and Commitment to Safety

Any team sport or activity that kids participate in should be supervised by qualified adults. Select leagues and teams that have the same commitment to safety and injury prevention that you do.

The team coach should have training in first aid and CPR, and the coach's philosophy should promote players' well-being. A coach with a win-at-all-costs attitude may encourage kids to play through injury and may not foster good sportsmanship. Be sure that the coach enforces playing rules and requires that safety equipment be used at all times.

Additionally, make sure your kids are matched for sports according to their skill level, size, and physical and emotional maturity.

Proper Preparation

Just as you wouldn't send a child who can't swim to a swimming pool, it's important not to send kids to play a sport that they're unprepared to play. Make sure that your child knows how to play the sport before going out on the field.

Your child should be adequately prepared with warm-ups and training sessions before practices as well as before games. This will help ensure that your child has fun and reduce the chances of an injury.

In addition, kids should drink plenty of fluids and be allowed to rest during practices and games.

Common Types of Sports Injuries

Three common types of sports injuries in children are acute injuries, overuse injuries, and reinjuries:

Acute Injuries

Acute injuries occur suddenly and are usually associated with some form of trauma. In younger children, acute injuries typically include minor bruises, sprains, and strains. Teen athletes are more likely to sustain more severe injuries, including broken bones and torn ligaments.

More severe acute injuries that can occur, regardless of age, include: eye injuries, including scratched corneas, detached retinas, and blood in the eye; broken bones or ligament injuries; brain injuries, including concussions, skull fractures, brain hemorrhages; and spinal cord injuries.

Acute injuries often occur because of a lack of proper equipment or the use of improper equipment. For example, without protective eyewear, eye injuries are extremely common in basketball and racquet sports. In addition, many kids playing baseball and softball have suffered broken legs or ankles from sliding into immobile bases.

Overuse Injuries

Overuse injuries occur from repetitive actions that put too much stress on the bones and muscles. Although these injuries can occur in adults as well as kids, they're more problematic in a child athlete because of the effect they may have on bone growth.

All kids who play sports can develop an overuse injury, but the likelihood increases with the amount of time a child spends on the sport.

Some of the most common types of overuse injuries are:

  • anterior knee pain: Anterior knee pain is pain in the front of the knee under the kneecap. The knee will be sore and swollen due to tendon or cartilage inflammation. The cause is usually muscle tightness in the hamstrings or quadriceps, the major muscle groups around the thigh.
  • Little League elbow: Repetitive throwing sometimes results in pain and tenderness in the elbow. The ability to flex and extend the arm may be affected, but the pain typically occurs after the follow-through of the throw. In addition to pain, pitchers sometimes complain of loss of velocity or decreased endurance.
  • swimmer's shoulder: Swimmer's shoulder is an inflammation (swelling) of the shoulder caused by the repeated stress of the overhead motion associated with swimming or throwing a ball. The pain typically begins intermittently but may progress to continuous pain in the back of the shoulder.
  • shin splints: Shin splints are characterized by pain and discomfort on the front of the lower parts of the legs. They are often caused by repeated running on a hard surface or overtraining at the beginning of a season.
  • spondylolysis: Spondylolysis often results from trauma or from repetitive flexing, then overextension, twisting, or compression of the back muscles. This can cause persistent lower back pain. Spondylolysis is commonly seen in kids who participate in soccer, football, weight lifting, gymnastics, wrestling, and diving.

Overuse injuries can be caused or aggravated by:

  • growth spurts or an imbalance between strength and flexibility
  • inadequate warm-up
  • excessive activity (for example, increased intensity, duration, or frequency of playing and/or training)
  • playing the same sport year-round or multiple sports during the same season
  • improper technique (for example, overextending on a pitch)
  • unsuitable equipment (for example, nonsupportive athletic shoes)

Reinjuries

Reinjury occurs when an athlete returns to the sport before a previous injury has sufficiently healed. Athletes are at a much greater risk for reinjury when they return to the game before recovering fully. Doing so places stress upon the injury and forces the body to compensate for the weakness, which can put the athlete at greater risk for injuring another body part.

Reinjury can be avoided by allowing an injury to completely heal. Once the doctor has approved a return to the sport, make sure that your child properly warms up and cools down before and after exercise.

Sudden exertion can also cause reinjury, so your child should re-enter the sport gradually. Explain that easing back into the game at a sensible pace is better than returning to the hospital!

Treating Sports Injuries

Treatment of sports injuries varies by the type of injury.

For acute injuries, many pediatric sports medicine specialists usually take a "better safe than sorry" approach. If an injury appears to affect basic functioning in any way — for example, if your child can't bend a finger, is limping, or has had a change in consciousness — first aid should be administered immediately. A doctor should then see the child. If the injury seems to be more serious, it's important to take your child to the nearest hospital emergency department.

For overuse injuries, the philosophy is similar. If a child begins complaining of pain, it's the body's way of saying there's a problem. Have the child examined by a doctor who can then determine whether it's necessary to see a sports medicine specialist. A doctor can usually diagnose many of these conditions by taking a medical history, examining the child, and ordering some routine tests.

It's important to get overuse injuries diagnosed and treated to prevent them from developing into larger chronic problems. The doctor may advise the child to temporarily modify or eliminate an activity to limit stress on the body.

In some cases, the child may not be able to resume the sport without risking further injury. Because overuse injuries are characterized by swelling, the doctor may prescribe rest, medications to help reduce inflammation, and physical therapy. When recovery is complete, your child's technique or training schedule may need to be adjusted to prevent the injury from flaring up again.

Reviewed by: Alfred Atanda Jr., MD
Date reviewed: November 2011
Originally reviewed by: Joseph A. Congeni, MD