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.
When to Be Seen for a Concussion
In this video, Dr, Marcantuono from Nemours/Alfred I. duPont Hospital for Children explains the signs to look out for after your child has a head injury.
Learn more about concussions from Dr. Marcantuono:
More on Concussions in Children & Teens
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:
- nausea and/or vomiting
- blurred vision
- memory difficulties surrounding the injury
- balance difficulties
Symptoms after the injury might include:
- balance problems
- behavior or personality changes
- confusion or difficulty remembering things
- difficulty paying attention
- feeling foggy
- double or blurry vision
- irritability or a change in behavior
- 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
- weakness or numbness in the arms or legs
- slurred speech
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)
- mood disorders
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
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
From Nemours' KidsHealth
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And while we often hear about head injuries in athletes, most concussions happen off the playing field — in car and bicycle accidents, in fights, and even minor falls.
A concussion is a type of traumatic brain injury. The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. The brain can move around inside the skull and even bang against it. If the brain bangs against the skull — for example, due to a fall on a playground or a whiplash-type of injury — blood vessels can be torn and the nerves inside the brain can be injured. These injuries can cause a concussion.
Anyone who has a head injury should be watched closely for signs of a concussion, even if the person feels OK. An undiagnosed concussion can put someone at risk for brain damage and even disability. So anyone who has any symptom of a concussion should be examined right away by a doctor.
Sports-related concussions are receiving increased attention. Doctors now recommend these steps after a suspected concussion:
- The player should immediately stop playing or practicing.
- The player should get checked out by a doctor before returning to practice or play.
Kids who get concussions usually recover within a week or two without lasting health problems by following certain precautions and taking a break from sports and other activities that make symptoms worse.
Signs and Symptoms
Someone with a concussion may be knocked unconscious, but this doesn't happen in every case. In fact, a brief loss of consciousness or "blacking out" doesn't mean a concussion is any more or less serious than one where a person didn't black out.
If your child might have had a concussion, go to the emergency room if he or she has any of these symptoms:
- loss of consciousness
- severe headache, including a headache that gets worse
- blurred vision
- trouble walking
- confusion and saying things that don't make sense
- slurred speech
- unresponsiveness (you're unable to wake your child)
Call your doctor right away to report other problems, such as vomiting, dizziness, headache, or trouble concentrating. Then you can get advice on what to do next. For milder symptoms, the doctor may recommend rest and ask you to watch your child closely for changes, such as a headache that gets worse.
Symptoms of a concussion don't always show up right away, and can develop within 24 to 72 hours after an injury. Young children usually have the same physical symptoms as older kids and adults, but cognitive and emotional symptoms (such as irritability and frustration) can appear later, be harder to notice, and last longer. Sleep-related issues are more common in teens.
Though most kids recover quickly from concussions, some symptoms — including memory loss, headaches, and problems with concentration— may linger for several weeks or months. It's important to watch for these symptoms and contact your doctor if they last. Often, in these cases, children need further evaluation and treatment.
To diagnose a concussion, the doctor will ask about how and when the head injury happened, and about your child's symptoms. The doctor also may ask basic questions to test your child's consciousness, memory, and concentration ("Who are you?"/"Where are you?"/"What day is it?").
The doctor also will do a physical exam and focus on the nervous system by testing balance, coordination, nerve function, and reflexes. Sometimes a computed tomography (CAT scan or CT scan) or magnetic resonance imaging (MRI) brain scan will be done to rule out internal bleeding or other problems from the injury.
Some kids who have head injuries from playing organized sports are examined by a coach or athletic trainer immediately after they're injured. This is known as sideline concussion testing because it might happen on the sidelines during a game. Sideline testing is common in schools and sports leagues. By watching a player's behavior and doing a few simple tests, a trained person can see if immediate medical care is needed.
Lots of schools or sports leagues use computerized programs that test players at the start of a sports season to measure their normal brain function and ability to process information. These tests are called baseline concussion tests. After a possible injury, sideline test results are compared with baseline test results to help doctors determine if there's been a change in brain function and to help make a diagnosis.
Because each concussion is unique, symptoms can differ in severity. For this reason, treatment depends on a child's particular condition and situation.
If a concussion is not serious enough to require hospitalization, a doctor will give instructions on home care. This includes watching the child closely for the first 24 to 72 hours after the injury. It is not necessary to wake the child up while he or she is sleeping to check for symptoms.
If a child has a headache that gets worse quickly, becomes increasingly confused, or has other symptoms (such as continued vomiting), it may mean there is a more serious problem. Call the doctor if your child has any of these symptoms.
Otherwise, home care for a concussion may include:
- Physical rest. This means not doing things like sports and physical activities until the concussion is completely healed. While they still have symptoms, kids should do only the basic activities of day-to-day living. This reduces stress on the brain and decreases the chances of re-injuring the head in a fall or other accident.
When all symptoms are gone, kids should return to physical activities slowly, working their way back to pre-concussion levels.
- Mental rest. This means avoiding any cognitive (thinking) activity that could make symptoms worse, such as using a computer, cellphone, or other device; doing schoolwork; reading; and watching TV or playing video games. If these "brain" activities do not make symptoms worse, kids can start them again gradually, but should stop immediately if symptoms return.
- Eating well and drinking plenty of non-caffeinated beverages.
Kids with concussions also should avoid bright lights and loud noises, which can make symptoms worse. While they have symptoms, teens should take time off from work and not drive, operate heavy machinery, or do any other activities that require quick decisions and reactions.
Healthy kids usually can return to their normal activities within a few weeks, but each situation is different. The doctor will monitor your child closely to make sure that recovery is going well, and might recommend acetaminophen, ibuprofen, or other aspirin-free medicines for headaches. Pain medicines can hide symptoms, though, so kids should not return to normal activities until they no longer need to take them.
Returning to Normal Activities
Be sure to get the OK from the doctor before your child returns to sports or other physical activities. Sometimes kids feel better even though their thinking, behavior, and/or balance have not yet returned to normal.
Even if your child pleads that he or she feels fine or a competitive coach or school official urges you to go against medical instructions, it's essential to wait until the doctor has said it's safe to return to normal activities. To protect kids and remove coaches from the decision-making process, almost every state has rules about when kids with concussions can start playing sports again.
It's very important for anyone with a concussion to heal completely before doing anything that could lead to another concussion. Hurrying back to sports and other physical activities increases the risk of a condition called second-impact syndrome, which can happen as a result of a second head injury. Although very rare, second impact syndrome can cause lasting brain damage and even death.
All kids should wear properly fitting, appropriate headgear and safety equipment when playing contact sports or biking, rollerblading, skateboarding, snowboarding, or skiing. Nothing can prevent every concussion, but safety gear has been shown to help protect against severe head trauma.
Childproofing your home will go a long way toward keeping an infant or toddler safe from concussions and other injuries. Babies reach, grasp, roll, sit, crawl, pull up, "cruise" along furniture, and walk. Toddlers may pull themselves up using table legs; they'll use bureaus and dressers as jungle gyms; they'll reach for whatever they can see. All of these activities can result in a head injury that leads to a concussion. Be sure your child has a safe place to play and explore, and never leave a baby or toddler unattended.
People are much more likely to sustain a concussion if they've had one before, so prevention is even more important following a head injury. Evidence shows that repeated concussions can result in lasting brain damage, even when the injuries happen months or years apart.
Concussions are serious injuries that can become even more serious if kids don't get the time and rest needed to heal them completely. Safety precautions can help prevent concussions, and following a doctor's advice can minimize their effects if they do happen.
Reviewed by: Elana Pearl Ben-Joseph, MD, and Todd A. Maugans, MD
Date reviewed: March 2015