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

Concussions

The term concussion conjures up the image of someone knocked unconscious while playing sports. But concussions — temporary loss of brain function — can happen with any head injury, often without any loss of consciousness.

A concussion is also known as a mild traumatic brain injury. Although we usually hear about head injuries in athletes, many occur off the playing field in car and bicycle accidents, in fights, and even minor falls.

Kids who sustain concussions usually recover within a week or two without lasting health problems by following certain precautions and taking a breather from sports.

But a child with an undiagnosed concussion can be at risk for brain damage and even disability.

Anyone who sustains a head injury should stop participating and be removed from the activity or sport. Even without a loss of consciousness, it's important to watch for symptoms of a concussion.

Common initial symptoms include:

  • a change in level of alertness
  • extreme sleepiness
  • a bad headache
  • confusion
  • repeated vomiting
  • seizure

Someone with these symptoms should be taken to the emergency room.

About Concussions

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 does bang against the skull — for example, due to a fall on a sidewalk or a whiplash-type of injury — it can be bruised, blood vessels can be torn, and the nerves inside the brain can be injured. These injuries can lead to a concussion.

Many different systems have been used to grade or describe concussions. The severity of a concussion is determined by how long signs and symptoms last and so can only be known after someone has recovered. The longer the symptoms of changes in brain function, the more severe the concussion.

Signs and Symptoms of a Concussion

Someone with a concussion may lose consciousness, but this doesn't happen in every case. In fact, a brief loss of consciousness or "blacking out" isn't a factor in determining concussion severity.

Other signs of a concussion include:

  • headache
  • sleepiness or difficulty falling asleep
  • feeling confused and dazed
  • difficulty concentrating, thinking, or making decisions
  • dizziness
  • difficulty with coordination or balance (such as being able to catch a ball or other easy tasks)
  • trouble remembering things, such as what happened right before or after the injury
  • blurred vision
  • slurred speech or saying things that don't make sense
  • nausea and vomiting
  • feeling anxious or irritable for no apparent reason

Concussion symptoms may not appear initially and can develop over the first 24-72 hours. Anyone showing any of these signs should be seen by a doctor. Young kids can have the same concussion symptoms as older kids and adults, but changes in mood and behavior may be more subtle.

Call an ambulance or go to the ER right away if, after a head injury, your child:

  • can't be awakened
  • has one pupil — the dark part of the eye — that's larger than the other
  • has convulsions or seizures
  • has slurred speech
  • seems to be getting more confused, restless, or agitated

Though most kids recover quickly from concussions, some symptoms — including memory loss, headaches, and problems with concentration — may linger for several weeks or months. Nearly 15% of kids age 5 and older have symptoms and/or changes in functioning lasting 3 months or longer. It's important to watch for these symptoms and contact your doctor if they persist.

Diagnosis

If a concussion is suspected, the doctor will ask about how the head injury happened, when, and its symptoms. The doctor also may ask basic questions to gauge your child's consciousness, memory, and concentration ("Who are you?"/"Where are you?"/"What day is it?").

The diagnosis of a concussion is made by health care provider based on history and physical exam. The doctor will perform a thorough examination of the nervous system, including testing balance, coordination, nerve function, and reflexes.

Sometimes a doctor may order a CT scan of the brain (a detailed brain X-ray) or an MRI (a non-X-ray brain image) to rule out bleeding or other serious brain injury. Concussions can change the way the brain works, but in most cases, imaging tests will show normal results.

Treatment

If the concussion is not serious enough to require hospitalization, the doctor will provide instructions on how to take care of your child at home. The doctor may have you wake your child up at least once during the night.

If your child cannot be easily awakened, becomes increasingly confused, or has other symptoms (such as continued vomiting), it may mean there is a more serious problem that requires contacting the doctor again.

The primary treatments for a concussion include both physical and mental rest. While your child has symptoms, he or she should not:

  • attend school or have a normal workload
  • take any high-stakes testing (for example, state testing, PSATs, SATs, etc.)
  • participate in physical activity including gym class, recess, and sports
  • participate in wheel activities (for example, biking, rollerblading, scootering, or skateboarding)
  • drive or operate heavy machinery
  • return to work

After a concussion, the brain needs time to heal. Recovery time will depend on how long the symptoms last. It's very important for kids to wait until all symptoms have ended before resuming normal activities. Physical symptoms, balance and coordination, and thinking and personality all should return to the pre-injury level.

Be sure to get the OK from the doctor before your child resumes 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 given the OK.

Healthy kids can usually resume their normal activities within a few weeks, but each situation is different. The doctor will monitor your child closely to ensure that recovery is going well and might recommend acetaminophen, ibuprofen, or other aspirin-free medications for headaches.

Even mild concussions require a player to sit out for the remainder of the game. People are much more likely to sustain a concussion if they've had one previously. And evidence shows that repeated concussions can result in lasting brain damage, even when the injuries occur months or years apart.

Kids who have resumed normal activities and no longer have symptoms might be allowed to slowly return to sports. This is a gradual process that can take anywhere from a few days to weeks. A person should never return to play or other strenuous activities on the same day of the injury and should see a doctor.

Preventing Concussions

All kids should wear properly fitting, appropriate headgear and safety equipment when biking, rollerblading, skateboarding, snowboarding or skiing, and playing contact sports. Safety gear has been shown to reduce the occurrence of 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, and eventually 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.

The time you spend taking these safety precautions — and getting your kids into the habit of abiding by your safety rules and regulations — will help keep your family safe and sound!

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