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

Bike Safety

Bike riding is a great way to get exercise and fresh air and share time as a family. But before you and the kids rush out and start pedaling, there's an important factor that you need to consider — safety.

Helmet Basics

Bicycle helmet use should not be optional for anyone in your family, no matter where you are or how short the ride. In many states it's the law.

Here's why: Many bike accidents involve a head injury, so a crash could mean permanent brain damage or death for someone who doesn't wear one while riding. In fact, each year in the United States, about half a million kids are seriously injured in bicycle-related accidents, and most of those injuries could have been avoided if a helmet was worn. To protect against brain injury, make sure your kids wear a correctly fitting helmet on every ride.

Here are some things to keep in mind when buying a helmet:

  • Pick bright colors or fluorescent colors that are visible to drivers and other cyclists.
  • Look for a helmet that's well ventilated.
  • Make sure that the helmet has a CPSC or Snell sticker inside. These indicate that the helmet meets standards set by the Consumer Product Safety Commission (CPSC) or the Snell Memorial Foundation, a nonprofit group that tests helmet safety.
  • Make sure your child's helmet fits correctly and can be adjusted.

P_helmet-fit

You should be able to get help finding a well-fitting helmet and adjusting it properly at any bicycle store.

When kids wear a helmet, make sure that the straps are fastened. Also make sure they don't wear any other hat underneath it.

Be sure to replace any helmet made before 1999. If your child hits any surface hard while wearing a helmet, replace it — helmets lose their capacity to absorb shock after taking serious hits.

A few bike helmets can be used as protection for other activities, but in general, they're best suited to biking. Most helmets are made for one specific type of activity — for example, special helmets also are made for inline skating, baseball, and snowmobiling.

Kids should not wear any helmet when they're on a playground or climbing a tree — there is a risk of strangulation from the chin strap during these types of activities.

Safe Clothing

What kids wear when riding a bike is also very important for safety:

  • Fluorescent or bright-colored clothes will help kids be visible on the road, and they’re more visible than white clothes. (Avoid dark clothes, especially during early dusk and twilight hours.)
  • Wear something that helps to reflect light like reflective tape.
  • Lightweight clothes will help them avoid becoming overheated.
  • Pant legs shouldn't be too loose-fitting or flared. These can get caught up in the chain while riding.
  • If your child wears a backpack while riding, make sure the straps are tied up and can't get tangled in the spokes of the wheels. Keep the backpack as light as possible.
  • Choose shoes that grip the bike's pedals. Cleats, shoes with heels, or flip-flops can all create problems while riding. Kids should never ride barefoot!

Rules of the Road for Bike Riding

Here are some must-know safety tips to teach kids:

  • Stop at all stop signs and obey traffic lights just as cars do. Yield to pedestrians, stop at red lights, and be especially careful at intersections.
  • Always ride in the same direction as cars do. Never ride against traffic.
  • Older kids should try to use bike lanes or designated bike routes whenever you can — not the sidewalk! Kids less than 10 years should ride on the sidewalk.
  • Never ride at dusk or in the dark.
  • Always stop and check for traffic in both directions when leaving a driveway, an alley, or a curb.
  • Watch traffic closely for turning cars or cars leaving driveways.
  • Don't ride too close to parked cars — doors can open suddenly.
  • Always walk a bike across busy intersections using the crosswalk and following traffic signals.
  • When riding in a group, always ride single file on the street.
  • When passing other bikers or people on the street, always pass to their left and call out "On your left!" so they'll watch for you.
  • Never share the seat with a friend or ride on the handlebars — only one person should be on a bike at a time. It's easy to lose balance or suddenly swerve into traffic when riding with a passenger.
  • Never wear headphones while biking — it's essential to hear everyone else on the road at all times.
  • Never stand up while riding a bike.
  • Never hitch a ride on a moving vehicle.
  • Never change directions or lanes without first looking behind you, and always use the correct hand signals. Use your left arm for all hand signals:

    • Left turn: After checking behind you, hold your arm straight out to the left and ride forward slowly.
    • Stop: After checking behind you, bend your elbow, pointing your arm downward in an upside down "L" shape and come to a stop.
    • Right turn: After checking behind you, bend your elbow, holding your arm up in an "L" shape, and ride forward slowly. Or, hold your right arm straight out from your side.

Left turn


Stop


Right turn

Right turn alternative

Bike Maintenance

Check your child's bike at least once each season to keep it safe and well-maintained.

Be sure to check:

  • tires — inflate to the pressure that's recommended on the sidewall of the tire
  • chain — oil it regularly and remove dirt
  • handlebars — adjust for height as your child grows and tighten all bolts
  • brakes — check for frayed cables and replace worn-out brake pads
  • seat — keep the seat level and adjust for height as needed

Making Safety a Family Affair

One of the best ways to help kids learn safe bike riding is to set a good example by following the rules of the road yourself. Most important, always wear your helmet.

Go for bike rides with your kids so you can show them what safe riding looks like. It's also a great way to stay active as a family and get valuable together time that you'll all enjoy!

Reviewed by: Kate M. Cronan, MD
Date reviewed: September 2010