Concussions in Children

Helmets can help prevent concussions in children.

Is it just a harmless bump on the head — or something more serious? Our pediatric concussion experts have the experience, equipment and medical know-how to tell the difference. We take a team approach to assess and treat mild traumatic brain injuries and concussions in children of all ages.

Read More About Concussions In Children

A concussion is a type of mild traumatic brain injury that occurs when someone’s brain moves around inside the skull or bangs against it. Although the injury may seem mild, concussions in children can affect health, thinking ability, behavior/mood, school performance and social interactions.

A concussion can be caused by:
  • a fall, especially in babies, toddlers and young children
  • a sports injury
  • a crash involving an all-terrain vehicle (ATV), bike or automobile
  • a physical attack, a school fight or child abuse
  • whiplash
  • any major head trauma, blow to the head

With plenty of rest and reduced activity, kids often recover on their own from a concussion in a week or two. Concussions in other children might require weeks or even months of therapy, rehabilitation, and taking a break from school, sports and other physical and cognitive activities. One of the most important factors for a successful recovery is easing back in to regular activities slowly over time, one activity at a time, with guidance from your health care provider.

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Nemours/Alfred I. duPont Hospital for Children, Wilmington

1600 Rockland Road
Wilmington, DE 19803
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For Appointments: (302) 651-4200

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(800) 451-2854

Concussion Clinic Nurse Practitioner
  • Jennette Firlein, APN
Concussion Specialty Nurses
  • Dara DeVinney, RN, BSN
  • Margaret Zysk, RN, BSN
What to Bring
  • photo ID
  • medical and pharmacy insurance cards
  • preferred pharmacy name and phone number
  • names and dosage of all medications, including over-the-counter medication, your child is currently taking
  • guardianship and custody papers, if a legal guardian rather than a parent accompanies your child
Returning Patients
  • Patient Presents Without Legal Guardian (PDF)
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    Note: A parent or legal guardian must be with a child for a first visit.
Forms & Resources
Returning Patients
  • Patient Presents Without Legal Guardian (PDF)
    English | Spanish
    Note: A parent or legal guardian must be with a child for a first visit.
Resources for Patients & Families

A concussion is an injury to the brain, caused by a fall, car accident or other trauma — perhaps during a sport or on the playground. 

Most often, a child or teen with a concussion may be a little disoriented and/or have a mild headache. But it’s important to know that there could still be a concussion even if he or she didn’t black out and doesn’t have any of the usual symptoms (see below). At Nemours/Alfred I. duPont Hospital for Children, we offer a comprehensive Concussion Program to address concussions in children and teens.

What Is a Concussion?

A concussion is a brain injury caused by a blow or shaking of the head, neck or body that snaps the brain forward, sideways and/or backward inside the skull. The causes are many, ranging from accidents to sports injuries. Some children and teens may be more prone to sustaining concussions. This includes those with prior head injuries and concussions, children with learning differences, as well as those with mood disorders.

In recent years, sports-related concussions in children and teens have helped to raise public awareness of concussions and their long-term effects. As a result of this heightened awareness, concussions are now being reported and diagnosed more than they were in past years. The Centers for Disease Control and Prevention last published statistics for youth concussions and brain injuries in 2010, at which time they estimated there were 400,000 concussions and brain injuries per year among high school athletes alone.

All of the heightened awareness means that primary care pediatricians are more experienced than ever in the proper diagnosis and treatment of concussions. 

A concussion can affect your child’s brain functions, health, thinking ability, behavior, school performance and social interactions for quite some time. So it’s important to have your child or teen diagnosed and receive the proper care.

Typical Symptoms of Concussions in Children and Teens

It used to be commonly believed that a concussion only occurred when people hit their heads so hard they blacked out. We now know that’s not true. In fact, only 10 percent of children and teens with concussions report being "knocked out." Also, the symptoms people usually associate with concussions may not develop until after 24–72 hours — and they may not appear at all.

Symptoms can range from mild to severe, lasting for hours, days, weeks or even months. They often go away on their own in 24–48 hours with brain rest (no schoolwork, reading, TV, texting, etc.). It's very important to note that if your child or teen doesn't get the proper brain rest, the symptoms can drag on and it will very likely take longer for your child to recover from the injury.

Symptoms of concussions in children and teens 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 one to three days 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 change in behavior
  • sadness
  • feeling more emotional
  • nausea and/or vomiting
  • reduced energy level (tiredness)
  • sensitivity to light or noise
  • trouble falling asleep or change in sleep patterns
  • changes in school performance
Diagnosing Concussions in Children and Teens

Fortunately, our concussion team knows exactly what to look for. We’ll perform a complete examination of your child and may ask a variety of questions designed to check your child’s memory and ability to concentrate. We may also look into your child’s eyes and check visual tracking, reflexes and balance. Our team sees a wide range of children and teens for concussion diagnosis and treatment.

One helpful aid in diagnosis and management is having a baseline test done before your child participates in sports (more about this below).

Because a concussion affects the function of the brain, not its structure, there usually isn’t anything that can be detected with medical imaging tests such as X-rays, computed axial tomography (CAT or CT) scans or magnetic resonance imaging (MRI) exams. However, in rare instances, especially if your child lost consciousness or is feeling very sick in the emergency department, one of these forms of medical imaging may be used to make sure there’s no internal bleeding or bruising. If an imaging test is needed, it can be done right here in our hospital.

Learn More About the Different Kinds of Imaging Tests and What to Expect »

The Concussion Clinic at duPont Hospital for Children

When you call our Concussion Program at Nemours/Alfred I. duPont Hospital for Children for an appointment, our specially trained concussion nurse navigator will help determine which doctor will be best for your child. She’ll also answer your questions and give you any information you might need.

Depending on your child’s age and how the concussion occurred, your child could see a physician from our programs in pediatric sports medicine or pediatric rehabilitation medicine (also known as pediatric physical medicine and rehabilitation, or PM&R, these doctors specialize in conditions such as brain injuries). Specialists in neurology, neuropsychology, neurosurgery and ophthalmology may also be consulted if needed.

We know concussions can be scary, whether your child is an infant or adolescent. That’s why our concussion experts work together as a team to evaluate and treat concussions in children and teens and will give your child the precise, individualized care he or she needs. Knowing that your child is in good hands will hopefully give you a little peace of mind and ease your concerns.

Learn more about our team members:

Caring for Your Child or Teen’s Concussion

First and foremost, your child or teen will need rest. Rest gives the brain time to heal. This can mean missing a bit of school and avoiding physical activities such as gym class, sports activities, exercise, weight training, recess, bike riding and wheeled activities (to name a few), until cleared by a doctor. Your child or teen may also need to stay away from loud, bright, crowded places and limit activities that require a lot of thinking (including school, work and driving) or visual attention (use of computers, tablets, smart phones, TV, texting and reading).

Our specialists will set up a plan to help your child or teen gradually and safely ease back into normal activities. Depending on the circumstances, your child’s symptoms may dissipate in a few days or a week. Some factors that can contribute to how long your child has a concussion include the specific areas of the brain that were injured and the extent of the injury, if your child receives the proper brain rest, if your child has had a previous concussion, and if your child was already prone to headaches.

Symptoms for the vast majority of concussions in children and teens resolve in the first few weeks. For a smaller percentage of kids, the symptoms can last a number of months and, for a few, even more than a year — it's this group of kids that most need the care of our concussion rehabilitation specialists.

For these longer-term concussions, rehabilitative therapy services can be useful to help specific areas of the brain return to full function. This usually takes the form of physical therapy, occupational and speech therapy. Your child’s doctor may also prescribe something if frequent headaches continue to be a problem.

Convenient Follow-Ups at Other Nemours Locations

If it's more convenient for you and your child, you may be able to continue any necessary follow-up therapy at our Bear, Del., Voorhees, N.J., or Pennsylvania (Newtown Square, Philadelphia or Bryn Mawr) Nemours duPont Pediatrics locations.

Concussion Tips

Here are some things to keep in mind about concussions in children and teens:

  • 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 roughhousing 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.
Return to Play for Athletes

Under laws in Delaware, New Jersey and Pennsylvania, your child will require medical clearance from a physician before returning to play. Your child’s school can tell you the most recent regulations for your state. Our Concussion Program nurse navigator can set this appointment up for you as well. Our Return to Play (RTP) evaluation is designed to ensure that your child is fully healed, and typically involves post-injury neurological screening, balance and vision assessments.

Preventing Concussions in Children and Teens

Here are some common-sense steps you can take to reduce your child’s chance of getting a concussion:

  • 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.
Comprehensive Baseline Concussion Testing

If you have a young athlete, it’s a good idea to have your child’s brain function measured before an injury occurs.

You can find our Comprehensive Baseline Concussion Testing Program at Nemours/Alfred I. duPont Hospital for Children and Nemours duPont Pediatrics, Bryn Mawr (in Pennsylvania). Traditional baseline testing (not the full comprehensive testing) is available at our Nemours duPont Pediatrics locations in Newtown Square and Philadelphia, Penn., as well as Voorhees, N.J.

This comprehensive screening uniquely combines four separate tests for the most accurate screening available. The tests help measure your child's memory, balance and vision.

One of these tests is the ImPACT® (Immediate Post-Concussion Assessment and Cognitive Testing) test, a computerized, neuropsychological tool used to assess certain aspects of thinking known to be disrupted during a concussion. Preconcussion results are then used as a benchmark or baseline for comparison with postconcussion ImPACT® scores. These test results provide specific and individualized information for assessment, treatment and return to play.

Young athletes 10 years and older should have baseline testing done every year. Although many schools perform baseline testing, having it done at Nemours gives you the best chance that the test will be done in a carefully controlled environment by medically trained technicians, for more useful and medically valid results if a concussion occurs.

How the Test Works

Baseline testing is performed by a Nemours practitioner who has received special training in administering the test and evaluating the validity of the results. The testing requires a brief historical interview to gather information. Your child will sit at a computer and be given a series of questions and tasks, which must be completed in sequence.

The Process

The process takes less than an hour. We’ll review the results at a later date to ensure they’re valid for use, and we’ll store them in the ImPACT database. (If the test results aren't valid, your child may need to retake the test. If so, a nurse will call to reschedule.) If your child has a concussion or other brain injury later, one of our Concussion Program experts will administer a post-injury test and then compare the results with your child’s baseline testing results. That means we’ll be able to compare your child’s brain function before and after the injury.

Cost & Contact Information

Comprehensive baseline concussion testing costs $50 and traditional baseline testing is $12. Testing is not covered by insurance, and payment is due at the time of testing. This cost may, however, be covered by a Health Savings Account.

To schedule an appointment or learn more about baseline testing, contact us at (800) 416-4441.

Downloadable Brochures:

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 in these YouTube videos from Nemours: