By: Alcy R. Torres, MD, FAAP & Christina L. Master, MD, FAAP
A concussion is a type of mild traumatic brain injury (TBI). It can be caused by a bump, blow or jolt to the head or by a hit to the body. The impact moves the head quickly back and forth. This causes the brain to twist inside the skull, stretching the brain cells. Chemical changes in the brain temporarily disrupts normal brain function.
Causes of concussion in children & teens
Any activity that can result in injury to the head can lead to a concussion. This is especially true with contact sports like football, soccer, hockey, basketball, rugby, wrestling, lacrosse and
cheerleading. Kids can end up with concussions from other recreational activities too, such as bike riding, skateboarding or tree climbing.
Children are most likely to get concussions under age 4. (See "Concussions in Babies: What to Do If Your Infant or Toddler Hits Their Head.") Concussion are also more common during the teen years, when a growing urge for independence or peer pressure may lead kids to take more risks.
Common symptoms of concussions
Kids and teens who say they "don't feel right" after a bump, blow or jolt to the head or body may have a concussion or other more serious brain injury.
Parents may notice one or more of these common signs and symptoms:
Appears dazed or stunned
If the injury happened during sports, the child may forget an instruction, position or is unsure of the game, score or opponent
Moves clumsily
Answers questions slowly
Loses consciousness (even briefly)
Shows mood, behavior or personality changes
Can't recall events
before or after a hit or fall
Older kids and teens may report these symptoms:
Headache or a feeling of pressure in the head
Nausea or vomiting
Balance problems or dizziness, or double or blurry vision
Bothered by light or noise
Feeling sluggish, hazy, foggy, or groggy
Sleep changes, such as sleeping more or less after the injury
Confusion or concentration problems
Just feeling "off" or "down"
These symptoms often start right after the injury, but in some cases, may take up to a few days for them to occur.
More dangerous symptoms
Take your child to the emergency department right away if they have been hit in the head or body and have any of these symptoms:
Headache that gets worse and doesn't go away
Weakness, numbness or decreased coordination
Repeated vomiting or nausea
Slurred speech
Looks very drowsy or cannot be awakened
One pupil (the black part in the middle of the eye) is larger than the other
Convulsions or seizures
Cannot recognize people or places
Increased confusion, restlessness, or agitation
Unusual behavior
Loss of consciousness (even a brief loss of consciousness should be taken seriously and the child should be carefully monitored)
Will not stop crying and cannot be consoled (infants)
Will not nurse or eat (infants)
Diagnosing concussion
The doctor will get a detailed description of what happened, how your child is feeling and their past medical history.
The doctor will be especially interested in whether your child has had previous concussions and how long it took to recover from them. Other questions may focus on any history of attention deficit hyperactivity disorder (ADHD), learning problems, migraines, sleep disorders, autism or mood disorders. All this information helps your doctor work with your family to make a concussion treatment plan.
Because of the number of symptoms a concussion can have, your doctor might use a special questionnaire like the
Sport Concussion Assessment Tool (SCAT6). This tool helps guide your doctor through a standard concussion examination and help guide how to support your child after the injury.
Some doctors may use computerized tools to help evaluate patients with concussion. Examples include the King Devick or the ImPACT test (Immediate Post-Concussion Assessment and Cognitive Testing). However, these are not yet widely available and are not essential to diagnose and manage your child's concussion.
Are imaging tests needed?
Your child won't necessarily need any imaging tests of the brain or head, such as computerized tomography (CT) or magnetic resonance imaging (MRI). However, it depends on the situation. Doctors use specific reasons to decide when to do these tests, especially with kids, to avoid radiation exposure whenever possible.
It's important to remember that a concussion means there's a problem with how the brain is working, not that there's any structural damage. This means that even if your child's imaging test is normal, they might still experience symptoms related to the concussion.
Concussion treatment & recovery
The main treatment for concussion is to temporarily cut back on physical and mental activities for the first 48-72 hours. Although kids need to be monitored, contrary to old advice, you won't have to periodically wake up your child while they are sleeping.
Your child may need to take a few days off from school. Children with concussions don't have to be completely
symptom-free to go back, but they should be able to tolerate some activitiy for 30 to 40 minutes before a break.
Recess and physical education activities may need to be modified for a time, but
research has found that it's best not to cut these out completely since some physical activity that is helpful for recovery. You'll also need to be on the lookout for new or worsening symptoms and should follow-up with your primary care doctor or specialist as indicated.
While most kids recover from a concussion in about a month, up to 30% continue to have symptoms for longer periods of time. The amount of time it takes to recover depends on different factors such as how the concussion happened, your child's medical history (including any previous concussions), what treatments were used, and how well your child has followed your doctor's advice.
Talking with your child about concussions
Talk to your child about concussion and tell them to report any concussion symptoms at the time of injury to you and their coach right away.
Some teens think concussions aren't serious. Or, they worry that if they report a concussion, they'll lose their position on the team or look weak. Remind them that
it's better to miss one game than to miss the whole season. Newer research shows that the sooner an athlete comes out of a game after a concussion, the sooner they recover and get back to the game compared to athletes who continue to play after an injury.
Preventing head injuries
Not all concussions can be prevented, but there are some things you can do to reduce the force of the injury.
Children should wear helmets for any riding activities (like horseback, all-terrain vehicle (ATV), motorbike, bike, skateboard or snowboard) or contact sports (like football, hocke or lacrosse). Helmets should fit well and be in good condition. Helmets cannot completely prevent a concussion, but they do prevent more severe traumatic brain injury and can reduce the forces that cause a concussion. Athletes should also be taught safe playing techniques and to follow the rules of the game.
Most importantly, every athlete needs to know how crucial it is to let their coach, athletic trainer, or parent know if they have hit their head or their body and have symptoms of a concussion—even if it means stopping play. Never ignore a head injury, no matter how minor it seems at the time.
More information
About Dr. Torres:
 Alcy R. Torres, MD, FAAP, an Associate Professor of Pediatrics and Neurology at Boston University School of Medicine, is a member of the American Academy of Pediatrics Section on Neurology.
|
About Dr. Master:
 Christina L. Master, MD, FAAP, is a Professor of Pediatrics and Orthopaedic Surgery at University of Pennsylvania Perelman School of Medicine, and Co-Director of the Minds Matter Concussion Program at Children’s Hospital of Philadelphia. Dr. Master is a member of the American Academy of Pediatrics Council on Sports Medicine and Fitness. Follow her on Twitter at
@drtinamaster.
|