First Aid: Concussions in Children
Concussions are one of the most common brain injuries that affect approximately two million children and adolescents every year. Sports are a major contributing factor to this statistic with half of all concussions being the result of a sports injury. Cheerleading and contact sports like football, soccer, lacrosse, ice hockey, field hockey, basketball, rugby, and wrestling pose the greatest risk for concussions. However, while concussions are common sports injuries, kids can also get concussions from non-sports-related activities such as a car or bike accident, a fall while skateboarding or tree-climbing, or any activity that may lead to a head injury. While concussions result from obvious injuries, others can result from what may seem like a minor injury at first. Therefore, it is important for parents to understand what a concussion is and how it can be recognized so that appropriate treatment and safety measures may be put in place to prevent further injury.
What is a Concussion and How is it Caused?
A concussion is a mild traumatic brain injury (mTBI) that results in a temporary disruption of normal brain function. This happens as the result of a bump, blow, or jolt to the head or body that causes the brain to move or bounce around in the skull. This injury affects the function of the brain as opposed to the physical structure of the brain. Falls and head collisions during sports, sudden jolts from car accidents, or a hard push from roughhousing are all examples of activities that could possibly lead to a concussion in children and adolescents.
What Are the Signs and Symptoms of a Concussion?
Because the injury may seem minor at first, it is important for parents to be able to recognize the signs and symptoms of a concussion. While signs and symptoms of a concussion typically appear shortly after the injury, it is possible for some not to appear for hours or even days. Therefore, it is important for parents to closely monitor children suspected of a head injury immediately after the injury and again a few days after in case signs and symptoms should appear later.
The most common signs and symptoms of a concussion can be categorized into four groups: Those that are physical and those that are related to a disruption in sleep, thinking or remembering, or mood.
Physical
Headache
Nausea/vomiting
Balance problems, dizziness, double/blurry vision
Sensitivity to light or sound
Slowed/delayed reaction time
Sleep Disturbances
Sleeping more or less than usual
Difficulty falling asleep
Fatigue/drowsiness
Thinking/Remembering Issues
Confusion
Difficulty concentrating or remembering
Feeling sluggish, hazy, foggy, or groggy
Mood Disruption
Irritable
More emotional than usual
Sad, nervous, or depressed
Feeling “off/down” or “just not feeling right”
What are Dangerous Signs and Symptoms of a Concussion?
When a child is suspected of a head injury or concussion, call 911 right away with any of the following symptoms as they could indicate a more serious injury such as an intracranial hematoma (a collection of blood in or around the brain that requires immediate medical attention):
One pupil larger than the other
Difficult to arouse or unable to awaken
Worsening headache that does not go away
Slurred speech
Weakness, numbness, or decreased coordination
Repeated vomiting or nausea
Seizures or convulsions (shaking, twitching)
Unusual behavior such as increased confusion, restlessness, or agitation
Bloody or clear fluid from nose or ears
Loss of consciousness—Even if brief!
Dangerous Signs and Symptoms in Infants or Toddlers
Any of the above signs or symptoms
Persistent crying
Inability to be consoled
Refusal to nurse or eat
How is a Concussion Diagnosed?
A concussion is diagnosed with a physical exam where the injury will be assessed including range-of-motion of the head and neck, balance, eye movement, and neurocognitive ability. The cause of injury, any present symptoms, and your child’s past medical history will be discussed including any history with migraines, headaches, learning disabilities, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), visual disorders, and emotional and health conditions. Concussions may be more difficult to control with more severe or prolonged symptoms in a child with any of these pre-existing conditions.
Your child’s primary care provider may also use special questionnaires such as the Sport Concussion Assessment Tool (Scat 5) to help guide their neurological examination and help determine concussion severity. Other computerized tools such as the King Devick or the ImPACT Test (Immediate Post-Concussion Assessment and Cognitive Testing) may be used, however, they are not as widely available yet.
Will My Child Require Imaging Tests (Such as a CT Scan or MRI)?
Not necessarily—this depends on the severity of the injury. Concussions affect the function of the brain, whereas brain imaging, such as computed tomography scans (CT/CAT scans) or magnetic resonance imaging (MRI), look for structural changes of the brain. Therefore, you cannot see a concussion on brain imaging like a CT scan or MRI. However, further imaging studies may be required if a more severe head injury such as an intracranial hematoma is suspected.
How is a Concussion Treated?
The first-line treatment for a concussion is rest, both mental and physical. Proper rest allows the brain to heal. A gradual return to regular activities is recommended as symptoms allow. Any activity that requires too much physical exertion or concentration too quickly may cause symptoms such as a headache and should be stopped. As symptoms improve, these activities may be resumed slowly for shorter periods of time. Children with a concussion should sleep for as much as they need in the first few days following injury, and they should not return to school until symptoms are significantly improved. This gradual return to mental and physical activities should be guided by your child’s pediatrician.
It is very important to prevent any other head injuries while recovering from a concussion. A second concussion is more likely during this time of healing as the brain is vulnerable. Repeated concussions can result in more severe long-term complications such as post-concussion syndrome or chronic traumatic encephalopathy (CTE).
How Do I Help My Child Prevent a Concussion?
While it is not always possible to prevent a concussion, there are some ways to help reduce the risk:
Helmets—Well-fitted, proper helmets should always be worn for any riding activities (such as horseback riding, motorbiking, bicycling, skateboarding, or snowboarding) or contact sports (such as football, hockey, or lacrosse). While helmets are not specifically designed to prevent concussions, they can help reduce the risk of a serious brain injury or skull fracture.
Seatbelts, Car Seats, and Booster Seats—Children should always use seatbelts and age- and size-appropriate car seats and booster seats. Ensure that car seats and booster seats are properly installed according to the manufacturer.
Sports Safety Measures—Rules of the sport for fair play, safety, and sportsmanship should be enforced. Coaches should teach athletes techniques and skills to help avoid unsafe collisions or other injuries. Any athlete with a head injury or suspected concussion should be immediately removed from play without returning until cleared by a healthcare provider.
Key Points to Remember
While concussions can happen during any activity that can lead to a head injury, they often occur during sports. Most children recover completely from a concussion within a couple of weeks. It is important for parents to be able to recognize the signs and symptoms of a concussion quickly so that further injury to the brain with a second concussion may be prevented and appropriate treatment with proper rest may be initiated. A child with a concussion requires close monitoring for any new or worsening symptoms that may require additional or emergent medical treatment. Parents should work closely with their child’s primary care provider to help determine when and how quickly a child may safely return to school, sports, or other activities. You can help your child prevent a concussion and other head injuries by ensuring the proper use of helmets, seat belts, car seats, and booster seats as well as ensuring proper safety measures are taken during sports games and practices. Keep these prevention strategies in mind to help keep your child healthy and safe this year and all of the years ahead!
Concussion Prevention—You can find more like this video and follow along for other helpful resources here.
