A concussion is an injury to the brain caused by either a blow to the head or body. A child’s developing brain is more at risk than an adult’s, so parents and caregivers may want to know the signs of concussion and how to treat a concussion in a child.

We often hear about concussions in sports-related head injuries, but many concussions happen off the field — in car and bicycle accidents, playgrounds, fights, and even minor falls.

In this piece, we will look at the warning signs and how to spot concussion in a child, what to do if you think a child has a concussion, how to treat a concussion, and what type of medical professional can help.

SIGNS AND SYMPTOMS OF CONCUSSION

A concussion is a type of mild traumatic brain injury. The trauma can be a direct hit or an indirect blow. The brain can move around inside the skull and even bang against it. If the brain jostles within or against the skull — for example, in a fall on a playground, bike, or car accident — blood vessels can tear and the nerves inside the brain can be injured. These injuries cause a chemical or metabolic crisis that actually stops the brain from working normally for a period of time.

Concussion injury does not appear on any routine brain scan such as CT or MRI, and there is no diagnostic test for concussions. A diagnosis of concussion is made based on a group of symptoms that can become immediately present or blossom over the 24 hour time period after injury. Acute symptoms can be present for typically 10-14 days in adults and up to 30 days for the more developing child’s brain.

Concussions are no longer graded in severity but the single most reliable source of predicted outcomes is the severity of symptoms within the first 24 hours or first few days. Therefore, better outcomes for patients with fewer symptoms first 24 hours. Find your Free Concussion Symptom Tracker HERE.

Possible Signs and Symptoms

PHYSICAL

Headache
Fuzzy or blurry vision
Nausea or vomiting (early on)
Dizziness
Double or blurred vision
Sensitivity to noise or light
Balance problems
Feeling tired, having no energy

EMOTIONAL/MOOD

Irritability
Sadness
More emotional
Nervousness or anxiety

SLEEP

Sleeping more than usual
Sleeping less than usual
Trouble falling asleep

THINKING/REMEMBERING

Difficulty thinking clearly
Feeling slowed down
Difficulty concentrating
Difficulty remembering new information

WHAT TO DO IF YOUR CHILD HAS A CONCUSSION

Immediately

Removal from play is the most important decision one can make when a child has suffered a possible concussion. Whether the head injury occurred on a sports field, on a playground, or in an accident removing a child from play is necessary and the child should be watched closely. A loss of consciousness or “blacking out” is not required to have a concussion. Symptoms can actually blossom over the next 24 hours after head trauma.

Doctors now recommend these steps after a suspected sports concussion:

The player should immediately stop playing or practicing. This avoids the chance of Second Impact Syndrome, Read more HERE.
The player should get checked out by a doctor or trainer before returning to practice or play.

In rare cases, a head injury can cause a hematoma in a child’s brain. A hematoma is a collection of blood that forms in the brain and squeezes it against the skull. Doctors view a hematoma as a medical emergency.

Emergency Room may be necessary if a child has:

lost consciousness when hit
loss of memory for more than 24 hours
seizures, which could mean shaking or twitching
unequal pupil size
slurred speech
unable to wake up
vomited repeatedly
symptoms that suddenly get worse

Download the Free Custom Care Rehab ebook on Guide on Concussion Symptom Management. Full of great tips and how to get the quickest recovery for your child!

First 24-48 Hours

All injured body parts take time to heal, even brains. By resting and taking certain important precautions, kids with concussions usually recover within a week or two without lasting health problems. Current literature supports physical and cognitive rest for 24-48 hours with a subthreshold progression back to full activity. Subthreshold, meaning only performing activities that do not cause symptoms. With the typical recovery time for concussion being under 10–14 days in adults and under 4 weeks in children.2

One common question I get is…”Is it okay to let my child sleep?” Yes! Brain or Cognitive rest is good for recovery in the first 24-28 hours. However, a child should be able to be roused from sleeping, but allow them to sleep if they want to. If you cannot get your child to

See How to Get Cognitive Rest in Concussion for much more detailed information on this topic.

First Week to 30 Days

Within the first week, you should schedule an appointment with your primary doctor or a concussion specialist so they can see your child when symptoms are at their peak. Follow the tips in the ebook Guide on Concussion Symptom Management and gently encourage your child to start subthreshold activities; meaning stop an activity if symptoms begin. For example, light walking should be encouraged for 20-30 minutes a day without symptoms, resting when necessary. Napping is fine, but limit naps through the day to 20-30 minutes, and no naps near bedtime.

Your child should be encouraged to get back to normal school work, social life, and physical activity that does not put them at risk for another head injury, ALL with following the subthreshold rule: if you start to get symptoms, go rest in a quiet space until symptoms subside.

After One Month

Nearly 80% of concussions in children are healed by 4 weeks; those that are not are considered to have post-concussion syndrome. At this time your primary doctor may encourage you to seek treatment. This is when you may be referred to a myriad of medical providers and things can start to get overwhelming. In my experience, a trained physical therapist in the area of concussion, a concussion specialist physician to manage restrictions and diagnostics, and possibly a neuropsychologist is a great place to start.

According to the Berlin Consensus Statement on Concussion the most effective treatment for post-concussive syndrome is:

Cervical ( neck treatment)
Vestibular (inner ear and dizziness treatment)
Psychological
Individualized symptom-limited graded aerobic exercise prescription (normally done by a trained concussion PT or athletic trainer)

How to Manage Post Concussion Syndrome

This topic could be a whole separate blog, but the most important item to remember is that you should find a trained concussion Physical Therapist, like Custom Care Rehab. I have helped hundreds of children and athletes recovery from various concussion injuries and get them back to sport and school. Getting to a trained concussion specialist will allow you to help root out the source of remaining symptoms and start the right individualized treatment approach versus seeing many different medical providers who may order a bunch of tests, but provide no treatment. By starting with Custom Care Rehab and your physician of choice it can save you time, money, and have your child get back what they love to do more quickly!

Find a Certified Concussion Professional in your area HERE.

Prevention in Concussion

All kids should wear properly fitting, appropriate headgear and safety equipment when playing contact sports or biking, rollerblading, skateboarding, snowboarding, or skiing. Nothing can prevent every concussion, but safety gear has been shown to help protect against severe head trauma.

Proper child car seats and seatbelts can help prevent head injuries in the event of a car accident and should be used every time kids are in a car.

People are much more likely to sustain a concussion if they’ve had one before, so prevention is even more important following a head injury.

Concussions are serious injuries that can become even more serious if kids don’t get the time and rest needed to heal them completely. Safety precautions can help prevent concussions, and following a doctor’s advice can minimize their effects if they do happen.

Call Custom Care Rehab at 330-618-5703 with any questions or to set up a Free Discovery Visit for your child.

Resources

Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016https://cfpsm.com/wp-content/uploads/2018/01/concussion-consensus-2016.pdf.

HOW TO TREAT A CONCUSSION IN A CHILD