Pediatric concussion

What is a pediatric concussion?

A concussion is a brain injury caused by a blow to the head or body that shakes the brain inside the skull. As a mild traumatic brain injury (mTBI), a concussion affects the brain’s normal function, causing physical, cognitive (thinking), emotional and sleep-related symptoms.

It’s possible to have a concussion without losing consciousness or having a noticeable, external head injury.

Concussions in children can range from mild to severe, and the effects are different for each child. If you think that your child may have a concussion, we recommend taking them to the emergency room right away for a doctor’s evaluation.

Children's Health also provides a 24-hour concussion advice line at 844-414-6824.

What are the signs and symptoms of a pediatric concussion?

If your child receives a head injury, the signs and symptoms of a concussion/mTBI may appear right away, or they may develop over several hours or days. With children’s concussions, the signs can be less noticeable than in adults, and very young children may not be able to tell you about their symptoms. That’s why it’s important for parents and caregivers to watch their children closely after a head injury and pay attention to any changes in behavior or mood.

In children, concussions can cause signs and symptoms that medical experts describe in four categories.

Physical signs and symptoms of a concussion

• Concussion-related headache

• Dizziness

• Fuzzy or blurred vision or sensitivity to light

• Nausea and vomiting

• Ringing in the ears or sensitivity to sound

• Trouble with balance or coordination

• Sluggishness (feeling slowed down)

Cognitive (thinking and remembering) effects of a concussion

• Difficulty concentrating

• Trouble with memory, such as not remembering the injury

• Confusion or “brain fog”

• Slowed thinking

Sleep disturbances after a concussion

• Sleep that lasts longer or shorter than usual

• Fatigue (tiredness)

• Trouble falling asleep

Emotional and mood changes after a concussion

• Anxiety and nervousness

• Sadness and depression

• Mood swings or irritability

When to seek emergency care after a head injury

If your child has had a head injury, take them to the nearest emergency room if they have any of these signs or symptoms:

• Any loss of consciousness, even if brief

• Seizures (twitching or jerking movements in the body)

• Inability to recognize people or places

• Repeated vomiting

• Slurred speech

• Difficulty waking up or staying awake

• Blood or clear fluid coming out of the nose or ears

• One pupil (black center of the eye) that’s larger than the other

• Weakness or tingling in the arms or legs

Children's Health also provides a 24-hour concussion advice line at 844-414-6824.

How are pediatric concussions diagnosed?

It’s not possible to see a concussion with imaging, and there’s not one specific test that can diagnose a concussion/mTBI. If your child receives a head injury, our expert team looks for signs of injury to their brain function to determine if they have a concussion.

Our pediatric concussion specialists begin with a physical exam, and we’ll ask you about their medical history, including any previous injuries. To diagnose concussions in children, we do a complete neurological exam, which is a painless series of tests to understand how the brain is working.

Neurological exam

• Mental status, including attention, memory, language and other cognitive (thinking) skills

• Visual tracking (the eyes’ ability to track motion)

• Motor and sensory skills, including movement, hearing and vision

• Balance and coordination

• Reflexes

Many schools and sports organizations have established concussion protocols to ensure proper diagnosis and management of concussions in children. If your child has a head injury during a sports event or practice, on-site staff may be available to immediately evaluate your child and determine next steps for their care .

Imaging

Depending on your child’s symptoms, we may do imaging tests to check for more severe head injuries or rule out other brain conditions. Your child might need one or more imaging studies, such as:

• Computed tomography (CT) scan - This imaging uses a combination of X-rays and computer technology to produce cross-sectional, 3D images of the brain.

• Magnetic resonance imaging (MRI) - Powerful magnets and radio waves create images that show our specialists a more detailed and complete view of the brain.

Baseline concussion testing for student athletes

A baseline test measures your child’s healthy brain function before any injuries, creating a record of their physical and cognitive abilities. Our doctors and providers can then use this baseline measure as a comparison to help diagnose a concussion after a head injury. This testing helps us understand your child’s post-injury brain function, decide on the proper treatment and determine when they’re ready to get back to sports and other activities.

Many schools require student athletes to complete baseline concussion tests, and we recommend that student athletes complete these tests before their sports season begins. At the Children’s Health Andrews Institute for Orthopaedics and Sports Medicine, we offer ImPACT® (Immediate Post-Concussion Assessment and Cognitive Testing) through our Pediatric Sports Concussion Program.

What causes a pediatric concussion?

A concussion/mTBI (mild traumatic brain injury) happens when the brain is injured. A child can get a concussion from any hard hit to the head, face, neck or body. These kinds of injuries, such as the head forcefully snapping forward and back, cause rapid acceleration of the brain inside the skull.

Some causes of a pediatric concussion include:

• Vehicle and motorcycle accidents, including collisions with pedestrians

• Falls

• Accidents with bicycles, skateboards, ATVs or other recreation activities

• Collision and contact sports injuries, such as a blow to the head, face mask or chest

• Assaults (being hit by someone)

How are pediatric concussions treated?

Once our concussion team confirms a diagnosis of a concussion/mTBI, we work with you and your child to provide treatment recommendations.

• Physical and mental rest - Rest is the cornerstone of concussion recovery, giving the brain and body a break so the brain can heal. Your child should avoid physical activity, including sports, and activities that require concentration, such as screen time and homework. Your child may need to stay home from school for a few days, depending on their symptoms. They may also benefit from extra sleep for a few days

• Pain management - Over-the-counter pain medications, such as ibuprofen (Advil®) or acetaminophen (Tylenol®) can help manage headaches and other pain due to children’s concussion.

• Emotional support - Parents, caregivers, family members and friends can play a vital role in supporting a child's emotional well-being. They can provide reassurance, patience and understanding, and they can keep a child engaged in calm activities such as talking and playing quiet games.

• Gradual return to activities - As their symptoms improve, your child can gradually get back to their usual activities, but it's vital for them to listen to their body and avoid overexertion. They can add less intense activities, such as walking, but if their symptoms get worse, they can stop until they feel better.

Concussion management at Children’s Health

Most children recover from a concussion within a month. If concussion symptoms last longer than one month, your child may need rehabilitation to help them recover. Our pediatric concussion teams in Dallas, Plano and other North Texas locations offer comprehensive, specialized care for children with concussions/mTBIs, including those with delayed or incomplete recovery.

We provide evaluation, diagnosis and treatment for children of all ages who have had head injuries.

Our pediatric concussion care providers include:

• Neurologists (doctors who specialize in the care of conditions and injuries affecting the brain, spinal cord and nerves)

• Nurses and nurse practitioners trained in pediatric concussion care

• Neuropsychologists (providers with specialized training in how brain conditions and injuries affect behavior and cognitive skills)

• Occupational therapists (OT)

• Physical therapists (PT) who provide vestibular (balance) and ocular (vision) physical therapy (PT)

• Speech-language pathologists

We also provide ongoing follow-up care to monitor your child’s progress, ensure that the concussion heals completely and watch for any new or worsening symptoms. Our teams can also provide guidance on ways to reduce the risk of future concussions, which is important to prevent potentially life-threatening brain injuries.

Second impact syndrome can occur if a child experiences a second concussion before the first one has fully healed. Second impact syndrome, also called repetitive head injury syndrome, can lead to rapid brain swelling and even death within a matter of minutes.

Learn more about our Pediatric Concussion Program in Dallas and Plano and our Pediatric Sports Concussion Program in Plano, Frisco and Prosper.