By: Alcy R. Torres, MD, FAAP
A concussion is a type of traumatic brain injury (TBI) that temporarily disrupts normal brain function. It's caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth inside the skull. This fast movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging the brain cells.
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. Many kids end up with concussions from other activities too such as bike riding, skateboarding, or tree climbing.
Children are most likely to get concussions when they are under 4 and younger, and then again in their teens, when a growing urge for independence or peer pressure sometimes leads them 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 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
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, it can take up to a few days for them to occur.
More dangerous symptoms
Take your child to the emergency department right away if he or she has been hit in the head or body and has any of these symptoms:
Headache that gets worse and doesn't go away
Weakness, numbness or decreased coordination
Repeated vomiting or nausea
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
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)
Your child's doctor will get a detailed description of what happened, as well as your child's past medical history. The doctor will be especially interested in whether your child has had multiple blows to the head or body, lost consciousness, and when your child recovered. 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 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 (SCAT5). This tool helps guide your doctor through a standard neurological examination and figure out how severe the concussion is. Some doctors may use computerized tools to help evaluate patients with concussion such as the King Devick or the ImPACT test (Immediate Post-Concussion Assessment and Cognitive Testing), although they are not yet widely available.
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.
Treatment and recovery
The main treatment for concussion is to cut back on physical and mental activities for a while. Though kids need to be monitored, contrary to old advice, you won't have to periodically wake up your child while he or she is 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 symptoms should be tolerable for 30 to 40 minutes. Recess and physical education activities may need to be reduced for a time, but
research has found that it's best not to cut these out completely. You'll also need to be on the lookout for new or worsening symptoms.
While most kids recover from a TBI in less than three weeks, 10% to 15% continue to have symptoms for longer periods of time. The amount of time it takes to recover depends on different factors such as how severe the injury was, how it 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 him or her to report any concussion symptoms to you and his or her 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.
Preventing head injuries
Not all concussions can be prevented, but some may be avoided. Children should wear helmets for any riding activities (like horseback, all-terrain vehicle (ATV), motorbike, bike, skateboard, or snowboard) or contact sports (like football, hockey, or lacrosse). Helmets should fit well and be in good condition. Athletes should 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 have symptoms of a head injury—even if it means stopping play. Never ignore a head injury, no matter how minor.
About the Author
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. Follow him on Twitter at @AlcyTorresMD.