Pediatric Concussions

A concussion, also called a traumatic brain injury or TBI, is a type of injury that affects brain functioning. They are triggered by the brain hitting up against the skull, affecting the typical performance of the nervous system.

Concussions are caused by an impact to the head, or by the head being suddenly and forcefully jerked or jolted. Many children experience a concussion due to a fall, car or bicycle crash, or sports injury.

The signs and symptoms of a concussion can be difficult to detect. Young children may not have the words to report on their symptoms, and even older children and young adults may not be able to accurately self-assess their symptoms in the aftermath of a head injury. It is, therefore, important that both children and adults are aware of what to look for. If you think your child has experienced even a mild concussion, you should call your doctor right away. In some cases, it will require immediate emergency care. When in doubt, head to the emergency department.

Signs and symptoms include:

• Unusual behavior, including changes to personality or trouble controlling emotions

• Delayed physical or verbal reactions

• Changes to balance or coordination

• Nausea

• A dazed expression

• Blurred or double vision

• Headache

• Dizziness

• Difficulty focusing or feeling foggy

• Sensitivity to lights or sound

• Feeling sleepy or experiencing having difficulty sleeping

Signs that should prompt an immediate visit to the emergency department include:

• Loss of consciousness (even briefly)

• Memory loss or confusion

• Looking very tired or not waking up from sleep

• One pupil looking larger than the other

• Convulsions or seizures

• Difficulty recognizing people or places

• Increasing agitation or confusion

• Inconsolable crying

• A headache that gets worse or won’t go away

• Weakness, numbness, or inability to coordinate movements

• Vomiting or persistent nauseous

• Slurred speech

Traumatic brain injuries account for nearly three million emergency department visits, hospitalizations, and fatalities in the U.S. each year. Adolescents, young adults, and older adults are at the highest risk. Older adults (age 75 and up) are most likely to suffer a fatality related to a traumatic brain injury, but it is important to take a concussion seriously at all ages.

Children who play sports are at particularly high risk of experiencing a concussion. Contact sports such as football, hockey, rugby, and soccer have the highest rates, and experiencing one concussion increases the risk for a second (even from a lesser impact). It is important to take sports safety seriously by making sure that children wear appropriate headgear, being aware of the signs, and removing children from play if they experience a head injury.

No--athletes who are suspected of suffering a concussion should be removed from practice or play immediately, even if the symptoms seem mild. This guidance is in accordance with Maryland and Washington, D.C., athletic concussion prevention laws. It can be difficult to detect if a head injury has caused a concussion, particularly because symptoms may not become obvious until hours or days later. Children who have suffered a concussion may also not be able to report on their symptoms reliably. This means it is important for coaches, parents, and teammates to know the signs and play it safe. By removing children from practice or gameplay, you can eliminate the risk of further injury or a second concussion.

Even children who have already received an appropriate diagnosis of traumatic brain injury from their primary care physician or a physician at the emergency department may require specialized follow-up care. The division of pediatric neurology can help assess persistent symptoms and develop a recovery plan. The team of brain experts at the Division of Pediatric Neurology evaluate neurological functioning, balance, and cognition. If a child has experienced a sports injury and was initially screened with ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing, a computerized test used by some schools for suspected concussions), this testing may be repeated to assess for changes. After assessing a child’s functioning, our team will provide recommendations about when it is safe to return to school or sports, what accommodations may be needed, and additional therapies that may be beneficial (for example, occupational, physical, vestibular, and/or speech and language therapy).