Start with a clear understanding of what a concussion is to better identify the signs and symptoms of concern — and to know when to consult your child’s healthcare provider. Simply put, a concussion is a brain injury, says Matthew Grady, MD, a sports medicine pediatrician at Children’s Hospital of Philadelphia who specializes in pediatric concussions. “There has to be a force that shakes the head, which can cause a change in brain function,” he says. “Structural changes to the brain would represent a different type of brain injury.” The sooner you intervene after a potential concussion the better, says Dr. Grady. “A late diagnosis or misdiagnosis can lead to longer-lasting symptoms,” he says.
What to Look For When You Suspect a Concussion and When to Get Help
Symptoms of a concussion may not show up right away nor are they always easy to identify — particularly if your child has a high pain tolerance and doesn’t complain of headaches, eye strain, or other invisible symptoms. However, if your child experiences an injury and shows these immediate signs and symptoms, head straight to the ER:
BleedingVomitingSlurred speechSevere head painMental confusionSignificant balance impairmentVision deficits (i.e., can’t look to the right or left)Weakness or numbness on one side of the bodyDifficulty rousing from sleep
If no immediate signs are evident but you’re concerned that your child might have a concussion, watch for a cluster of symptoms, says Grady. “Signs are physical, but what the patient is experiencing — the symptoms — are the things you want to evaluate before calling your primary care doctor,” he says. Symptoms of a concussion include these problems:
Vision changes, like eye strain, difficulty tracking and focusing, or sensitivity to light and soundMood swings, anxiety, depression, irritability, or perseveration (uncontrollable repetition of a particular response)Changes in cognition, like delays in reaction time, processing speed, or memoryHeadaches, nausea, dizziness, or loss of balanceExcessive fatigue during the day or sleeping more or less than usual
For children with special needs who may be nonverbal or unable to communicate their symptoms, watch for cues that may alert you to something out of the ordinary, like being bothered by noise or bright lights. You may also see some regression of newly developed skills, like blurting out answers in class if he just learned to raise his hand or more meltdowns if she’s recently learned to self-regulate. If you’re seeing any of these symptoms, schedule an appointment with your child’s pediatrician for a full evaluation, which will include specific tests for balance and eye tracking. “These evaluations are so important because if your child has balance or vision deficits, there are treatments that can help,” Grady says.
Getting Back to a Regular Routine After a Concussion
It’s hard to keep active kids down. Fortunately, though, they can still be physically active following a concussion. “There’s a myth that kids need to stay in a dark room forever,” says Grady. “But children should be allowed to do activities provided their symptoms don’t get worse.” Sports and full-contact activities are the exception, though. The most important thing is to avoid reinjury while the brain is still healing. If a child experiences another injury while still concussed, the injury is amplified, Grady says. Experts at the Weill Cornell Concussion and Brain Injury Clinic say that children who sustain one concussion are at a higher risk for a second if they experience an injury soon after the first. In addition, per the clinic, children who are still recovering from a concussion can sustain a second one from a lesser impact than is generally required to produce a concussion. The first day after a concussion is the best day to stay home and rest, says Grady. A 2016 study affirms the importance of this timing: Children who rested, physically and cognitively, from the beginning — instead of waiting a few days before slowing down — recovered four days faster. That’s why it’s key to catch a concussion early so you can rest early and ramp up activity gradually. However, it’s important not to continue strict bed rest for too long. Children may get behind in school, lose out on social interactions, and become depressed. And there is no evidence that prolonged periods of complete rest are beneficial. According to a 2017 review, the most beneficial duration of rest requires further investigation, but 24 to 48 hours seems appropriate for most patients. In fact, a 2018 review supports gradually returning to aerobic exercise as opposed to prolonged rest from any activity. To assess their readiness for returning to school, it’s acceptable to do a trial at home, says Grady. The cognitive demands of high school are certainly more strenuous than elementary, but if your child of any age is experiencing eye or head strain, pressure, or pain — particularly when doing homework — scale back.
