Learn

In most cases, check with the pediatrician first, if at all possible. Emergency Department (ED) personnel can evaluate your child's neurological (brain) functions to determine whether additional tests are needed. Not all concussions require emergency care, but the ED can provide a diagnosis and rule out more severe injury.

The pediatrician may want to schedule an appointment to examine the child or adolescent, send them to the ED, or choose to refer them to a concussion specialist. However, the child should be taken to emergency care if any of the following danger signs are demonstrated:

• Headaches that worsen
• Looks very drowsy or can't be awakened
• Can't recognize people or places
• Change in state of consciousness
• Focal neurological signs
• Increasing confusion or irritability
• Neck pain
• Seizures
• Slurred speech
• Repeated vomiting
• Unusual behavior change
• Weakness/numbness in arms/legs

While some professionals may use concussion grading systems to describe the early aspects of the injury, grading systems are not directly related to the length of time it will take to recover and not generally used beyond the early phase of an injury. All concussions are considered a mild traumatic brain injury and there are many factors involved that determine how long it takes for the individual to recover.

Yes, it is possible that the child did have a concussion. Loss of consciousness is not necessary for the diagnosis of concussion. It is only one sign of this injury and occurs in 10% of injuries or less. Most importantly watch for any of the more common signs and symptoms. If any of them are present, you should suspect a concussion and notify the child’s healthcare provider.

No. CT scans are not used to diagnose a concussion. They can detect bleeding and swelling in the brain, usually signs of a more significant brain injury. A concussion, or mild traumatic brain injury, results in changes in the chemical and physiological properties of the brain that cannot be seen on a CT scan, so most scans are normal after concussion.

Under no circumstances should a child fully participate in practice or game if they are not yet recovered, and have not yet received clearance from a healthcare professional with training and experience in concussion management. In terms of attending a practice for non-contact activities, this may be recommended by your healthcare provider assuming that they can assure that the child will not be at risk of being re-injured. Early mild-to-moderate exercise can be helpful for recovery, and may be recommended in a sport practice setting when it can be arranged safely. Contact-related activities, or activities with risk of contact, remain prohibited until the individual has fully recovered.

It is helpful for recovery from a concussion to gradually return the injured child as soon as possible to safe everyday activities such as school. Physical activity and socialization in school benefit recovery, as is limiting the stress that occurs from missing school. Some students may need a few days at home as their symptoms begin to improve but, in general, returning to school sooner is usually better for them. When returning, the recovering student will likely need temporary supports, including a modified schedule such as a partial day, receiving extra time to complete assignments, or delaying tests. Contact your health care provider and school to determine appropriate academic supports based on their symptoms and tolerance for activities. The student should not participate in any risky activities, such as P.E., recess, or sports until fully recovered and cleared by a healthcare provider. If your child is not recovering or has difficulty returning to school, see a concussion specialist with experience in working with schools.

The individual has fully recovered from a concussion when their functioning has returned to normal as determined by an appropriate healthcare professional trained in concussion evaluation and management. This means the child does not have any concussion symptoms at rest or with normal cognitive and physical activity, and their cognitive and balance performance is normal. Children who have not fully recovered should not return to contact sports or activities, or put themselves in situations where they could be re-injured. When in doubt, sit them out!

Just like all injuries or illnesses, every concussion must be managed and treated individually. The evaluation of the child is important in determining the treatment for that person.

• An active rehabilitation approach is the most effective means of managing a concussion. Maximizing careful reintegration into everyday activities while minimizing over-exertion (physical, mental) is the key to recovery. It is important to strike a balance between what activities are safe and do not significantly worsen symptoms. Significantly worsened symptoms are occurring when an individual is feeling worse over time, rather than feeling better, and when the increase in those symptoms is long lasting after the activity and affects the person’s ability to do other activities afterwards.
• Guidelines for managing concussions have been developed within the sports context due to the need for safe return to play in order to minimize the risk for re-injury. These guidelines are also relevant to the return of the child or teenager to any activity involving increased physical or mental exertion.
• The 2022 International Concussion in Sport Group (CISG) recommended the following updated guidelines for managing concussion and returning athletes to play:
  • Emphasis on sport-specific strategies to prevent concussions through interventions such as policy or rule changes as well as training exercises.
  • Support for physical activity and aerobic exercise treatment as early intervention.
  • Early return to activities of daily living is encouraged as long as symptoms remain mild or only briefly increased.
  • Academic supports should be provided to include environmental, physical (e.g., avoid contact activities), curriculum, and testing adjustments.
  • Referral to a multidisciplinary clinic if symptoms persist for greater than 4 weeks.
  • Use of tools such as symptom rating scales, balance assessment, and neuropsychological testing to recognize and manage a concussion; however, these results should be interpreted in the context of broader clinical findings.
  • Continued recommendation to remove a player from the field if there is any suspicion (signs or symptoms) of a possible concussion to avoid further injury. Athletes should not return to play with any symptoms.
  • During recovery from concussion, an athlete should engage in exercise strategies to include daily activities that do not exacerbate symptoms (e.g., walking), then aerobic exercise (e.g., stationary biking). Once an athlete is symptom free and has received medical clearance, they can then engage in sport-specific exercise that does not involve any risk of accidental head impact. After symptoms have resolved and cognitive function and other clinical findings are believed to be returned to baseline, the athlete can then engage in non-contact training drills and full contact practice, before finally returning to full sport and game play.

There are two important things to do after a concussion to help your child. First, make sure that they do not participate in any high-risk activities where they could take additional blows to the head or jolts to the body. You may need to increase supervision (particularly younger children) to make sure that they are not too active or put themselves in situations where they could be re-injured. Second, after an initial period of rest for 24-48 hours, daily activities should be gradually reintroduced with attention given towards worsening symptoms and ability to perform those daily activities successfully. In the first few days after a concussion, parents should monitor the child for symptoms regularly at least several times per day.

As the child recovers, monitoring should occur every few days, particularly as the child returns more fully to activities and symptoms are improving. Note that strict rest, which involves a reduction in all activities including any exercise, any social contact, no school-related work, and severely reduced stimuli like lights and noises, is not recommended beyond the first 24-48 hours, and only if symptoms are severe.

As symptoms lessen, it is good to gradually increase safe activities as long as symptoms do not significantly worsen. Only allow a higher risk activity (practices, scrimmages, and competition) after a qualified healthcare professional evaluates and clears your child to do so.

Appropriate early evaluation, management and treatment is the key to a safe outcome and allowing recovery to occur as quickly as possible. The symptoms of a concussion can cause problems when the child returns to school, home or community activities. The concussion evaluation assesses possible cognitive, behavioral or physical symptoms to assist in management and planning during recovery for all of these environments.

During an evaluation, a child may be given tests of attention, memory, speed, and balance. Test results are used to determine any needed interventions, as well as plan for return to school, sports, and other physical activities. Children with concussions sometimes experience prolonged symptoms, which interfere with their daily activities and sports. Clinicians will evaluate the child and help put a plan together that provides the necessary support for school, work and return to play decisions, and keeps their recovery moving forward.

• The developing brain appears to be more vulnerable to brain injury.
• High school athletes may take longer to recover from concussion than college athletes and younger kids.
• Even seemingly “mild” concussions can have significant effects. A large number of youth (~30%) may continue to experience concussion symptoms for longer than a month after a concussion, and how long the concussion symptoms will last is very hard to predict at the time of an injury.
• Effects of multiple concussions can be cumulative when a prior concussion has not fully healed. Multiple concussions that occur close together may lower the threshold for the next concussion injury and increase symptom severity in subsequent concussions.
• Continued headaches that are different from pre-injury headache patterns may indicate incomplete recovery. Youth experiencing headaches one week post-injury are more likely to experience more overall symptoms and perform more poorly on neurocognitive measures than those who do not report headaches.
• Physical and/or mental activity/exertion should be modified during recovery. Doing too much, too soon can lead to significant increases in symptoms. We don’t yet know how that relates to the time until recovery, but to manage symptoms and discomfort, some activities may need to be reduced or modified.

The time to recovery from a concussion can range widely, from days to weeks, or months. It can be difficult to predict the length of recovery for any one person, especially right after the injury occurs. Parents and other professionals can help young people minimize their recovery time by balancing rest with a gradual increase in physical and cognitive (thinking) activity. Strict rest, which involves a reduction in all activities including any exercise, any social contact, no school-related work, and severely reduced stimuli like lights and noises, is not recommended beyond the first 24-48 hours, and only if symptoms are severe.

There are certain factors that may prolong recovery such as a prolonged loss of consciousness or amnesia (memory loss) for the event, repeat concussion before the first injury has healed, and multiple concussions that occur within a short period of time (within several months). Children who have been diagnosed with ADHD, learning disabilities, headaches, sleep problems or emotional problems or who experience notable stress during recovery can also take longer to recover. Individualized treatments, reducing stress, and a coordinated approach to care across setting may help symptoms to resolve more quickly.

During concussion recovery, an individual can feel physically unwell and may spend less time with friends and peers, or enjoying their favorite activities. Individuals can also experience worry about their recovery and missing out on important events. Within the brain, concussions result in a chemical change that can temporarily affect an individual’s mood and behavior. These symptoms can include feeling more irritable, sad, or reactive. Pre-injury symptoms of anxiety or depression may feel worse. Fortunately, the vast majority of individuals recover completely from concussion and these symptoms go away. We also now know more about the strategies that can help an individual feel better, such as participating in regular, low level (non-contact) exercise, keeping good sleep habits, connecting with friends, and balancing returning to school with necessary supports. During concussion recovery, it is important to monitor the individual's emotional well-being and seek out help and treatment when needed.

If you or someone you know is experiencing urgent mental health concerns, access suicide prevention and crisis resources by calling the 988 Suicide and Crisis Lifeline (Dial 988).