Concussions in Kids

Concussions in kids are mild traumatic brain injuries that happen before a child turns 18. These injuries always need professional medical attention, but most don’t turn out to be dangerous. After getting professional medical care, most children recover within days or a few weeks.

Concussions usually happen because of impacts or sudden sharp movements. The human brain and spinal cord float in a surrounding layer of cerebrospinal fluid (CSF). The CSF cushions and supports them both.

But CSF can also change how fast your child’s brain moves compared to their body. So, if your child’s body moves suddenly, there’s a tiny delay before their brain follows suit. That delay means your child’s brain can smack against the inside of their skull. Brain tissue is sensitive. If there’s enough force to that impact, it can cause a concussion.

Symptoms of concussions in children

Concussions can look different in children depending on their age.

Common infant and toddler concussion signs (up to age 4)

• Behavior changes, like throwing more tantrums or feeling sad
• Changes in how they talk (like speaking slower than usual) or trouble speaking
• Comfort-seeking behaviors, like being clingy or needing someone to hold them
• Having a blank, confused or dazed look
• Crying more than usual
• Not wanting to eat (either nursing or from a bottle)
• Sleep pattern changes, like sleeping less
• Throwing up, especially right after the injury
• Trouble with balance or walking

Common concussion signs in children ages 5 and up

Children ages 5 and up usually have symptoms similar to those in adults, including:

• Behaving out of character, like showing more anger
• Being unable to correctly answer basic questions, like where they are or what time it is
• Being slower than usual to answer questions or react to things happening around them
• Clumsiness and trouble with balance
• Struggling to focus or concentrate (especially on things they enjoy and usually have no trouble focusing on)
• Sensitivity to bright light or loud sounds

Concussion red flag symptoms

Some concussion symptoms can signal that something dangerous or even life-threatening is happening. Red flag symptoms you should watch for in your child include:

• Being knocked out (unconscious) for any amount of time, especially if they take longer to wake up or have trouble staying awake once they come to
• Changes in behavior, like acting confused, restless or agitated
• Double vision
• Having different-sized pupils in each eye, or new, noticeable eye misalignments
• Headache that gets worse and doesn’t go away
• Neck pain or tenderness
• Shaking, twitching or convulsions (these can be seizure symptoms)
• Trouble recognizing people around them or where they are
• Vomiting more than once after a head impact
• Weakness, burning or tingling in both arms or in one or both legs

These red flags are mainly the same for all children. But infants may also refuse to eat, cry uncontrollably or be inconsolable.

If you see any of these red flag symptoms in your child after a possible or definite impact to their head, call 911 or your local emergency services number right away. Your child needs medical care ASAP.

Concussion causes in children

Concussions in children can happen for the same reasons as in adults. But some of these causes are a lot more likely for children at certain ages.

For younger children, especially those under 8 years old, falls are the most common cause of a concussion. These don’t have to be falls from very high. Even a fall from standing height is enough to cause a concussion in younger children.

For children ages 8 and up, the top causes are all related to sports and recreation. Sports with a high risk of contact or collisions carry the highest risks. Those include:

• Soccer
• Tackle football
• Basketball
• Ice hockey
• Lacrosse

But concussions commonly happen with low-contact and noncontact sports and activities, too. Some key examples include:

• Cheerleading (especially on vaults and lifts)
• Volleyball
• Softball and baseball
• Snowboarding
• Swimming

Car crashes are also a common cause of concussions in children. And there’s a risk of concussions (among other injuries) with activities like bicycling, roller skating and using ATVs.

How doctors diagnose concussions in kids

Healthcare providers can diagnose concussions in kids using multiple approaches. These include:

• Doing a physical exam to check for injuries like bruising, swelling, bleeding and tenderness
• Doing a neurological exam to look for any disruptions in your child’s nervous system
• Asking questions about what happened and gathering information from you and your child (if your child can talk and answer questions)

Symptom descriptions are usually key for diagnosing a concussion. But children who are too young to understand and answer questions can’t offer such descriptions. That means it’s harder for providers to diagnose concussions in very young children. Any information you can give your child’s provider — especially how the injury happened and any changes in your child’s behavior since — can help them make the diagnosis.

Imaging tests like CT scans or MRIs aren’t always a routine part of diagnosing minor concussions in kids. Providers may use them when they suspect a more serious concussion or need to rule out severe injuries or complications, like skull fractures.

Some factors that make imaging scans more likely to happen include:

• Age under 2 years old
• Being knocked out
• Headache that’s severe and/or getting worse
• Memory loss
• Signs of decreased consciousness (scoring anything under 15 on the Glasgow coma scale)
• Vomiting more than once

Probable concussions in athletes

In some places, youth athletes in certain sports must have preseason concussion testing. Healthcare providers can use those preseason results for comparison if your child has a possible concussion at some point during the year. These tests usually need updating at least once a year.

Sports personnel like athletic trainers and coaches often learn or get trained on how to spot key signs of concussions. While they can’t make a formal diagnosis, they can tell you if your child could have a concussion and needs additional medical care. It’s common for athletics personnel to use checklists or tools specially designed to protect athletes. Those checklists can help healthcare providers make a formal diagnosis later.

How are concussions in kids treated?

There’s no direct treatment for concussions at any age. The main treatment for most minor concussions in children is giving their brain time to recover and helping them gradually get back to their usual routine. There are also supportive treatments that may help with any lingering effects.

In general, your child’s pediatrician or other healthcare providers will recommend rest for at least one to two days. That includes avoiding physical activity and limiting screen time or mentally challenging tasks. Research shows that resting for a couple of days is better in the long run than older approaches, like several days of bed rest.

After the initial rest days, your child should start gradually easing into their usual routine (except for sports or situations like the one where they had their concussion). Your child’s provider can help you plan the recovery steps.

If your child does need treatment, this might include:

• Medicines for symptoms like pain and nausea
• Vestibular rehabilitation for balance and coordination issues
• Specialized therapy for brain injuries

If the concussion is severe, your child may need care in a hospital. That kind of care can vary greatly, so your child’s healthcare team is your best source of information on treatment options.

What can I expect if my child has a concussion?

Most children recover from a concussion within several days. If your child still has lingering symptoms or effects two to four weeks after the concussion happened, talk to their pediatrician. They may recommend seeing a specialist.

Complications of concussions in children

Kids can have the same concussion complications as adults. But having concussions during childhood can also lead to lifelong issues. And some complications can be much more severe in children than in adults. Some examples of complications include:

• Future concussions (having one concussion increases your chances of having another)
• Intellectual and learning disabilities
• Paralysis or other physical disabilities
• Post-concussion syndrome and chronic traumatic encephalopathy
• Second impact syndrome and death

Second impact syndrome

Second impact syndrome is a rare complication of a concussion. It happens when someone with a concussion gets another head injury before their brain recovers from the initial concussion. That leads to severe, deadly brain swelling (cerebral edema).

Second impact syndrome is especially dangerous because your brain is much more vulnerable. Impacts or sudden, sharp movements that wouldn’t normally be dangerous can be deadly if they occur too soon after a concussion. That’s why children who might have a concussion need to stop playing immediately until a healthcare provider can check them.

That’s also why kids with concussions need to rest first and then slowly get back to their usual activities. But they should only resume activities as recommended by their healthcare provider, and they should never play sports before their provider says it’s safe to do so.

How to prevent concussions in kids

You can’t prevent concussions in kids 100% of the time, but you can make them a lot less likely. Some things you can do include:

• Use safety gear. Make sure your child wears a helmet and other safety gear when they’re doing activities like riding a bike or roller skating.
• Use barriers to prevent falls. Set up barriers to keep your child away from places where they might fall, like stairs or windows.
• Practice car safety. Secure your child properly in the car, using a car seat or booster seat (depending on height and age), or with a seat belt.
• Don’t keep using a damaged helmet or car seat. Once damaged, these items may not protect your child from harm.
• Avoid high-risk activities. No child under 16 should operate an ATV or even ride as a passenger. Using a trampoline is also a high-risk activity.

How do I check for a concussion at home?

It takes a qualified healthcare provider to diagnose a concussion in a child. That’s because:

• The signs and symptoms are easy to miss.
• Concussions share signs and symptoms with other, more dangerous conditions.

So, the best way to help your child and protect them from further harm after a possible concussion is to get them professional medical care.