What parents should know about concussions in children

Blake Windsor, MD

Pain Medicine

Concussions don’t just happen on the football field. They can happen to kids of all ages – boys and girls. But how can you prevent a concussion or even know if your child has one? Blake Windsor, MD, explained what to do.

What is a concussion?

A concussion is the name given to the combination of symptoms that someone experiences after a mild traumatic brain injury from head trauma or a sudden acceleration or deceleration force (such as a whiplash). A concussion is not caused by major structural injury to the brain. Instead, it is a form of chemical injury experienced by the brain from the sudden discharge of nerve transmitters released by the impact the brain experiences.

How can you get a concussion?

Concussions most often involve a traumatic impact to the head. Common situations where someone may experience a concussion are with a sports injury, accidental or nonaccidental head strike, and car wrecks. Concussions can occur during a car wreck even if there is no head strike because the whiplash experienced can cause the brain to strike the inside of the skull.

How can I tell if my child has a concussion?

Concussions produce a wide range of symptoms that can include:

• Headache
• Dizziness
• Dazed or confused appearance
• Vomiting
• Emotional changes
• Difficulty with memory
• Difficulty walking

“These symptoms can take the appearance of someone stumbling and needing support to maintain balance, asking the same question multiple times, acting dazed, speaking slowly, or not quite making sense,” said Dr. Windsor.

What should I do if I think my child has a concussion?

If a concussion is suspected, the first priority is making sure that there are not signs of a more serious injury, such as a neck injury or broken bones, and prevent any repeat injury to the brain. “For athletes, this means sitting out the rest of the game because a repeat injury may set someone up for a prolonged recovery. It’s better to miss the rest of the game than to miss the rest of the season,” said Dr. Windsor.

Children who have symptoms of a concussion need to be evaluated by a healthcare provider or athletic trainer. Seek emergency care if there are symptoms such as:

• Vomiting that is getting worse with time
• Changes in consciousness
• Seizures
• Muscle weakness or numbness
• Bruising under both eyes
• Bleeding from ears

Children and adolescents experiencing a concussion will need a plan to help them manage their symptoms while they are recovering from their injury. Dr. Windsor said most students should engage in active rest for the first 2–3 days after their concussion. This means avoiding screens, sustained concentration and significant physical exertion.

“Screen time for 10–15 minutes, up to a few times a day, is probably okay, and going for light walks outside is encouraged,” he said.

Most students should be out of school for 2–3 days during this period, and then should return back to school with special accommodations to reduce the impact of the concussion on their academic performance and reduce the impact of school on their concussion recovery. Students do not need to be symptom free before returning to school, and in fact, this practice can prolong recovery. South Carolina state law requires written medical clearance by a physician before being cleared to return to their sport after a concussion.

How serious are concussions?

Dr. Windsor said concussions are not a dangerous or progressive disease. However, they can have a tremendous impact on someone’s life. Emotional symptoms of depressed mood and anxiety are common, as well as prolonged headaches or migraines, dizziness and poor coordination, difficulty sleeping, difficulty concentrating and processing information.

It is common for these symptoms to last up to 3–4 weeks in an adolescent. Symptoms can last for up to 3 months (or even longer). After this period of time, a child is likely dealing with the consequences of a concussion and not necessarily the active phase of injury.

Do concussions have long term effects?

Dr. Windsor said it isn’t clear if there are serious, long-term effects from a concussion. What is clear is that a concussion that isn’t treated properly can have prolonged symptoms such as vision difficulties, balance and coordination difficulties, emotional changes, and head and neck pain.

It is also clear that if someone experiences another concussion before making a recovery from the initial concussion, then you can expect worsening symptoms and an even longer recovery. “An important life skill to learn is when to push and when to recover, and that if they push when they need to recover, they may just set themselves even further behind,” he said.

If significant symptoms of a concussion are continuing for 10–14 days after the injury, it’s probably a good idea to start thinking about a specialty concussion evaluation, particularly if a child has remained out of school. Concussion clinics normally like to see patients sooner rather than later to start treatment.

How can I prevent my child from getting a concussion?

In general, protective equipment is important. This includes using properly fitted helmets; properly using seat belts, car seats, and maintaining your vehicle; and home safety equipment for smaller children such as gates at the top and bottom of stairs.

“Just as important as wearing protective equipment is cultivating a culture of safety that encourages students to protect their brain and report symptoms of a concussion. As the saying goes, an ounce of prevention is worth a pound of cure,” said Dr. Windsor.