Most of us assume that we don’t need to worry much about concussions in children unless our kids play football. While there have been many high-profile cases of footballers suffering from chronic traumatic encephalopathy (CTE) as a result of concussions suffered decades earlier, concussions are a common occurrence in all contact sports and can even occur outside of sports. Kids tend to engage in a variety of physical activities that are essential for healthy growth and development, but they all pose some risk of physical injury, from minor bruises to head injuries that cause concussions. We can’t eliminate all of these risks but we can be better prepared to deal with them, in terms of both risk reduction and management.
Understanding Concussions in Children
What is a concussion?
A concussion describes a mild form of traumatic brain injury, unlike more severe brain trauma seen with car crashes or falls. Nevertheless, a concussion can cause brain damage as it involves any blow to the head, neck, or face, which can cause the brain to collide against the skull. Research shows that although many of these injuries can appear mild, they can still cause physiological and neurological changes that increase the risk of neurodegenerative diseases later in life. This is why pediatric concussion care is regarded as critical after any head injury in a child.
Why are children more vulnerable than adults
Children are more vulnerable to concussions because their brains are still developing and they also have weaker necks and torsos. As a result, the brain can get jostled within the skull more easily, potentially disrupting brain maturation and leading to long-term complications.
Common Symptoms of Concussions in Kids
Pediatric concussion symptoms can include physical, cognitive, and behavioral symptoms.
- Physical symptoms
Physical symptoms often include headaches, dizziness, nausea, vomiting, and fatigue. These can make everyday activities feel overwhelming and may indicate that a concussion has occurred.
- Cognitive Symptoms
Cognitive issues are also common and may include confusion, memory impairment, loss of balance, a dazed or blank expression, changes in vision, and trouble focusing. These signs can affect a child’s ability to process information or engage in tasks as they normally would.
- Behavioral symptoms
After a concussion, children may exhibit irritability, moodiness, and emotional outbursts as their brain adjusts to the injury. They might also lose interest in activities they normally enjoy, feel unusually fatigued, or experience changes in their sleep patterns, such as sleeping more or less than usual.
Red Flags That Require Immediate Medical Attention
Danger signs parents and caregivers should not ignore
While you should never ignore any symptoms of concussion in kids, there are some signs that are particularly concerning and demand immediate medical attention. These red flags include:
- Persistent vomiting over twice within a 24-hour period.
- Memory loss or loss of consciousness lasting over 30 seconds.
- Feelings of disorientation and confusion.
- Changes in vision or speech such as blurring or slurring.
- Drainage of clear fluid from the nose or ears.
- Loss of strength in the limbs.
- Onset of seizures or convulsions.
When to Visit the ER or Consult a Specialist
In case you notice any pediatric concussion symptoms that are categorized as red flags, get your child to the ER without further delay. In other cases, it is advisable to consult a specialist even if there are no clear symptoms as concussions can occur without immediate symptoms. A pediatric concussion clinic will be able to help with a diagnosis and next steps so that your child can resume normal activities safely.
Diagnosing Concussions in Children
The Clinical Assessment Process
There is no reliable way to determine if your child has suffered a concussion without a proper clinical assessment. This includes physical examination, assessing the medical history, testing balance, coordination, gait, and cognitive functions. When possible, baseline testing can be extremely helpful as doctors can then compare brain function before and after injury, making it easier to detect a concussion. These assessments can also help track progress and recovery after a concussion.
Why Balance and Neurological Tests Are Needed
Balance and neurological tests are regarded as essential for the diagnosis and management of concussions in children as they can help to identify any deficits or disturbances in vestibular, visual, and cognitive functions that may not be obvious at first.
Imaging: When it is and isn’t necessary
The diagnosis of concussions in children does not involve routine head imaging tests such as MRI or CT scans. However, imaging tests are recommended when dealing with worsening symptoms and severe headaches after a head injury, especially if there is suspicion of bleeding or a skull fracture.
Treatment Options for Pediatric Concussions
For any child, head injury treatment should be provided immediately and this involves withdrawal from any activity and rest, followed by a gradual return to activities based on clinical assessment and recommendations.
Initial rest and monitoring
Rest and monitoring is essential for the first one or two days following a suspected concussion to ensure early detection of symptoms and to prevent their worsening.
Gradual return-to-school guidelines
Before returning to school, your child should be able to tolerate moderate cognitive exertion, such as reading for about 30 minutes at a time. The amount of time spent in a cognitive or learning activity can then be gradually increased, with return to half-day school, exemption from examinations and homework, increased rest breaks, and other modifications as determined by specialists.
Safe return-to-sports protocols
Child concussion recovery requires time and it’s only safe to resume sports after a successful resumption of regular academics without the presence of symptoms. When resuming sports, you need a phased approach under medical supervision to lower the risk of complications and delayed recovery.
Role of specialized concussion clinics
At a pediatric concussion clinic, including StabilityLAB in Vancouver, your child can expect to receive comprehensive care from specialist teams that offer a holistic approach to address physical, cognitive, and behavioral symptoms. Such an approach is important, as specialized concussion clinics can offer rehabilitation and recovery plans that are specially adapted to childhood developmental needs. Leading clinics for pediatric concussion care also provide vestibular rehabilitation therapy or VRT, which is shown to improve symptom management and recovery. With computerized VRT or CVRT, this takes on an added layer of personalization, which can greatly enhance recovery.
Long-Term Risks if a Concussion Goes Untreated
With prompt and appropriate care, most kids recover without any long-term complications. However, failure to follow child head injury treatment protocols can increase the risk of long-term damage.
Post-Concussion Syndrome (PCS)
This is seen in up to 30% of concussion patients and describes the presence of symptoms beyond the typical recovery period of four weeks. This poses significant challenges to children as they struggle to cope with academics and may experience behavioral problems and mood disorders.
Recurrent concussions and cumulative effects
Parents are advised to pull children out of play after a head injury because of the risk of having another concussion. Recurrent concussions are associated with incomplete recovery and long-term complications as they can cause brain swelling and permanent damage.
Impact on learning and development
Studies show that concussions in children tend to have worse cognitive symptoms as compared to adults, up to a year after the injury. Without proper treatment, this can lead to severe delays in learning and development, also interfering with socialization and relationships.
Preventing Concussions in Children
Prevention of concussions in children requires a combination of stringent sports safety practices and increased awareness among parents and coaches. This includes:
- Updating sports rule changes based on the latest research and safety recommendations.
- Strict adherence to rules of the sport designed for safety.
- Use of proper technique and avoidance of head-to-head collisions on the field.
- Use of appropriate and well-fitted protective gear and helmets.
- Encouraging exercises to strengthen the neck muscles.
- Installation of shock-absorbing surfaces in playgrounds or at home to cushion any impact from falls or collisions.
- Educating other parents and coaches about concussion symptoms and first aid.
- Strict concussion protocols for kids who suffer head injuries, immediately withdrawing them from play.
Why Specialized Pediatric Concussion Care Matters
When seeking kids’ concussion treatment, it’s important that you prioritize care from specialists with expertise in dealing with concussions, especially pediatric concussions. This is because concussion clinics have multidisciplinary teams that are well-equipped to meet the complex needs of recovery and rehabilitation after a head injury. This ensures collaborative care that meets physical and mental health needs, with experts such as neurologists, sports medicine physicians, behavioral therapists, physical therapists, speech therapists, and occupational therapists. Evidence from studies suggests that early access to such specialized care can reduce recovery time by as much as 6 days. When accessed within 48 hours from the time of the injury, the likelihood of a healthy recovery is four times higher.
At StabilityLAB, we combine evidence-based treatments and cutting-edge technology to deliver highly personalized rehabilitation plans for our pediatric patients. Our Computerized Vestibular Retraining Therapy (CVRT) programs are known for their high efficacy and safety, ensuring that concussion treatment is not just personalized, but highly adaptable to patient responsiveness. This helps to speed up recovery times and improve long-term outcomes, protecting against long-term cognitive or functional impairment. Reach out to us to schedule a consultation with our pediatric concussion team to find out how our individualized CVRT and multidisciplinary approach can support your child’s safe return to school, play, and everyday life.
FAQs
Q1: What are the most common concussion symptoms in children?
A1: The most common concussion symptoms in children include headaches, dizziness, nausea, vomiting, fatigue, confusion, memory impairment, loss of balance, dazed expression, changes in vision, loss of focus, and emotional or behavioral changes.
Q2: How long does it take for a child to recover from a concussion?
A2: When prompt and appropriate concussion treatment is provided, most children recover within about four weeks.
Q3: What should I do if I suspect my child has a concussion?
A3: If you suspect your child has a concussion, pull them out of any activity immediately, ensure that they rest, monitor them closely, and get specialist care within the first 48 hours; if you notice any red flag symptoms, seek ER care immediately.
Q4: Can children return to sports after a concussion?
A4: Children can return to sports only after they have successfully resumed regular academics without symptoms and following a phased, medically supervised return-to-sports protocol.
Q5: What is Post-Concussion Syndrome in kids?
A5: Post-Concussion Syndrome in kids refers to the persistence of concussion symptoms beyond the typical four-week recovery period, which is observed in up to 30% of cases, making specialized care vital for long-term recovery.
Q6: How can clinics like StabilityLAB in Vancouver help with pediatric concussions?
A6: Clinics like StabilityLAB in Vancouver offer comprehensive, multidisciplinary pediatric concussion care, providing holistic, developmentally adapted rehabilitation and recovery plans, including vestibular rehabilitation and personalized Computerized VRT to speed recovery and improve long-term outcomes.
Sources:
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4479139/
- https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2015.00069/full
- https://www.aafp.org/pubs/afp/issues/2024/0800/poems-imaging-mild-traumatic-brain-injury.html
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6388574/
- https://ijspt.scholasticahq.com/article/128282-effectiveness-of-vestibular-rehabilitation-in-children-post-concussion-a-systematic-review
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3208826/
- https://www.cdc.gov/heads-up/prevention/index.html
- https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-024-00866-w
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9290185/
