Thomas P. Drake, MD
Director, Pediatric Concussion Program
Children’s Regional Hospital at Cooper
A concussion is a common brain injury that results in more than 100,000 emergency room visits for school aged children in the United States each year. Concussions often disrupt regular brain function and affect children in multiple ways. They are caused by some type of physical impact to the head or body, and the resulting problems are often temporary. While loss of consciousness can be seen with such an injury, this is typically present only in a small percentage of concussions.
Many concussions are sports related but these injuries can also be sustained from falls, fights, non-sports accidents, or even abuse. There are many different types of symptoms a child may experience as a result of concussion. A concussion can affect children physically, cognitively, and emotionally, and can also affect sleep.
Physical symptoms typically seen with concussion may include headaches, nausea or vomiting, dizziness, lethargy, clumsiness or balance problems, blurry vision, poor coordination, and sensitivity to light or noise.
Cognitive (or thinking) symptoms typically include confusion, disorientation, difficulty with memory, or inability to concentrate. Sometimes children with these symptoms are slow to answer questions and follow commands, or they are easily distracted.
Emotional symptoms may include nervousness or anxiety, sadness, irritability or mood swings, inappropriate behavior, or feeling depressed or sad for no apparent reason.
Sleep problems can also occur and can include difficulty falling asleep, frequent waking at night, fatigue, or tiredness during the day.
Treating a Concussion
If you suspect a concussion, it is important to take your child to a health care provider who can assess the injury and properly advise you on treatment. Most children with a concussion feel better within a couple of days or weeks but, for some, symptoms may last a month or longer. Symptoms may appear during the healing process as your child returns to their regular activates. It is best to make short-term changes to your child’s daily routines to help him or her return to normal activities.
Your child will need some degree of rest along with proper sleep following a concussion diagnosis. Mental rest is usually very helpful in reducing symptoms and in achieving a speedy recovery. It can be important to limit your child’s use of computers, television, phones, and other electronic devices. Post-concussion symptoms may make returning to school difficult to tolerate. When your child does return to school, work with your doctor and your child’s school to let them know that your child may need help. Often it is helpful to specify that the child needs (and deserves) a reduced workload, extra time for schoolwork and homework, and alternatives to the current tests or assessments in the classroom. Sometimes, a brief period away from school is even required if the signs and symptoms make attending school difficult to tolerate. Either way, it is extremely important for your child’s well-being, and for their success when returning to school, that you communicate with the school on a plan that accommodates their current health status.
Returning to sports requires caution, planning, and professional advice. Your child should not be allowed to return to sports or activities with a risk of head injury until a proper professional evaluation has occurred. This is to help avoid further complications and to prevent consequences of repeated head injuries during this time period. Many states, including New Jersey and Pennsylvania, have a youth sports concussion law that requires a written clearance by a licensed professional to authorize your child’s return to sporting activities. In some cases this authorization can come from your child’s pediatrician, but frequently this may require a specialist such as a neurologist or other personnel with expertise in this area to help with these “return to play” decisions. Furthermore, returning to any sport should not happen until your child has returned to managing their academic responsibilities.
When to Go the Emergency Room
Professional evaluation is always recommended if you are unsure of what to do after a head injury. Furthermore, if there are any more concerning signs or symptoms following a possible concussion, one should seek care at an emergency department. Some of the more concerning things to look out for could include:
- One pupil larger than the other.
- Drowsiness or inability to wake up.
- A headache that gets worse and does not go away.
- Slurred speech, weakness, numbness, or decreased coordination.
- Repeated vomiting or nausea, convulsions or seizures (shaking or twitching).
- Unusual behavior, increased confusion, restlessness, or agitation.
- Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously.
In a toddler or infant, it is also concerning if the child will not stop crying and cannot be consoled, or if they will not nurse or eat.