PEDIATRIC CONCUSSIONS 101 GUIDE:
Symptoms, Signs, and Treatment
of Concussions in Children

Dr. Garfinkle

Dr. Rebecca Garfinkle, Pediatric Neurologist

Pediatric Concussion Specialist
Pediatric Neurology of Orange County, CA

Pediatric Concussion Basics 

Can you prevent concussions?

Unfortunately, preventing head injuries like a concussion is not possible. Some parents think that keeping their children from playing sports will prevent concussions. While concussions in sports are frequently discussed, they can also be caused by physical activity, car accidents, and falls.

Clinicians recognize the importance of children, parents, and coaches being educated on its causes, signs, and symptoms. The best plan is to get educated on concussion symptoms and know what to do if a concussion is suspected. Be sure your child’s youth sports league implements baseline testing for all the athletes. After proper education, baseline testing is the best way to be prepared if your child gets a concussion.

Is concussion a treatable injury?

Concussions can be treated. With the right healthcare team, active rehabilitation strategies, and targeted treatment, your child can recover from a concussion. The US Centers for Disease Control (CDC) has created pediatric concussion guidelines to help guide treatment for the brain injury.

You may have talked to people who remember getting their bell rung and got back into the game the next play. Thankfully, times have changed. Athletic trainers and trained healthcare professionals are on the field to recognize a concussion when it happens and keep your child safe. Athletes who are removed from play immediately following a concussion are much more likely to recover from a concussion in less than 3 weeks.

Clinicians use objective data together with symptom reporting to measure the extent of the injury. They create individualized treatment plans that actively target deficits until the child is back to normal. Most importantly, clinicians now have a variety of tools they use to get a full picture of the injury. No more relying just on an athlete saying “I feel better.”

 

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Pediatric Concussions 101 Guide
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Pediatric Concussion Signs and Symptoms

What are concussion symptoms in children?

After a concussion, the symptoms that occur differ from patient to patient. Symptoms may not appear for days or weeks after the injury.

Concussion symptoms can include:

  • Headache
  • Balance problems
  • Vision problems
  • Sleep issues
  • Difficulty concentrating
  • Light or noise sensitivity
  • Anxiety/mood disturbances
  • Dizziness or fogginess

Download this Concussion Signs & Symptoms guide for easy reference.

What are signs of a concussion in children?

There are many concussion signs to be aware of in children. Teammates, coaches, and parents can learn to recognize these signs. Keep in mind that concussions may not involve losing consciousness. Getting a concussion feels different for every person who experiences it.

Signs of a concussion can include:

  • Change in behavior
  • Sleeping much more or less than usual
  • Grades dropping for a student
  • Increased anxiety
  • Vomiting
  • Dizziness
  • Headaches
  • Difficulty focusing
  • Light or noise sensitivity
  • Feeling worse in the afternoon compared to the morning

It's important to seek medical attention for concussion care if you notice these signs in your child. It’s especially important to be on the lookout for these signs in young children, because they may not know to report their symptoms.

Download this Concussion Signs & Symptoms guide for easy reference.

Child head injury: when to worry

A concussion is a traumatic brain injury, so it shouldn’t be taken lightly. There are several warning signs that indicate you should take your child to the emergency room. These include:

  • Drowsiness or inability to wake up
  • A headache that gets progressively worse
  • Slurred speech
  • Repeated vomiting
  • Increased confusion
  • Loss of consciousness

You should monitor your child closely after an accident or blow to the head. If they have a concussion and don’t receive treatment, the consequences can be severe. Repeated concussions can cause long-term brain damage if not cared for properly. If you are concerned your child has a concussion, take them to a trained healthcare provider.

 

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Pediatric Concussions 101 Guide
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Pediatric Concussion Diagnosis and Treatment

What is a concussion assessment?

A concussion assessment is a healthcare provider’s method of checking for a concussion. It involves multiple tools. Their assessment will determine the severity of the head injury (or concussion). Healthcare providers need to get an objective picture of head injuries in children who may not know how to report their symptoms. A concussion assessment will include a symptom check, neurocognitive testing, balance screening, and vestibular ocular testing.

What is a baseline concussion test?

Baseline testing is a way of tracking brain functioning at a healthy state. A baseline neurocognitive test measures how the brain functions when it’s not injured.

A baseline test measures reaction time, memory, and processing speed. It gives healthcare providers an accurate picture of your child’s normal brain function. They can use that baseline test data to compare with post-injury data to determine the extent of an injury. They can also use this data to help decide when your child is back to normal cognitive functioning.

One tool that clinicians use for pediatric concussion patients is ImPACT Pediatric: an FDA-cleared assessment tool for ages 5-11. It measures a child’s cognitive functioning using iPad.

Schools and clinics use ImPACT Pediatric and ImPACT (for ages 12-59) to get baseline testing results for students and patients. Healthcare providers use the baseline clinical reports to follow up in case of a concussion.

Every test taker is given an ImPACT Passport ID to take to their healthcare provider. This ImPACT Passport ID allows the healthcare provider to find your child’s ImPACT Pediatric clinical reports.

Download the ImPACT Passport App to save your child’s ImPACT Passport ID.

How are pediatric concussions treated?

If you’ve ever had a concussion, you were probably told to rest and wait it out. In the past, clinicians used the “dark room” approach, telling patients to rest until they felt better. The problem with that treatment is: most patients didn’t feel better.

Strict rest is not effective in treating concussions. Instead, an active rehabilitation model that targets specific, unique problem areas has been much more effective. Clinicians combine symptoms, neurocognitive testing data, and vestibular/ocular testing to determine a patient’s clinical pathway and treatment plan.

It’s easier now for clinicians to create targeted, individual treatments for each unique injury. We know concussions require more than a “one-size-fits-all” approach. When properly cared for, concussions are like any other sports injury: appropriate rehabilitation gets kids back to activity safely.

When can my child return to school after a concussion?

After a concussion, your child should return to school relatively quickly. Getting a child back to their routine after a concussion is an important step in recovery.

Often, a healthcare provider will recommend academic adjustments so your child can return to school sooner. They understand that missing school can be very difficult on a student. Academic adjustments help a student successfully learn while recovering from a concussion. Share this educational accommodations checklist with a healthcare provider to ensure your child gets the help they need.

When can my child return to play after a concussion?

Your child can return to play when their symptoms and all assessments have returned to baseline levels. A trained healthcare provider should always make the return to activity decision. They will use ImPACT Pediatric, vestibular ocular screening, and a comprehensive clinical interview to determine if your child is ready to return to activity.

Keep in mind that returning to school should come before returning to sports. A trained healthcare provider will put your child through a return to play protocol, a rehabilitation approach that ensures your child is ready for full activity. The protocol includes sports-specific activities for children that sustained a sports concussion. You can find a sample return to activity strategy here.

 

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