Concussions: Important Signs to Recognize in Your Child

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Concussions in children and teens are very common. The American Academy of Pediatrics (AAP) estimates that between 1.1 to 1.9 million children and teens in the U.S. are treated for a recreational or sport-related concussion every year. 

A concussion is a type of traumatic brain injury that affects normal mental function for a short period of time (usually less than 6 hours). Concussions are caused by a blow, hit, or jolt to the head or body that causes the brain to bounce against, or move very rapidly inside the skull. This can happen during a fall, a car accident or when playing sports.

“There's a wide variety of scenarios where I see concussions in patients. Most common with older children and teenagers are situations where they are involved in contact sports like football, hockey, soccer, and basketball,” Kirk Mulgrew, MD, Stanford pediatrician at Pediatric Group of Monterey, part of Stanford Children’s Health, explains. “However, concussions can also happen during sports like cheerleading and swimming where you’d least expect it. With children below the age of 10, I see concussions that occur from any range of normal playing activities.”

Symptoms of Concussions

Some of the noticeable symptoms of a concussion are:

  • Dizziness
  • Loss of consciousness (even if it’s briefly)
  • Clumsy movements
  • Mood and/or behavioral changes
  • Short-term memory loss

Other symptoms your child may complain of or mention to you in passing are:

  • Headaches
  • Nausea
  • Blurry vision and loss of eye coordination
  • Confusion
  • Sluggishness
  • Simply not feeling right

Complications of Concussions

Most children fully recover from a concussion, but some may develop complications—especially if they do not completely heal from the initial head trauma before resuming normal activity. 

Second-Impact Syndrome: This condition is a rare but potentially fatal complication of concussions. 

“A concussion causes what's called a neuro-metabolic cascade where, basically, the brain cells are working extra hard to heal, requiring different energy requirements, and are generally in a confused state,” Dr. Mulgrew explains. “With second-impact syndrome, you get another hit in that time frame that worsens the process—to the point that blood flow is affected and the brain swells quickly.”

Post-Concussion Syndrome: This condition refers to a group of symptoms that last for weeks or even months after the injury that caused the concussion happened. These symptoms include headaches, dizziness, memory problems, mood swings, fatigue, noise and light sensitivity, and vision problems

Getting Your Child Appropriate Medical Care

“It's very important that the child gets evaluated by his or her pediatrician, even if the symptoms seem mild at the time,” Dr. Mulgrew emphasizes. Symptoms can sometimes be delayed too, so parents should be watchful for some days after the child experiences a head-related incident.

Finding out whether a child has a concussion is a multi-step process. “My standard concussion evaluation involves writing down the details of the event if the child remembers them. That gives me an idea of the potential severity of the injury. Then I conduct a standard concussion assessment using the SCAT5 tool,” Dr. Mulgrew explains. “I use the test results to compare on subsequent visits, and I also perform a neurologic exam.”

As a member of Stanford Children’s Health, Dr. Mulgrew has access to the Stanford Children’s Health Concussion Program, which is run by a network of specialists (such as pediatric orthopedists, sports medicine specialists and neurologists) who are on the forefront of concussion research and innovation.

Treating Complex Concussions

Serious cases sometimes require a direct referral to the Stanford Concussion Program—a program designed to help children safely return to sports and regular activity after a concussion.

“I would consider a referral to the Stanford Children’s Health Concussion Program if the child is not getting better after the expected amount of time, or if the symptoms are so severe and/or complex to necessitate it,” Dr. Mulgrew explains. “There, your child will be treated by specialists who can help with vestibular rehabilitation, ocular rehabilitation, treatment of underlying migraines, and referrals for counseling and cognitive behavioral therapy, if necessary.” 

The vestibular rehab will help with dizziness and balance difficulties, ocular rehabilitation with eye and vision problems, and counseling or cognitive behavioral therapy with mood and behavioral changes.

Preventing Concussions

“The most important prevention steps are teaching children head and body awareness, as well as ways to protect themselves during activities,” Dr. Mulgrew says. “They should also be taught the signs of concussions so they know to alert an adult if they experience any.”

Additionally, parents should:

  • Ensure a child wears a seat belt every time he or she is in a vehicle.
  • Make certain a child wears (or is given) a helmet or appropriate headgear during sports and recreational activities.
  • Childproof their home.
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