Concussions in Children: Recognizing, Assessing and Assisting Recovery

Concussions, whether from sports or from daily activities, have increased in both adult and pediatric populations. Research continues to evolve, improving care to recognize concussions better, reduce symptoms and minimize their effects. Although this article focuses on sports-related concussions, many of the signs, symptoms and treatments apply to concussions from all causes in children of all ages. 

A concussion is defined as “a mild injury…caused by a direct blow to the head, face, neck or elsewhere…and force transmitted to the head”. When a child is suspected of this type of injury, they should be removed immediately from the activity or sport and should not return until a full assessment by a medical professional is completed. 

This is essential because a second trauma to the head within 24 hours can result in significantly more intense and prolonged symptoms. Parents and caregivers should watch for the following symptoms in these categories: 

• Body Sensations: headache, tiredness, dizziness or sensitivity to noise and light 

• Vestibular: nausea or motion sickness 

• Vision: blurry vision, pain in the eyes, difficulty reading, difficulty bringing both eyes to center, double vision 

• Cognition: memory/concentration issues or fogginess 

• Mood: increased nervousness, irritability or sadness 

• Sleep: trouble falling asleep, sleeping too much, new napping schedules or increased fatigue during the day with normal sleep patterns 

While evaluating each child’s signs and symptoms, it is important to consider pre-existing anxiety or depression.  In addition, many studies have found that children often underreport symptoms and the severity of concussions. When a medical professional screens and evaluates your child, they should be aware of all pertinent medical history (ADHD, learning difficulties, previous head injuries) and complete a physical exam with a focus on eye tracking, balance and pupil response. For the balance assessment, studies show that a tandem gait (walking heel to toe) for children older than 5 is a strong indicator differentiating symptomatic and healthy individuals. 

Although imaging (CT scans) can be beneficial for more severe injuries, studies have found that it does not frequently improve diagnosis or treatment for mild injuries. However, if there is a loss of consciousness, frequent vomiting or a significant decline in symptoms and mental status, experts highly recommend further imaging. 

After a complete evaluation, the caregiver’s role in concussion management is essential. Caregivers should provide opportunities for rest, followed by a gradual return to school and social activities. Current guidelines recommend a rest period of 24 to 48 hours. However, research shows that prolonged rest for mild injuries may increase symptom severity. Therefore, a gradual return to cognitive and physical activity is recommended after about 2 days. Most schools have staff who can support a return-to-school plan that promotes appropriate socialization without overstimulation.  

Additionally, controlled, non-strenuous aerobic exercise has been shown to improve symptoms after a concussion. Caregivers should avoid overly strenuous activity and consult their doctor or physical therapist for further guidance.  

For sport-specific recovery, return-to-play protocols are available, but it is essential that the child communicates any onset or worsening of symptoms during exercise. If symptoms persist beyond 4r weeks, more extensive evaluation and rehabilitation are recommended. Vestibular and vision rehabilitation are specialized forms of physical therapy that can address deficits at all ages. If a child is experiencing cognitive deficits, neuropsychologists can be beneficial for their recovery.  

The Centers for Disease Control and Prevention has published guidelines for mild traumatic brain injuries, linked below for further information.  

In conclusion, recognizing, assessing and treating concussions in children involves multiple steps, with open communication being essential throughout the process. If your child has experienced a concussion and you’re searching for pediatric physical therapy in Colorado, contact us at OASIS Pediatric Therapy. 

Written by: Jess Westphal, DPT, PT

References and/or Sources:  

Link to CDC Guidelines: https://www.cdc.gov/heads-up/guidelines/index.html

Link to Article: pmc.ncbi.nlm.nih.gov/articles/PMC9290185