Pediatric Concussion 

Has your child hit their head and you are wondering if they have a concussion? Read on for more information on pediatric concussion. 

What is a concussion?

A concussion is a mild traumatic brain injury (mTBI) caused by a bump, blow or jolt to the head or body that causes the brain to be injured. A concussion or traumatic brain injury causes the brain to not work normally and can result in many symptoms. Each year, thousands of children and youth are diagnosed with concussion — only half are sports related.

Concussions can occur anywhere to anyone at any age. Concussions can happen on the playground, at home, or from a variety of other ways. 

It is important to note that a child can experience a concussion even when a child does not lose consciousness. In fact, only 10 percent of children with concussions report being “knocked out.” 

Some of the symptoms of a concussion can appear immediately after the injury, while others may not show up for several days. Symptoms may last days, weeks or months. It is also important to understand that symptoms are individual and may be subtle and not obvious. 

“It wasn’t until a few hours after a football game that we realized our son had a concussion. Initially he complained of a headache and we watched him closely but about 12 hours after the game his eyes began to stop tracking together.” PS, local Helena parent

Signs and symptoms

Let’s take a quick look at signs and symptoms of a concussion. The symptoms of a concussion are related to how well the brain cells are functioning and working together. The most common symptoms are related to four groups: physical, sleep, thinking/remembering, and mood disruption.

Sleep

• Sleeping more or less than usual
• Trouble falling asleep
• Feeling fatigued or drowsy

Mood disruption

• More emotional
• Irritable
• Sad
• Nervous
• Depressed

Often, symptoms will worsen over a matter of a few days, and it is common for new symptoms to appear in the first few days following the injury. Symptoms may also worsen when the brain is stressed, for example, when a child is doing schoolwork or participating in a physical activity.

“Not all concussions present with the same symptoms or immediately after an incident. It can be hours or even a couple of days before symptoms of a concussion are obvious. If your child is in an accident or takes a hard blow to their body, have them evaluated by a health care professional as soon as possible to avoid missing crucial treatment and healing time for the brain.” PS, local Helena parent

Pre-existing conditions and concussion symptoms

For children with pre-existing conditions, such as migraine headaches, learning disabilities, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), visual disorders, processing disorders, sensory disorders, and emotional and mental health conditions, concussion symptoms may be more severe or prolonged. It is important to know that a concussion may also worsen these underlying conditions and make them more difficult to control. These underlying conditions may require additional treatment. 

When to call 911

Call 911 immediately if your child has any of the following symptoms after experiencing a bump, blow or jolt to their head or body:

• Seizures (twitching or jerking movement of parts of the body; may look stiff)
• Weakness or tingling in the arms or legs
• Cannot recognize people or places
• Confused, restless or agitated
• Difficult to arouse or unable to awaken
• Repeated vomiting
• Slurred speech
• Bloody or clear fluid from the nose or ears
• Loss of consciousness 

Testing and diagnosis

Because a pediatric concussion can present many different ways, your child’s medical provider will ask a lot of questions to understand how the injury happened and what symptoms your child is experiencing. The evaluating healthcare provider will do a physical exam to test your child’s head-and-neck range of motion, balance, eye movement and neurocognitive function. There may be additional testing performed. 

CONCUSSION DIAGNOSTICS

Concussion is a clinical diagnosis of a functional injury, which means that currently there is not a single test to diagnose a concussion, but your child’s healthcare provider may assess your child’s condition by using a combination of tests. 

For example, your child may be asked to play a memory game that challenges their “delayed recall” ability. Or, your child may be asked to take a computerized test to better understand how their brain is functioning.

You cannot see a concussion on brain imaging, like a CT scan or an MRI, because brain imaging looks at the structure of the brain, and a concussion affects the function of the brain — not its structure. However in some cases, emergency room providers may choose to perform diagnostic imaging to rule out a structural injury or a more severe injury like a brain bleed, subdural hematoma, or skull fracture. 

Healthcare providers will use all of the information they have gathered during the examination to diagnose and determine a plan of care to help manage your child’s concussion. 

Treatment

If you think your child or adolescent has sustained a concussion, you should remove them from the sport or activity that they are playing immediately. Research shows that continuing to play and delayed access to a healthcare provider after sport-related concussion are associated with longer recovery. Following up with a healthcare provider trained in concussion is key to recovery.

Your healthcare provider can discuss symptoms and help you create a plan of care to help manage your child’s symptoms. The Optimal Sports Physical Therapy concussion specialists are specifically trained in concussion evaluation and management, and are specially equipped with clinical based diagnostic support tools for concussion.

Treatment may include aerobic exercise, balance re-training, neck strengthening, eye tracking exercises, manual therapy, and more. Your child’s pediatric concussion specialist will guide you in every step of recovery from return to learn to return to play. We are here to help you and your child throughout recovery.