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Concussions

The term concussion might make you think of someone knocked unconscious while playing sports. But concussions — temporary disruptions of brain function — can happen with any head injury, often without a loss of consciousness. And while we often hear about head injuries in athletes, most concussions occur off the playing field — in car and bicycle accidents, in fights, and even minor falls.

About Concussions

A concussion is also known as a mild traumatic brain injury. The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. The brain can move around inside the skull and even bang against it. If the brain bangs against the skull — for example, due to a fall on a playground or a whiplash-type of injury — it can be bruised, blood vessels can be torn, and the nerves inside the brain can be injured. These injuries can cause a concussion.

Anyone who has a head injury should be watched closely for signs of a concussion, even if the person feels OK. An undiagnosed concussion can be put someone at risk for brain damage and even disability, so anyone who has any symptom of a concussion should be examined right away by a doctor.

Kids who get concussions usually recover within a week or two without lasting health problems by following certain precautions and taking a break from sports and other activities that make symptoms worse.

Signs and Symptoms

Signs of a concussion can be physical, cognitive (how the brain processes information), emotional, or related to sleep. Anyone showing any of these signs of a concussion should be seen by a doctor.

Physical

  • headache
  • dizziness
  • nausea and vomiting
  • difficulty with coordination or balance (not being able to catch a ball, perform other easy tasks, etc.)
  • blurred vision

Cognitive

  • feeling confused and dazed
  • difficulty concentrating, thinking, or making decisions
  • trouble remembering things, such as what happened right before or after the injury
  • slurred speech or saying things that don't make sense

Emotional

  • feeling anxious or irritable for no apparent reason
  • feeling sad or more emotional than usual

Sleep-related

  • sleepiness or difficulty falling asleep
  • sleeping more or less than usual

Someone with a concussion may be knocked unconscious, but this doesn't happen in every case. In fact, a brief loss of consciousness or "blacking out" doesn't mean a concussion is any more or less serious than one where a person didn't black out.

Symptoms of a concussion don't always show up right away, and can develop within 24 to 72 hours after an injury. Young children usually have the same physical symptoms as older kids and adults, but cognitive and emotional symptoms (such as irritability and frustration) can appear later, be harder to notice, and last longer. Sleep-related issues are more common in teens.

Call 911 or go to the ER right away after a head injury if your child:

  • can't be wakened
  • has convulsions or seizures
  • has slurred speech
  • seems to be getting more confused, restless, sleepy, or agitated
  • has vomited more than once
  • has a headache that gets worse or won't go away

Though most kids recover quickly from concussions, some symptoms — including memory loss, headaches, and problems with concentration — may linger for several weeks or months. It's important to watch for these symptoms and contact your doctor if they last. Often, in these cases, children need further evaluation and treatment.

Diagnosis

To diagnose a concussion, the doctor will ask about how and when the head injury happened, and about your child's symptoms. The doctor also may ask basic questions to test your child's consciousness, memory, and concentration ("Who are you?"/"Where are you?"/"What day is it?").

The doctor also will do a physical exam and focus on the nervous system by testing balance, coordination, nerve function, and reflexes. Sometimes a computed tomography (CAT scan or CT scan) or magnetic resonance imaging (MRI) brain scan will be done to rule out internal bleeding or other problems from the injury.

Some kids who have head injuries from playing organized sports are examined by a coach or athletic trainer immediately after they're injured. This "sideline testing" is becoming more common in schools and sports leagues. By watching a child's behavior and doing a few simple tests, a trained person can see if the child needs immediate medical care. Often, these sideline results are compared with similar tests done at the start of the sports season (called "baseline concussion tests") to check for changes in brain function. These tests also can help doctors make a diagnosis.

Treatment

Because each concussion is unique, symptoms can differ in severity. For this reason, treatment depends on a child's particular condition and situation.

If a concussion is not serious enough to require hospitalization, a doctor will give instructions on home care. This includes watching the child closely for the first 24 to 48 hours after the injury. It is not necessary to wake the child up while he or she is sleeping to check for symptoms.

If a child has a headache that gets worse quickly, becomes increasingly confused, or has other symptoms (such as continued vomiting), it may mean there is a more serious problem. Call the doctor if your child experiences any of these symptoms.

Otherwise, home care for a concussion may include:

  • Physical rest. This means not doing things like sports and physical activities until the concussion is completely healed. While they still have symptoms, kids should do only the basic activities of day-to-day living. This reduces stress on the brain and decreases the chances of re-injuring the head in a fall or other accident. When all symptoms are gone, kids should return to physical activities slowly, working their way back to pre-concussion levels.
  • Mental rest. This means avoiding any cognitive (thinking) activity that could make symptoms worse, such as using a computer, cellphone, or other device; doing schoolwork; reading; and watching TV or playing video games. If these "brain" activities do not make symptoms worse, kids can start them again gradually, but should stop immediately if symptoms return.
  • Eating well and drinking plenty of non-caffeinated beverages.

Kids with concussions also should avoid bright lights and loud noises, which can make symptoms worse. While they have symptoms, teens should take time off from work and not drive, operate heavy machinery, or do any other activities that require quick decisions and reactions.

Healthy kids usually can return to their normal activities within a few weeks, but each situation is different. The doctor will monitor your child closely to make sure that recovery is going well, and might recommend acetaminophen, ibuprofen, or other aspirin-free medicines for headaches. Pain medicines can hide symptoms, though, so kids should not return to normal activities until they no longer need to take them.

Returning to Normal Activities

Be sure to get the OK from the doctor before your child returns to sports or other physical activities. Sometimes kids feel better even though their thinking, behavior, and/or balance have not yet returned to normal.

Even if your child pleads that he or she feels fine or a competitive coach or school official urges you to go against medical instructions, it's essential to wait until the doctor has said it's safe to return to normal activities. To protect kids and remove coaches from the decision-making process, almost every state has rules about when kids with concussions can start playing sports again.

It's very important for anyone with a concussion to heal completely before doing anything that could lead to another concussion. Hurrying back to sports and other physical activities increases the risk of a condition called second-impact syndrome, which can happen as a result of a second head injury. Although very rare, second impact syndrome can cause lasting brain damage and even death.

Preventing Concussions

All kids should wear properly fitting, appropriate headgear and safety equipment when playing contact sports or biking, rollerblading, skateboarding, snowboarding, or skiing. Nothing can prevent every concussion, but safety gear has been shown to reduce the occurrence of severe head trauma.

Childproofing your home will go a long way toward keeping an infant or toddler safe from concussions and other injuries. Babies reach, grasp, roll, sit, crawl, pull up, "cruise" along furniture, and walk. Toddlers may pull themselves up using table legs; they'll use bureaus and dressers as jungle gyms; they'll reach for whatever they can see. All of these activities can result in a head injury that leads to a concussion. Be sure your child has a safe place to play and explore, and never leave a baby or toddler unattended.

Proper child car seats, booster seats, and safety belts can help prevent head injuries in the event of a car accident and should be used every time kids are in a car.

People are much more likely to sustain a concussion if they've had one before, so prevention is even more important following a head injury. Evidence shows that repeated concussions can result in lasting brain damage, even when the injuries happen months or years apart.

Concussions are serious injuries that can become even more serious if kids aren't given the time and rest needed to heal them completely. Safety precautions can help prevent concussions, and following a doctor's advice can minimize their effects if they do happen.

Reviewed by: Elana Pearl Ben-Joseph, MD, and Todd A. Maugans, MD
Date reviewed: May 2014