Concussions

About Concussions

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 does bang against the skull — for example, due to a fall on a sidewalk 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 lead to a concussion.

Many different systems have been used to grade or describe concussions. The severity of a concussion is determined by how long signs and symptoms last and so can only be known after someone has recovered. The longer the symptoms of changes in brain function, the more severe the concussion.

Signs and Symptoms of a Concussion

Someone with a concussion may lose consciousness, but this doesn't happen in every case. In fact, a brief loss of consciousness or "blacking out" isn't a factor in determining concussion severity.

Other signs of a concussion include:

• headache
• sleepiness or difficulty falling asleep
• feeling confused and dazed
• difficulty concentrating, thinking, or making decisions
• dizziness
• difficulty with coordination or balance (such as being able to catch a ball or other easy tasks)
• trouble remembering things, such as what happened right before or after the injury
• blurred vision
• slurred speech or saying things that don't make sense
• nausea and vomiting
• feeling anxious or irritable for no apparent reason

Concussion symptoms may not appear initially and can develop over the first 24-72 hours. Anyone showing any of these signs should be seen by a doctor. Young kids can have the same concussion symptoms as older kids and adults, but changes in mood and behavior may be more subtle.

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

• can't be awakened
• has one pupil — the dark part of the eye — that's larger than the other
• has convulsions or seizures
• has slurred speech
• seems to be getting more confused, restless, or agitated

Though most kids recover quickly from concussions, some symptoms — including memory loss, headaches, and problems with concentration — may linger for several weeks or months. Nearly 15% of kids age 5 and older have symptoms and/or changes in functioning lasting 3 months or longer. It's important to watch for these symptoms and contact your doctor if they persist.

Diagnosis

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

The diagnosis of a concussion is made by health care provider based on history and physical exam. The doctor will perform a thorough examination of the nervous system, including testing balance, coordination, nerve function, and reflexes.

Sometimes a doctor may order a CT scan of the brain (a detailed brain X-ray) or an MRI (a non-X-ray brain image) to rule out bleeding or other serious brain injury. Concussions can change the way the brain works, but in most cases, imaging tests will show normal results.

Treatment

If the concussion is not serious enough to require hospitalization, the doctor will provide instructions on how to take care of your child at home. The doctor may have you wake your child up at least once during the night.

If your child cannot be easily awakened, becomes increasingly confused, or has other symptoms (such as continued vomiting), it may mean there is a more serious problem that requires contacting the doctor again.

The primary treatments for a concussion include both physical and mental rest. While your child has symptoms, he or she should not:

• attend school or have a normal workload
• take any high-stakes testing (for example, state testing, PSATs, SATs, etc.)
• participate in physical activity including gym class, recess, and sports
• participate in wheel activities (for example, biking, rollerblading, scootering, or skateboarding)
• drive or operate heavy machinery
• return to work

After a concussion, the brain needs time to heal. Recovery time will depend on how long the symptoms last. It's very important for kids to wait until all symptoms have ended before resuming normal activities. Physical symptoms, balance and coordination, and thinking and personality all should return to the pre-injury level.

Be sure to get the OK from the doctor before your child resumes 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 given the OK.

Healthy kids can usually resume their normal activities within a few weeks, but each situation is different. The doctor will monitor your child closely to ensure that recovery is going well and might recommend acetaminophen, ibuprofen, or other aspirin-free medications for headaches.

Even mild concussions require a player to sit out for the remainder of the game. People are much more likely to sustain a concussion if they've had one previously. And evidence shows that repeated concussions can result in lasting brain damage, even when the injuries occur months or years apart.

Kids who have resumed normal activities and no longer have symptoms might be allowed to slowly return to sports. This is a gradual process that can take anywhere from a few days to weeks. A person should never return to play or other strenuous activities on the same day of the injury and should see a doctor.

Preventing Concussions

All kids should wear properly fitting, appropriate headgear and safety equipment when biking, rollerblading, skateboarding, snowboarding or skiing, and playing contact sports. 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, and eventually 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.

The time you spend taking these safety precautions — and getting your kids into the habit of abiding by your safety rules and regulations — will help keep your family safe and sound!

Reviewed by: Rochelle Haas, MD, and Kate M. Cronan, MD
Date reviewed: January 2011