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Concussions


What Is a Concussion?

A concussion is a brain injury that causes temporary changes in the way the brain works. Concussions happen when someone has a blow to the head or the head shakes back and forth with great force.

A concussion is also called mild traumatic brain injury.

What Are the Signs & Symptoms of a Concussion?

Someone with a concussion might be knocked unconscious. But a person doesn't have to "black out" to have a concussion.

Signs and symptoms of concussion include:

  • loss of consciousness (may be brief)
  • headache
  • blurred or double vision
  • dizziness, balance problems, or trouble walking
  • confusion and saying things that don't make sense
  • being slow to answer questions
  • slurred speech
  • nausea or vomiting
  • not remembering what happened
  • not feeling well

Symptoms of a concussion usually happen right away, but can show up hours or days after an injury. Your child may complain of trouble focusing, learning or memory problems, a headache that gets worse, and sleep problems. You may notice moodiness or changes in behavior.

Call the doctor right away if your child:

  • has a severe headache or one that gets worse
  • has a seizure
  • is unconscious or cannot wake up
  • has other symptoms (such as continued vomiting) that worry you

These could be signs of a serious concussion, and your child might need treatment in a hospital.

What Happens in a Concussion?

The skull helps protect the brain from injury. Spinal fluid cushions the brain inside the skull. A blow or jolt to the head can make the brain move around and bang up against the hard bone of the skull. This injury disrupts the signals between nerves, which causes concussion symptoms.

How Do Kids and Teens Get Concussions?

Concussions can happen whenever there is a head injury. For instance:

  • in car and bicycle accidents
  • in fights
  • with head bumps and falls

Sports-related concussions are becoming more common. The risk is highest for kids who play football, ice hockey, lacrosse, soccer, and field hockey.

How Are Concussions Diagnosed?

To diagnose a concussion, the doctor will want to know how and when the head injury happened. The doctor will ask about symptoms and ask questions to test your child's memory and concentration. The doctor also will do a physical exam and test balance, coordination, and reflexes.

Concussions do not show up on a CAT scan or MRI. So, the doctor may not order a brain scan for a mild concussion.

If your child has a head injury while playing sports, a coach or athletic trainer may do sideline concussion testing. This is when a trained person does a few simple tests after a head injury to help decide if the athlete needs immediate medical care. An athlete who might have a concussion must stop playing and see a doctor before returning to play.

Many schools or sports leagues are using baseline concussion tests. Baseline testing uses computer programs to test a player's normal brain function. It includes attention, memory, and speed of thinking. Doctors compare testing after an injury with baseline results to see how a child is recovering.

If a child has a more serious injury or severe symptoms, a doctor might want a CT scan to check for bleeding or a skull fracture. This test might be done for a child who:

  • is younger than 2 years old
  • lost consciousness (passed out)
  • keeps vomiting
  • has a severe headache or a headache that gets worse
  • was injured in serious accident, such as from a car accident or very high fall

How Are Mild Concussions Treated?

For a mild concussion, the doctor will recommend watching your child closely for the first 24 to 72 hours after the head injury. You don't need to wake your child up during sleep to check for symptoms.

Concussion home treatment includes:

Physical rest. This means taking it easy in the first few days after a head injury. Physical rest may help lessen symptoms and speed recovery. After several days of rest, kids can return to activities slowly, as long as symptoms don't get worse.

Cognitive rest. This means avoiding any cognitive (thinking) activity that makes symptoms worse. This includes:

  • using a computer, cellphone, or other device
  • doing schoolwork
  • reading
  • listening to or playing loud music
  • watching TV or playing video games

When symptoms are mild or gone, your child can return to most regular activities. But he or she should stop right away if any symptoms return.

Hydration. Drink plenty of non-caffeinated liquids.

Good sleep habits. Help your child get enough sleep by:

  • having regular sleep and wake times
  • keeping the bedroom quiet and dark
  • turning off TV, phones, and other electronic devices an hour before bed

Kids with concussions should avoid bright lights, loud noises, or other situations that make symptoms worse. Pain relievers, such as acetaminophen and ibuprofen, can help headaches in the first days. But these medicines might not work after a few days and can make headaches worse when the medicine wears off (called rebound headaches).

What Can We Expect After a Concussion?

Most kids can return to school within a few days. Children with concussions may need changes, such as:

  • a lighter workload (like less homework)
  • shorter school day
  • frequent breaks
  • extra time for assignments and tests
  • extra help, such as class notes or tutoring

Talk to your child's doctor and school to come up with a plan that is right for your child. If symptoms continue, your child may need other support.

Student athletes must wait until a doctor says it's safe before returning to sports. This means that they:

  • have had a physical exam
  • are back in school
  • have no symptoms
  • aren't taking any medicines for concussion symptoms
  • are back to their baseline results on physical and cognitive testing

Hurrying back to sports and other physical activities puts kids at risk for second-impact syndrome. This is when someone gets another head injury before the concussion has healed. Although very rare, second-impact syndrome can cause lasting brain damage and even death. To protect kids, almost every state has rules about when kids with concussions can start playing sports again.

It's hard to know how long it will take to recover from a mild traumatic brain injury. Most kids and teens who have had a concussion will feel better within a few weeks. Those with symptoms that last longer than 1 to 3 months may need other tests and treatment.

People are much more likely to get a concussion if they've had one before. So preventing concussions is very important after a head injury.

If you think your child may have a concussion, or had a concussion and is not improving, call your doctor right away.

Reviewed by: Mary L. Gavin, MD
Date reviewed: October 2018

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