Does My Child Have a Concussion?
Bumps and bruises are normal for physically active kids who explore the world head-on. But concussions are not. Here’s what you need to know about the signs and symptoms of a concussion and when to seek medical attention.
The deep cut on her forehead and the small raised lump beneath it were the most visible signs of my daughter Naya’s gym class spill. But when the nurse handed me a ziplock bag with my 7-year-old’s mangled glasses inside, I knew she must have fallen hard.
Because Naya has a large benign cyst in her brain, we’re quite vigilant about head injuries. I pressed the school for more information on the incident, and they reported that the class had been skipping around cones on the blacktop outside. My daughter is hemiplegic, and while it only affects her mildly, she struggles with balance and gait issues because her left side is weaker. She also has vision problems, so the coordination required for skipping around cones does not come easily to her.
The most concerning piece of the report was her reaction to the fall. According to the teacher, Naya sat on the ground for almost a minute after her fall, which is unusual for our active, resilient girl. As she’s prone to falls, she is quick to get back up again and keep moving. Sitting on the ground for a minute, in my view, demonstrated the severity of the blow.
Several days later, we noticed some unusual mood swings, signs of eye strain, and sensitivity to light and sound. These symptoms persisted, so we reached out to her neurologist, who recommended we schedule an appointment with her pediatrician.
After seeing our pediatrician and sharing the story of Naya’s fall and subsequent symptoms of concern, the eye tracking and balance evaluations clinched a concussion diagnosis.
What to Look For When You Suspect a Concussion and When to Get Help
It’s important to start with a clear definition of concussion to better understand the signs and symptoms of concern — and to know when a consult with your child’s healthcare provider is necessary.
According to Matthew Grady, MD, a sports medicine pediatrician at Children’s Hospital of Philadelphia who specializes in pediatric concussions, a concussion — simply put — is a brain injury. “There has to be a force that shakes the head, which can cause a change in brain function,” he says. “Structural changes to the brain would represent a different type of brain injury.”
The sooner you intervene after a potential concussion the better, says Dr. Grady. “A late diagnosis or misdiagnosis can lead to longer lasting symptoms,” he says.
Symptoms of a concussion may not show up right away nor are they always easy to identify — particularly if your child has a high pain tolerance and doesn’t complain of headaches, eye strain, or other invisible symptoms.
However, if your child experiences an injury and shows these immediate signs and symptoms, head straight to the ER:
- slurred speech
- severe head pain
- mental confusion
- significant balance impairment
- vision deficits (i.e., can’t look to the right or left)
If no immediate signs are evident but you’re concerned that your child might have a concussion, watch for a cluster of symptoms, says Grady. “Signs are physical, but what the patient is experiencing — the symptoms — are the things you want to evaluate before calling your primary care doctor,” he says.
Symptoms of a concussion include these problems:
- vision changes, like eye strain, difficulty tracking and focusing, or sensitivity to light and sound
- mood swings, anxiety, depression, or perseveration (uncotrollable repetition of a particular response)
- changes in cognition, like delays in reaction time, processing speed, or memory retrieval
- headaches, nausea, dizziness, or loss of balance
For children with special needs who may be nonverbal or unable to communicate their symptoms, watch for cues that may alert you to something out of the ordinary, like being bothered by noise or bright lights. You may also see some regression of newly developed skills, like blurting out answers in class if he just learned to raise his hand or more meltdowns if she’s recently learned to self-regulate.
If you’re seeing any of these symptoms, schedule an appointment with your child’s pediatrician for a full evaluation, which will include specific tests for balance and eye tracking.
“These evaluations are so important because if your child has balance or vision deficits, there are treatments that can help,” Grady says.
Getting Back to a Regular Routine After a Concussion
It’s hard to keep active kids down. Fortunately, though, they can still be physically active following a concussion.
“There’s a myth that kids need to stay in a dark room forever,” says Grady. “But children should be allowed to do activities provided their symptoms don’t get worse.”
Sports and full-contact activities are the exception, though. The most important thing is to avoid reinjury while the brain is still healing. If a child experiences another injury while still concussed, the injury is amplified, Grady says.
Experts at the Weill Cornell Concussion and Brain Injury Clinic say that children who sustain one concussion are at a higher risk for a second if they experience an injury soon after the first. In addition, per the clinic, children who are still recovering from a concussion can sustain a second one from a lesser impact than is generally required to produce a concussion.
The first day after a concussion is the best day to stay home and rest, says Grady. A study published in December 2019 in the Journal of Child Neurology affirms the importance of this timing: Children who rested, physically and cognitively, from the beginning — instead of waiting a few days before slowing down — recovered four days faster. That’s why it’s key to catch a concussion early so you can rest early and ramp up activity gradually.
In fact, kids who engaged in moderate physical and mental activity and gradually returned to their regular schedule had a better recovery than those who either did nothing or did too much, per a February 2015 study in Pediatrics.
To assess their readiness for returning to school, it’s acceptable to do a trial at home, says Grady. The cognitive demands of high school are certainly more strenuous than elementary, but if your child of any age is experiencing eye or head strain, pressure, or pain — particularly when doing homework — scale back.
Naya was prescribed a removal from all activities at school that could potentially lead to reinjury (recess, gym, and physical therapy). Doctors also suggested that she limit extracurricular activities to allow the brain time to rest and heal. We were advised to keep daily tablet time to a minimum, as it could cause headaches, eye strain, or fatigue. We also made an appointment with our vision therapist, who did a brief postconcussive vision therapy session.
Following a week of no recess or gym, and about three weeks of a slower pace after school and minimal screen time, Naya was back to her usual active self. Without a quick diagnosis, she might not have been able to recover so well.
Video: Signs Your Child Has Suffered a Concussion
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