Concussion Diagnosis and Treatment in Children

Head injuries and resulting concussions affect many children and teenagers every year.  A concussion is a type of traumatic brain injury from a direct blow to the head or from a transmitted force causing linear or rotational acceleration.  The definition of concussion has evolved over the last decade, and loss of consciousness is no longer a criteria for the diagnosis.  Children and adolescents with concussions experience, on average, 10-14 days of symptoms.  Evidence suggests this may be longer in younger children.
Though organized sports are thought to be the primary arena for injuries, head injuries and concussions can happen from any recreational injury, even an injury first thought to be a minor one.  High schools in many localities have undergone extensive training in order to recognize concussions in athletes.  Concussion rates are highest in football (American football - not soccer), Boys' ice hockey and lacrosse,  and Girls' soccer. 
Many schools use an evaluation tool called IMPACT --this test is composed of a series of questions, as well as mental and reflex performance measures -- designed to pick up on key nuances and signs resulting from a head injury.  Athletes are given a baseline test at the beginning of the school year, or the beginning of the sports season, and further tests are done after injuries.  The scores are compared with one another to look for impairments.  Medical professionals find the IMPACT test useful as one tool in determining whether athletes are mentally able to return to school activities or sports participation.  Another tool that is useful is the SCAT3 (Sport Concussion Assessment Tool).  The SCAT3 has one section called the Sideline Assessment, designed to evaluate an athlete right away at the time of injury, as well as a symptom checklist (completed by the child) with severity levels for each symptom, a cognitive and memory assessment, and a physical balance and coordination test.  Again, this test is useful when performed multiple times in an assessment of a child who has had a concussion.
Common symptoms of traumatic brain injury and concussions include:
Physical symptoms - dizziness, problems with balance, headache, nausea/vomiting, sensitivity to light or noise, visual problems
Cognitive symptoms - change in school performance, difficulty paying attention or concentrating, difficulty remembering, feeling confused about recent events, feeling foggy/"in a daze", forgetfulness, slowed response times
Emotional symptoms - irritability, increased emotions/moodiness, sadness, nervousness or anxiety, loss of interest in activities
Sleep/energy symptoms - drowsiness, fatigue, sleeping more than usual or insomnia/difficulty falling asleep


Following an initial evaluation, your medical provider will likely talk about putting your child on "cognitive rest" for a minimum of 5 days.  This means absence from school and associated school work, as well as no sports or physical activity, no TV/computer/texting/video games/driving.  When symptoms improve, a gradual return to activity can be coordinated.  It is important to realize that the cognitive symptoms may remain even after the initial physical symptoms go away.  Close coordination with medical providers, school personnel, trainers and coaches is important to give a child a good environment in which they can return to full functioning.