How to Recognize and Treat Concussions in Kids

Recently, the NFL changed a key element of its concussion policy after one of its players returned to play too early and reignited the head injury conversation across the country. A concussion is defined as a traumatic brain injury caused by a blow to the head or jolt to the body that results in immediate and temporary neurological symptoms. It can cause difficulty with focus, balance, sleep, and more, which is why as fall sports are underway, it’s important for parents to recognize the signs and symptoms of the injury.

Yvette Brown-Shirley, MD, pediatric neurologist, and Arvind Balaji, MD, pediatric sports medicine specialist, answer your questions about preventing concussions in your child and what to expect during the recovery process.

Q: Are concussions more likely to be caused by sports or other things?

Brown-Shirley: We commonly see sports-related concussions in children and adolescents. But we also see concussions from injuries that are not sports-related, such as falls, being hit in the head by an object, or being involved in a car accident.

Q: If my child has a concussion, how do I know whether to take them to receive medical care?

Balaji: A concussion consists of a shaking injury to the brain plus symptoms of abnormal brain function. Symptoms can range from mild to severe and may include headache, dizziness, nausea, and balance issues. A hit on the head with local pain only is not specifically concerning for a concussion. But a head injury with one or more of those symptoms is concerning for concussion and can warrant medical evaluation.

Coaches, parents, athletic trainers, and doctors should recognize signs of head injury right away and remove players from playing until they are fully evaluated. A careful evaluation and physical examination are effective in identifying concussions and preventing youth athletes from putting themselves at risk by returning to play while injured.

Q: How is concussion treated?

Balaji: The goals of concussion treatment are appropriate rest time from activity to reduce symptoms; rehabilitation using physical, cognitive, and visual/balance exercises; and a gradual return to desired activity. This approach is applied broadly to all concussion injuries, although there can be varying rates of recovery, person to person.

Brown-Shirley: The typical timeline of recovery for adolescents and children is four weeks, although there is some variability on that timeline, depending on a couple of factors. Most notably would be a prior history of concussions and the time to recovery from those concussions, as well as a history of migraines and history of mental health concerns such as anxiety or depression.

Q: How do you protect the brain post-concussion?

Brown-Shirley: When there is enough force transmitted to the head, the brain undergoes changes at the brain cell level, and it will gradually return to its normal function with time. We encourage our concussed patients to stay away from participating in high-risk activities, like collision and contact sports, as that could increase their chances of sustaining another head injury while they are recovering from their current concussion. Another head injury while in recovery can increase their risk of rare life-threatening consequences or, more commonly, worsening symptoms and prolonging duration of recovery.

Q: For children who have had multiple concussions, is it safe to keep playing the sport?

Balaji: We know, in general, having one concussion increases your risk of having additional concussions, but currently there is not conclusive evidence about how many concussions is considered too many. Here at Stanford Medicine Children’s Health, we have an open and transparent conversation with parents and athletes to discuss the risks and benefits of continued sports participation if an athlete has had several concussions.

Q: Concussion protocols are based on research of mostly adult males. Do girls and women have different experiences of concussion?

Balaji: It’s important to recognize that adolescent girls seem to suffer concussions from sports more frequently than boys and can take longer to recover. More research is being done to investigate exactly why this is the case. Recent evidence suggests that we are not doing as great of a job as we could in recognizing concussions in girls and getting them medical attention as quickly as we do with boys. New research shows that if we can improve this discrepancy, girls have a good chance of recovery at the same rate as boys.

Q: Is there anything parents can do to prevent concussions?

Balaji: Sports rule changes have had a big impact on decreasing concussion rates in children. Making sure that kids adhere to the rules designed to protect them is important to preventing concussions. Some other prevention strategies include the following:

1. Avoid head-to-head collisions with other athletes.
2. Use proper techniques related to the sport, and wear proper protective equipment.
3. Have players who suffer a head injury or complain of any concussion symptoms come out of practice or the game to get evaluated immediately.

Q: What should parents look for when they are trying to figure out if their child’s sports team has sensible policies for identifying and handling head injuries?

Brown-Shirley: Concussion laws vary from state to state. California law mandates that all coaches must receive training on concussions. Communicating with your child’s coach, athletic trainers, and sports organization about their concussion protocols is highly encouraged and recommended. It’s also a good idea to include your pediatrician as part of your child’s treatment team to monitor your child’s recovery.