How to Recognize and Treat Concussions in Kids

This blog was originally posted on November 7, 2022, and updated on October 1, 2023

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.

Arvind Balaji, MD, pediatric sports medicine specialist, answers common questions about preventing concussions in your child and what to expect during the recovery process. If you suspect that your child has a concussion and you have any questions about their care, please call (844) 416-7846 to schedule an appointment with Dr. Balaji or another pediatric sports medicine specialist.

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

Dr. 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.

How is concussion treated?

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.

Concussions impact four different areas: exercise tolerance, visual/vestibular, mood, and cognition. All four must be addressed and rehabilitated.

• Exercise tolerance. Kids who suffer a concussion should rest for the first 24 hours after the injury. After that, studies have shown that light aerobic exercise that doesn’t give your child any symptoms (such as headache and dizziness) can speed recovery. Children can gradually increase their activity as long as they don’t start showing any symptoms, progressing from light exercise like biking and walking, to moderate sport-specific activity like dribbling a soccer ball, to vigorous non-contact exercise and resistance training, to practice with bodily contact, and finally, a return to play.
• Visual/vestibular. In one study, 69% of adolescents had a vision issue after a concussion. Eye tracking abilities can also affect students’ ability to read and take notes. Vestibular rehabilitation is critical.
• Cognition. Studies have shown that there are safe levels of cognitive activity that kids with concussions can tolerate without the risk of prolonging symptoms. As with exercise, return gradually and ensure that the activity is not causing any symptoms. And of course, returning to learning should be a priority over returning to sports.
• Mood. Several studies have shown that students are at increased risk for mental health concerns after suffering from a concussion. This is likely due to several reasons, including the child’s reduced activity level, potential issues with schoolwork, and the injury itself.

How do you know when a child is ready to return to playing sports after a concussion?

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.

Before returning to play, young athletes should be back in the classroom without any accommodations, have a normal visual/vestibular exam, and be symptom free, including ensuring that any mood issues are being addressed.

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

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.

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

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.

Is there anything parents can do to prevent concussions?

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.

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?

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.  

If your child has a concussion or you are concerned about their symptoms, please call (844) 416-7846 to schedule an appointment with Dr. Balaji or another pediatric sports medicine specialist.