What is a concussion?
A concussion is a mild traumatic brain injury (mTBI) caused by a blow or jolt to the head or body that causes the brain to shake. The shaking can cause the brain to not work normally and can result in serious side effects. Each year, thousands of children and youth are diagnosed with concussion — only half are sports related.
Concussions can occur even when a child does not lose consciousness. In fact, only 10 percent of children with concussions report being “knocked out.” Some of the symptoms of a concussion can appear immediately after the injury, while others may not show up for several days. Symptoms may last days, weeks or months. Sometimes symptoms may be subtle and not obvious.
Signs and symptoms
The symptoms of a concussion are related to how well the brain cells are functioning and working together. The most common symptoms are related to four groups: physical, sleep, thinking/remembering, and mood disruption.
- Nausea and vomiting
- Balance problems
- Slowed reaction time
- Sensitivity to light
- Sensitivity to sound
- Fuzzy or blurry vision
- Sleeping more or less than usual
- Trouble falling asleep
- Feeling fatigued or drowsy
- Difficulty concentrating
- Difficulty remembering
- Feeling “mentally foggy”
- Feeling slowed down
- More emotional
Often, symptoms will worsen over a matter of days, and it is common for new symptoms to appear in the days following the injury. Symptoms may also worsen when the brain is stressed, for example, when a child is doing schoolwork or participating in a physical activity.
Pre-existing conditions and concussion symptoms
For children with pre-existing conditions, such as migraine headaches, learning disabilities, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), visual disorders, and emotional and mental health conditions, concussion symptoms may be more severe or prolonged. It is important to know that a concussion may also worsen these underlying conditions and make them more difficult to control.
When to call 911
Call 911 if your child has any of the following symptoms:
- Seizures (twitching or jerking movement of parts of the body; may look stiff)
- Weakness or tingling in the arms or legs
- Cannot recognize people or places
- Confused, restless or agitated
- Difficult to arouse or unable to awaken
- Repeated vomiting
- Blurred speech
- Bloody or clear fluid from the nose or ears
Testing and diagnosis
Your child’s primary care provider will ask a lot of questions to understand how the injury happened and what symptoms your child is experiencing. The primary care provider will do a physical exam to test your child’s head-and-neck range of motion, balance, eye movement and neurocognitive ability.
There is not a single test to diagnose a concussion, but your child’s primary care provider may assess your child’s condition by a combination of tests. For example, your child may be asked to play a memory game that challenges his “delayed recall” ability. Or, your child may be asked to take a computerized test to better understand how his brain is functioning.
You cannot see a concussion on brain imaging, like a CT scan or an MRI, because brain imaging looks at the structure of the brain, and a concussion affects the function of the brain — not its structure.
Primary care providers will use all of the information they have gathered to diagnose and manage your child’s concussion.
Your child should see her primary care provider if you think she has a concussion. The primary care provider can discuss symptoms and help you create a plan. CHOP Primary Care physicians are located in more than 30 communities across Southeastern Pennsylvania and New Jersey, and are especially equipped with training and diagnostic support tools for concussion.
After seeing your primary care provider, if you have further questions, please call CHOP's Trauma Center at 215-590-5932, Sports Medicine and Performance Center at 215-590-6919 or Division of Neurology at 215-590-1719.
Initial treatment for a concussion is rest, both mental and physical. Rest allows the brain to heal.
- Activities that could cause another head injury (such as sports, gym class, riding a bike, etc.)
- Other physical activities that cause a sustained increase in your child’s heart rate and make her symptoms worse (such as any activity that causes her to break a sweat, lifting heavy items, etc.)
- Activities that require a lot of concentration (for example, attending school, doing homework, playing video games, texting, social media, etc.)
It is important to allow for sufficient brain rest so that the brain is able to heal. Allow your child to sleep as much as she needs. Your child should stay home from school until her symptoms are significantly improved. Reintroduce mental activity slowly as your child feels better. Your pediatrician can help guide this gradual process.
With guidance from your primary care provider, your child can slowly return to mental and physical activity as she begins to feel better.
It is important to watch your child closely, pay attention to her specific symptoms, and contact your physician with any concerns.
Full recovery goes beyond physical healing. Experts at CHOP have designed an evidenced-based website to help families with emotional recovery. Learn more about your child’s emotional recovery after an injury, and how you can help.
During follow-up visits, your child’s primary care provider may redo some of the cognitive testing to see if concussion symptoms are improving or if additional rest or other interventions are needed.
Common concussion questions
Our educational video series addresses some of the most common questions our concussion specialists hear from patients, parents, coaches and schools.