How do I know if my younger child has a concussion?

We often hear concussion is a worry for parents whose tween or teen participates in sports. What usually gets less attention is that younger children also suffer from concussions and that their symptoms may not have a typical manifestation.

Is there concern if your younger child has suffered a concussion and you missed it? Here is some information to help you answer these questions.

1. We depend on the child's complaints, performance and behaviors to diagnose a concussion. Concussion is a brain injury caused by a forceful bump, blow, or shaking of the head. The head does not need to be hit for the brain to be injured as some concussions occur only with head shaking, especially if the shaking is sudden and forceful. The brain injury cannot be detected by taking CT or MRI pictures of the brain.

What causes the brain injury in concussion is a change in the way brain cells use energy, communicate with each other as well as leaking of blood chemicals into the brain rather than physical changes in the brain. The doctor will know if a child has suffered a concussion based on the child's complaints, level of functioning, and behaviors that imply that the brain is not functioning normally.

Credit: JAMA Pediatrics

2. Concussions are becoming more common in younger children. A recent article describing 8,000 concussions occurring in the Children's Hospital of Philadelphia health system between 2010 and 2014 reported thatone-third of all concussions occurred in children under the age of 12. Many of these concussions were first treated by the primary care provider and not the emergency room showing that pediatricians are the ones that handle most concussions in younger children. While this is anecdotal, I can say that as a pediatrician, I have noticed in my practice that I am seeing more concussions and those occurring at an earlier age than perhaps 10 years ago.

3. The child's complaints, performance, and behaviors that doctors use to diagnose concussion differ with the child's age. Typically, concussion in a child 12 years or older is spotted by the coach or parent after a sports injury when he or she shows typical symptoms of fainting, nausea, headache, memory or concentration problems, balance problems or vision problems immediately following the injury. This is often suspected after a positive "sideline" assessment using a standard concussion questionnaire. In a younger child, the symptoms may be different.

A younger child might injure his or her head at home, playground, school or day care. The parent might not be aware of the circumstances or even that the injury occurred. A child may underreport symptoms to avoid getting in trouble or to go back to play. A child may also over report symptoms to skip school. A younger child should be suspected of having a concussion if there is a head injury AND the child has symptoms such as irritability, sudden mood changes, appetite change or sleep problems. These symptoms may be alone or in addition to the typical symptoms of loss of consciousness, nausea and vomiting, headaches, balance problems, and concentration difficulty seen in older children.

What if I missed a concussion in my child? Are there future consequences? We know that head injuries cause worse concussion symptoms if the child has had a previous concussion. Children having multiple concussion are at increased risk for prolonged recovery.  Here is what you can do to avoid missing a concussion and to prevent long term consequences:

Read up on signs and symptoms of concussion. Then you will be less likely to miss one. One of the best places to read about concussion in children is the Centers for Disease Control and Prevention website called HEADSUP.

When in doubt, see the doctor. If you suspect a concussion, then go to your child's doctor as soon as possible. An emergency room visit is warranted if your child has any of these symptoms: progressively worsening headache, vomiting, difficulty waking up or paying attention, seizures, slurred speech or balance problem on standing up.

Rest is always the first step. If you suspect a concussion, having your child rest physically and mentally, and removing her from sports is always a safe bet until you can see or talk to your doctor. This is important since treatment of concussion starts with this kind of rest. Your doctor will recommend the ultimate duration of this rest and if any additional treatment is needed.

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