Concussion: A-to-Z Guide from Diagnosis to Treatment to Prevention

Child with a wrapped head. Could it be a concussion?
Introduction to concussion:

Children’s energetic exploration of life often results in head “bonks.” Fortunately, most of them are not serious. Nevertheless, when we hear the awful thud of a child’s head, our breath catches for a moment…

What is concussion?

A brief, temporary loss of consciousness following a blow to the head is called a concussion. It is possible to have a mild concussion without losing consciousness completely. Any brief alteration in consciousness, vision, and balance following a head injury could be a mild concussion.

Who gets concussion?

Is toddlerhood a contact sport?

Almost every child experiences minor head injuries. They occur throughout childhood and adolescence. They are most common in infants and toddlers and then later when children engage in contact sports.

What are the symptoms of concussion?

The classic symptom of a concussion is a brief loss of consciousness. A mild concussion might only cause brief confusion or momentary amnesia. It can be normal to have a headache, feel sleepy, or vomit once or twice afterwards.

In a baby or toddler, a prompt cry after a head injury is reassuring. The following is a list of signals that tell you that you need to talk with your pediatrician, either initially, or again if they develop after the first conversation:

If your child is (or has):

  • Under 6 months of age
  • Unconscious, even briefly
  • Crying for longer than 10 minutes
  • Vomiting repeatedly
  • Bleeding or clear liquid from the ears or nose
  • Rapid swelling just above the ear
  • Unable to walk or talk normally
  • Unequal pupil size
  • Severe, worsening headache (or irritability before a child can talk)
  • Neck pain
  • Seizures
  • Skull indentation or large bump
  • Great force of injury (car accident, long fall, baseball bat, etc.)
  • Changes in behaviour, such as being sleepy and difficult to arouse>

If any of these symptoms or situations is present, call your physician right away. Your child may be fine but you should be in touch with an expert. If your child is unable to get up by himself immediately after the head injury, there may also be a neck injury. It might be best not to move him. Call 911 and wait for emergency help to arrive.

Is concussion contagious?

Concussions and head injuries are not contagious, although the risk-taking behavior that leads to them can be.

How long does concussion last?

The loss of consciousness from a concussion may last only a few seconds, but it can last considerably longer. If it lasts a few minutes or longer, the child will likely need to be hospitalized for observation or treatment.

New symptoms can develop after a head injury during the next 24 to 48 hours, especially if there is some internal bleeding.

How is concussion diagnosed?

The nature and extent of a head injury is first assessed based on the story and on the physical exam. If there is any concern that a serious injury may be present, additional studies, such as a head CT, may be needed.

How is concussion treated?

For most concussions, observation and rest is all the treatment that is needed. During the first night afterward, you’ll want to try to awaken your child once or twice to be sure that he awakens normally.

Some children need definitive treatment at a hospital or even in a pediatric ICU for severe head injuries.

With any concussion, the risk is much higher from a second concussion soon after the first one (called the second impact syndrome) because the healing brain is not able to regulate blood flow as well.

According to the AAP Clinical Report on Sport-Related Concussion in Children and Adolescents, all children who have suffered a concussion must proceed sequentially through the following steps. A child must pass 24 hours in each step of the rehabilitation process and wait a minimum of 5 days to return to competition-level sports participation:

  1. No activity — Complete physical and cognitive rest
  2. Light aerobic activity — Walking, swimming, stationary cycling at 70% maximum heart rate; no resistance exercises
  3. Sport-specific exercise — Specific sport-related drills but no head impact
  4. Noncontact training drills — More complex drills, may start light resistance training
  5. Full-contact practice — After medical clearance, participate in normal training
  6. Return to play — Normal game play

Repeated concussions increase the risks of acute or ongoing problems. Thus, physicians generally recommend avoiding contact sports for at least two weeks after a second mild concussion (confusion without loss of consciousness), for a month after a second moderate concussion (confusion and brief amnesia), and for the season after a second severe concussion (complete loss of consciousness).

How can concussion be prevented?

Helmets for using a bicycle, scooter, or roller-blades, and helmets for contact sports can help prevent many serious head injuries. Make sure your child is properly equipped for his activities.

Stair gates for infants and toddlers and car seats or seat belts for everyone in the car are also important safety equipment.

“Rock-a-Bye Baby,” the lullaby about a baby toppling from a poorly placed cradle, warns parents of a real danger. Falls from open windows, rooftops, balconies, play structures, and other heights injure more children than any other cause.

Summertime is the greatest danger period, with more open windows and more outdoor play. Children love to climb, so furniture is best kept back from windowsills and balcony railings. Window guards and window stops can let fresh air in but keep a child from falling out. Don’t rely on ordinary window screens to keep your children safe. In addition, placing shrubbery or something soft under danger areas can lessen the injury if a child does fall.

Related concepts:
Head injury

Dr. Alan Greene

As a father of four himself, Dr. Greene has devoted himself to freely giving real answers to parents' real questions -- from questions about those all too common childhood conditions to those that address the most recent and rare pediatric illnesses. His answers combine cutting edge science, practical wisdom, warm empathy, and a deep respect for parents, children, and the environment. He is also an electrifying public speaker, and has personally touched many during his talks in North America, Europe, Asia, and the Middle East.

Dr. Greene is a graduate of Princeton University and the University of California at San Francisco. Upon completion of his pediatric residency program at Children's Hospital Medical Center of Northern California he served as Chief Resident. He entered primary care pediatrics in January 1993.

Dr. Greene is the Past President of The Organic Center and on the Board of Directors of Healthy Child Healthy World. He is a founding partner of the Collaborative on Health and the Environment. He also consults for the Environmental Working Group.

In 1995, he launched DrGreene.com, cited by the AMA as “the pioneer physician Web site” on the Internet. His award-winning site has received over 80 million Unique Users from parents, concerned family members, students, and healthcare professionals. In addition to being the founder of DrGreene.com, he is the Medical Director for HealthTap.

In 2010 Dr. Greene founded the WhiteOut Movement to change how babies in the United States are fed. In 2012 he founded TICC TOCC - Transitioning Immediate Cord Clamping To Optimal Cord Clamping. He is also the founder of KidGlyphs, a free iPhone app that provides a tool for young children to express themselves beyond their verbal skills while teaching them important language skills.

Dr. Greene is the Founding President of the Society for Participatory Medicine and has served as both President and Board Chair of Hi-Ethics (Health Internet Ethics. He is on the Board of Directors for Healthy Child Healthy World, The Lunchbox Project, and The Society for Participatory Medicine. He has also served as an advisor to URAC for both their inaugural and their updated health web site accreditation program. He is a founding member of the e-Patient Scholars Working Group, and a founding board member of the Center for Information Therapy.

Dr. Greene is a regular columnist for Parenting Magazine. He is also the Pediatric Expert for The People’s Pharmacy (as heard on NPR) and Healing Quest (seen on PBS stations). He was the original Pediatric Expert for both Yahoo! and iVillage.

Dr. Greene is the author of Feeding Baby Green (Wiley, 2009), Raising Baby Green (Wiley, 2007), From First Kicks to First Steps (McGraw-Hill, 2004), The Parent's Complete Guide to Ear Infections (People's Medical Society, 1997), and a co-author of The A.D.A.M. Illustrated Family Health Guide (A.D.A.M., Inc., 2004). He is the medical expert for three additional books, The Parent's Soup A-to-Z Guide to Your New Baby, (Contemporary Books, 1998) The Parent's Soup A-to-Z Guide to Your Toddler, (Contemporary Books, 1999), and The Mother of All Baby Books, (Hungry Minds, Inc., 2002).

Dr. Greene is a frequent keynote speaker at important events such as Health 2.0 2011 held in San Diego, CA, IFOAM 2008 (International Federation of Organic Agriculture Movements), held in Modena Italy, the first European Internet health conference, held in Maastricht, the first International eHealth Association Conference, held in Jeddah, and the largest e-Healthcare World Conference, held in Las Vegas, and the first Green Power Baby Shower, held in Hollywood. Dr. Greene also appears frequently on TV, radio, websites, and in newspapers and magazines around the world, including such venues as the TODAY Show, Good Morning America, Fox and Friends, The Dr. Oz Show, CNN, ABC, CBS, and NBC network news, NPR, The New York Times, The Wall Street Journal, USA Today, Time Magazine, Parade, Parenting, Child, Baby Talk, Working Mother, Better Home's & Gardens, and the Reader's Digest.

Dr. Greene loves to think about challenging ideas, he enjoys being where nothing manmade can be seen, and he wears green socks.

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