Do I Need to Worry About Concussion?

By Dr. Angela Lumba-Brown, M.D.

Head injuries are common at all ages in childhood. Some are preventable with activity modification, some are impossible to prevent. Adopt a culture of care in your family by ensuring that children are properly supervised, restrained in vehicles and strollers at all times, wearing protective gear for their sport, engaging in age-appropriate activities, and understand the need to immediately notify an adult of an injury in themselves or others.

While most head injuries are mild, many result in mild traumatic brain injury (including concussion), and some result in more serious injury that will have significant effects. The symptoms of brain injury include headache, dizziness, irritability, loss of consciousness, problems seeing, problems walking, sleep disturbance, mood changes, difficulty concentrating, nausea and vomiting, to name a few. If your child has any severe or worsening symptoms, if you have serious concerns about their injury or behavior, or if they are an infant or have another serious medical problem — see a doctor right away.

Your doctor will want to interact with and examine your child. They may want to watch your child in the office or emergency department for several hours to understand if their symptoms are improving or worsening with time. In very few cases, your doctor may recommend tests to image your child’s brain like a CT or MRI. Contrary to recent reports in the news, there is no blood test to diagnose mild traumatic brain injury/concussion.

If your child is diagnosed with a mild traumatic brain injury/concussion, they will likely recover at home. Recent science supports children should rest at home if they need to for no more than 2–3 days, and then re-engage into their usual activity as they tolerate it.[i] While there is no limit on TV/screen time, recent literature supports only two hours of screen time in children regardless of injury.

Exercise is important for health, and returning to physical activity will support concussion recovery as long as it is approached in a safe way. This means that your child should avoid play that could put them at risk for re-injury such as contact sports, skateboarding, ice-skating or other activities in which the risk for falls is high. Your child’s doctor will monitor their recovery and let you know when they are ready to return to full activity.

Current science does not know what effects repeat head injuries may have on a person later in life. Science does not provide a specific cut off point for “safe” versus “unsafe” head injuries. Because of this, families need to make educated decisions supported by their doctor using the best evidence available (2018 CDC Guidelines for the Diagnosis and Management of Concussion Among Children), to determine what strategies for play are best for them.

Dr. Angela Lumba-Brown is Clinical Assistant Professor of Emergency Medicine and Pediatrics at Stanford University

[i]Lumba-Brown, A., Yeates, K. O., Sarmiento, K., Breiding, M. J., Haegerich, T. M., Gioia, G. A., . . . Timmons, S. D. (2018). Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children. JAMA Pediatr, e182853. doi:10.1001/jamapediatrics.2018.2853

Lumba-Brown, A., Yeates, K. O., Sarmiento, K., Breiding, M. J., Haegerich, T. M., Gioia, G. A., . . . Timmons, S. D. (2018). Diagnosis and Management of Mild Traumatic Brain Injury in Children: A Systematic Review. JAMA Pediatr, e182847. doi:10.1001/jamapediatrics.2018.2847

Lumba-Brown, A., Wright, D. W., Sarmiento, K., & Houry, D. (2018). Emergency Department Implementation of the Centers for Disease Control and Prevention Pediatric Mild Traumatic Brain Injury Guideline Recommendations. Ann Emerg Med. doi:10.1016/j.annemergmed.2018.03.045