Signs of Concussion in a Child

Sports are the cornerstones of many communities. As the air crisps and cools, fall soccer season brings friends and family together in support of their home teams. Children get together to train and compete in the spirit of teamwork. Refs don their whistles and parents slice oranges.

But while it gives fans and athletes alike plenty to celebrate, soccer — like football, ice hockey, basketball, and many other sports — poses a risk to children who play it: concussions.

Daniel Daneshvar, MD, PhD, a Mass General Brigham brain injury specialist, is an expert in concussion care. In this article, Dr. Daneshvar shares insights into the signs and symptoms of concussions in children, as well as how to treat them.

Dr. Daneshvar is co-director of Sports Concussion at Mass General Brigham and sees patients at Spaulding Rehabilitation.

What are concussions?

“Concussions are a common form of brain injury that can happen in a variety of scenarios, including during a fall, in an accident, or while playing sports,” explains Dr. Daneshvar.

They can happen when a person is hit directly in the head, or when another kind of injury causes a rapid movement to the head.

What are signs and symptoms of concussion in kids?

Dr. Daneshvar explains that concussion symptoms include:

• Loss of memory and/or consciousness (these are rare and aren’t required for a diagnosis)
• Headache (most common)
• Dizziness, light headedness, and/or problems with balance
• Visual problems (blurry or double vision) or sensitivity to light
• Feeling confused, difficulty concentrating, and/or sense of being foggy
• Problem with affect (the way your child expresses their emotions)
• Sleeping more or less than usual, trouble falling asleep, or feeling tired

Concussion symptoms may not appear right away after your child hits their head — in some cases, it can take up to 48 hours for symptoms to present. So if you believe your child may have a concussion, keep an eye on their behavior for a couple of days following the event.

Other signs of concussion in toddlers and infants

In very young children, such as toddlers and infants, you also may notice that your child:

• Cannot stop crying and cannot be soothed
• Seeks comfort and wants to be held more than usual
• Sleeps more or less than usual
• Won’t eat or chestfeed
• Doesn’t want to play or engage in usual activities
• Needs more help than usual

Can a concussion cause a fever in a child?

Yes — concussions and other head injuries can cause fever. Typically, fever is a short-term symptom of concussion if it occurs at all.

When to go to the ER for concussion

You typically don’t need to seek emergency care for a concussion. However, it's important to watch for warning signs of a more serious brain injury if your child hit their head.

Call 9-1-1 or go to the nearest emergency room if your child experiences:

• Loss of consciousness
• Seizures or convulsions
• Headache that worsens and persists over time
• Repeated vomiting and extreme nausea
• Persistent unusual behavior, like increased confusion, restlessness, or agitation
• Slurred speech, weakness, numbness, or less coordination
• Double vision, or one pupil becomes larger than the other
• Increased sleepiness with the inability to wake up or stay awake

How long does a concussion last in a child?

 “With proper recognition and treatment, most people recover quickly,” says Dr. Daneshvar. “Even if they’re treated somewhat later on, they can improve significantly within a week or two.”

Most children will start feeling better within a week after their injury. For some children, concussion symptoms can last a month or more. If you don’t see an improvement in your child’s symptoms over time, contact their health care provider.

Persisting symptoms after concussion

When symptoms last longer than 3 to 4 weeks, children may need additional specialized care for these persistent symptoms.

In addition to regular concussion symptoms, children with persistent symptoms may also experience:

• Anxiety or depression
• Irritability
• Trouble concentrating

Although researchers do not know why concussion symptoms persist for some people but not others, it appears more often in people with a history of:

• Anxiety or depression
• Migraine headaches
• Learning disabilities, such as attention deficit/hyperactivity disorder (ADD or ADHD)

Doctors manage persisting symptoms after a concussion based on symptom prevalence, severity, duration, and clinical exam. There is no standardized treatment for patients with these symptoms, so it’s important to see a specialized health care provider.

What to do if you suspect your child has a concussion

“If you think your child has a concussion, it’s important to report it quickly, so they can get early, focused treatment,” says Dr. Daneshvar. Recent studies on young athletes have shown that intervention within the first week leads to faster recovery times. So, if you believe your child has a concussion, it’s important to seek medical care as soon as possible to address the injury, rule out more serious ones, and recover more quickly.

In the meantime, remove your child from the situation where they were hurt and into a safe environment. “When in doubt, sit it out,” Dr. Daneshvar says. “If your child keeps playing with a headache after a concussive event, it can be dangerous in many ways and prolong long-term recovery.”

How to treat a concussion in a child

When managing a concussion, safety comes first. “Allow your child to sleep when they need it, but don’t overdo it. They don’t need to rest all day and stay in a dark room,” says Dr. Daneshvar.

Other important ways to treat concussion include:

• Staying hydrated. Drinking water helps your child’s brain heal. If your child finds it hard to drink water regularly, try drinking fruit water by infusing orange, lemon, cucumber, or pineapple.
• Prioritizing sleep. Sleep is important. You can set your child up for a good night’s sleep by developing a bedtime routine and avoiding caffeine (and other stimulants) close to bedtime. Consult your health care provider if your child has trouble sleeping.
• Eating healthy. Feed your child a balanced diet to support their brain health. Foods with healthy fats, such as nuts and avocado; lean proteins, like tofu, eggs, beans, fish, or chicken; whole grains; and plenty of fruits and vegetables give your child’s body the nutrients they need to recover.
• Symptom-limited light aerobic activity. Following a brief period of relative rest early on, Dr. Daneshvar recommends slowly reintroducing activity under medical supervision to improve outcomes.

Can you sleep with a concussion?

Yes — if your child has a concussion, let them sleep as usual and rest when they need it.

Many parents wonder, “Should you let a child with concussion sleep?” or “Should I wake my child up after a concussion?” It’s a common myth that you should keep your child awake if they injure their head. Rest is crucial for helping your child heal from a concussion. There's no need to wake them up unless their doctor tells you to.

If your child has trouble sleeping, check with their doctor before giving them any medication. Consult with their doctor if you notice any concerning symptoms.

Concussion and screen time

Many parents also wonder: is screen time OK after a concussion?

In the immediate time after the concussion occurs, reducing and regulating screen time may help your child recover faster. Dr. Daneshvar explains that continuous texting, phone use, or graphics can be harmful to people with concussions — certainly within the first 48 hours. During this time, encourage your child to rest their eyes and find safe, fun ways to pass the time. These may include drawing, spending time with friends, playing a quiet game, doing a craft, or enjoying a bath.

When your child does eventually return to screen use, try to make the transition gradual and encourage them to take breaks if the activity brings back or worsens symptoms.

Mass General Brigham concussion research and prioritizing post-concussion care

Dr. Daneshvar and other Mass General Brigham colleagues continue to advance their understanding of concussion treatment and diagnosis, so they can provide the best care for patients.

One recent study co-led by Dr. Daneshvar identified a new concussion sign to watch for in athletes, called SHAAKE. It stands for ‘Spontaneous Headshake After a Kinematic Event,’ when a person quickly shakes their head back and forth after hitting it. While the study didn’t include children, it’s an important step in recognizing any possible signs of concussion so you can seek treatment as quickly as possible.

No one wants to see their child hurt. And while you can’t prevent every injury that might come your child’s way, there’s much you can do to help them heal. With good rest, hydration, and by avoiding screens, your child can be on their way back to their favorite sport.