Concussions

What Is a Concussion?

A concussion is a type of mild traumatic brain injury (or mild TBI). It happens when a blow to the head or an injury makes the head move back and forth with a lot of force. This causes chemical changes in the brain and sometimes damage to the brain cells. 

Kids and teens who follow their health care provider's recommendations usually feel better within a few weeks of the concussion.

What Are the Signs & Symptoms of a Concussion?

Someone with a concussion might be knocked out (this is called a loss of consciousness). But a person doesn't have to get knocked out to have a concussion.

Signs and symptoms of a concussion include:

• headache
• blurred or double vision
• dizziness, balance problems, or trouble walking
• confusion and saying things that don't make sense
• being slow to answer questions
• slurred speech
• nausea or vomiting
• not remembering what happened
• not feeling well

Symptoms of a concussion usually happen right away, but can show up hours or days after an injury. A teen with a concussion may:

• have trouble focusing
• have learning or memory problems
• have a headache that gets worse
• have sleep problems
• feel sad, easily upset or angered, or nervous 

If your child has been diagnosed with a concussion, call your health care provider or go to the ER if your child:

• has a severe headache or one that gets worse
• has a seizure
• passes out
• has other symptoms (such as continued vomiting) that worry you

These could be signs of a serious concussion, and your child might need treatment in a hospital.

What Happens in a Concussion?

The skull helps protect the brain from injury. Spinal fluid cushions the brain inside the skull. A blow or jolt to the head can hurt the brain directly or make the brain move around and bang up against the hard bone of the skull. This changes the signals between nerves, which causes concussion symptoms.

How Do Kids and Teens Get Concussions?

Most concussions in kids and teens happen while playing sports. The risk is highest for kids who play football, ice hockey, lacrosse, soccer, and field hockey.

Concussions also can happen from:

• car or bicycle accidents
• a fight
• a fall

How Are Concussions Diagnosed?

To diagnose a concussion, the health care provider will:

• ask about how and when the head injury happened
• ask about symptoms
• test memory and concentration
• do a physical exam and test balance, coordination, and reflexes

If a head injury happens while someone is playing sports, a coach or athletic trainer may do sideline concussion testing. This is when a trained person does a few simple tests after a head injury to help decide if the athlete needs immediate medical care. An athlete who has a head injury must stop playing and see a doctor before returning to play.

Many schools or sports leagues use baseline concussion tests. Baseline testing uses computer programs to test a player's normal brain function. It checks attention, memory, and speed of thinking. Doctors compare testing after an injury with baseline results to see how someone is recovering.

Concussions do not show up on a CAT scan or MRI. So, the doctor may not order a brain scan for a mild concussion. A CAT scan or MRI might be done to look for other problems if someone:

• was knocked out
• keeps vomiting
• has a severe headache or a headache that gets worse
• was injured in serious accident, such as from a car accident or very high fall

How Are Mild Concussions Treated?

Each person with a concussion heals at their own pace. It's important to find a balance between doing too much and too little.

At first, your child needs to cut back on physical activities and those that require a lot of concentration. Then, he or she can start trying these activities again. Symptoms don't have to be completely gone for your child to add activities. But if symptoms interfere with an activity, your child should take a break from it. He or she can try it again after a few minutes or longer, or try a less strenuous version of the activity.

Help your child follow these steps:

Rest (for 1–2 days after the concussion)

• Have your child relax at home. Calm activities such as talking to family and friends, reading, drawing, coloring, or playing a quiet game are OK. If symptoms interfere with an activity, your child should take a break from it. He or she can try it again after a few minutes or longer, or try a less strenuous version of the activity.
• Your child should avoid or cut down on screen time. Video games, texting, watching TV, and using social media are likely to cause symptoms or make them worse.
• Don't let your teen drive.
• Be sure your child avoids all sports and any activities (such as roughhousing with friends, or riding a bike or skateboard) that could lead to another head injury. 
• Help your child get plenty of sleep. He or she should:
  • Keep regular sleep and wake times.
  • Avoid screen time or listening to loud music before bed.
  • Avoid caffeine.
  • Nap during the day, as needed.
• For the first few days after the injury, if your child has a headache and your health care provider says it's OK, your child can take acetaminophen (Tylenol® or a store brand) or ibuprofen (Advil®, Motrin®, or a store brand).

Light Activity (usually within a few days to a week after the concussion)

• Your child can slowly try more activities, such as going for a walk or watching TV. If symptoms interfere with an activity, your child should take a break from it. He or she can try it again after a few minutes or longer, or try a less strenuous version of the activity.
• After a few days, your child should feel well enough to return to school. Work with your health care provider and a school team to create a plan for returning to school. Your child may need to start with a shorter day or a lighter workload. If your child is not back in school by 5 days after the concussion, call your health care provider.
• If your teen drives, ask your health care provider when your teen can start to drive again.
• Be sure your child continues to avoid all sports and any activities that could lead to another head injury.
• Make sure your child continues to get plenty of sleep each night. If your child doesn't feel tired during the day, he or she doesn't need to nap.
• If your child still needs medicine for headaches, talk to your health care provider.

Moderate Activity (usually about a week after the concussion)

• If symptoms are nearly gone, your child can go back to most activities, including regular schedules for school and work.
• Be sure your child continues to avoid all sports and any activities that could lead to another head injury.
• If symptoms interfere with an activity, your child should take a break from it. He or she can try it again after a few minutes or longer, or try a less strenuous version of the activity.

Regular Activity (a month or more after the concussion)

• If all concussion symptoms are gone, your child can go back to all activities, except sports.
• For sports, your health care provider will work with your child's coach and athletic trainer (if available) to create a clear, written plan for a gradual return to play. Don't let your child go back to playing sports until your health care provider says it's OK.

When Can Teens Go Back to Sports After a Concussion?

Student athletes must wait until their health care provider says it's safe before returning to sports. This means that they:

• have had a physical exam
• are back in school
• have no symptoms
• aren't taking any medicines for concussion symptoms
• are back to their baseline results on physical and cognitive testing

Hurrying back to sports and other physical activities puts teens at risk for second-impact syndrome. This is when someone gets another head injury before the concussion has healed. Although very rare, second-impact syndrome can cause lasting brain damage and even death. Almost every state has rules about when teens with concussions can start playing sports again.

Looking Ahead

People are much more likely to get a concussion if they've had one before. So preventing concussions is very important after a head injury. To prevent another concussion:

• Be sure that any teams your child is on has rules to reduce the risk of concussions, such as limits on tackling (football) or heading the ball (soccer).
• Be sure your child wears a helmet for skiing, snowboarding, biking, riding a scooter, skateboarding, or rollerblading. A concussion can still happen while wearing a helmet, but the helmet can protect your child from a skull fracture and serious brain injury.
• Kids who get another head injury should never ignore symptoms or try to "tough it out." They need to stop the sport or activity they are doing and get medical care right away.