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Patient education: Concussion in children and teens (The Basics)

Patient education: Concussion in children and teens (The Basics)

What is a concussion? — 

This is a mild brain injury. It can cause confusion, memory loss, and headache.

A concussion can happen from a fall or other type of accident. But it can also happen in sports. Among older children and teens who play sports, concussion is one of the most common injuries:

Among boys, the sports most often linked to concussions are American football, ice hockey, and lacrosse.

Among girls, the sports most often linked to concussions are soccer, lacrosse, and field hockey.

If a child gets a concussion, it's very important they stop playing sports until the doctor says it's safe to start again. Sometimes, children might not be honest about their symptoms because they don't want to miss out on activities. So it's important to watch them closely for any problems that could be related to the concussion, like those listed below.

What are the symptoms of a concussion? — 

People used to think "passing out" or "blacking out" was an important feature of a concussion. But it is actually common to have a concussion without blacking out.

Symptoms that can happen immediately, or in the first minutes to hours after a concussion, include:

Memory loss – Children sometimes forget what caused their injury, as well as what happened right before and after the injury.

Confusion

Headache

Dizziness or trouble with balance

Nausea or vomiting

Feeling sleepy

Acting cranky, irritable, or strange

Some children recover quickly from a concussion and have no further symptoms. But others have symptoms that persist or happen hours to days after a concussion. These might include:

Trouble walking or talking

Memory problems or problems paying attention

Trouble sleeping

Mood or behavior changes

Vision changes

Being bothered by things like noise or light

Will my child need tests? — 

It depends on their injury and symptoms. To check if your child has a concussion, the doctor will ask about their symptoms and behavior, and do an exam. They will also ask your child questions to check if they are thinking clearly.

Children with a concussion do not need an imaging test. But if the doctor or nurse suspects a serious head injury, they might order a special kind of X-ray called a CT scan. This creates detailed pictures of the brain and skull.

If available, a test called an MRI can be done instead of a CT scan. An MRI takes longer and might require "sedation" for young children. This means they get medicines to make them very sleepy.

How is a concussion treated? — 

Your child should see a doctor who has experience treating concussions. This might be your child's regular doctor, or they might refer you to a different doctor.

Treatment involves:

Preventing further injury – Most concussions get better on their own. While your child is healing, it's important they don't do too much or play any organized sports. Having a second injury while the brain is healing from a concussion can seriously damage the brain. Even if your child seems fine, they should not go back to school or do organized sports until the doctor says it's OK.

Physical rest – Your child should rest for 24 to 48 hours. After that, they can slowly start to get back to regular activities. This includes light physical activity, as long as it doesn't make symptoms worse. Increasing activity gradually, as long as it doesn't cause symptoms, can actually help children get better faster than only rest. Your child should continue to avoid contact sports, or other sports that could cause a head injury, until they have completely recovered.

Mental rest, also called "cognitive" rest – This means avoiding things that make symptoms worse. Examples might include reading, playing video games, or using a smartphone, tablet, or computer. The child can gradually start doing these things again as they feel ready. But they should take a break again if their symptoms come back or get worse.

Most children can go back to school after 1 to 2 days of rest. Your child's doctor will help you decide when your child can return to school. In general, this is when they can stay focused and concentrate for at least 30 to 45 minutes at a time. Missing more than 5 days of school is usually not recommended.

Treating symptoms – In addition to rest, there are ways to help relieve your child's symptoms. For example:

Headache – If your child has a headache, their doctor might suggest they take an over-the-counter pain medicine. These include acetaminophen (sample brand name: Tylenol) and NSAIDs such as ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand name: Aleve). These medicines should only be used for a few days. Never give aspirin to a child younger than 18 years old.

Nausea – Your child's doctor can prescribe medicine to help with nausea. This medicine should only be used for 1 to 2 days after injury. In some cases, it can make other symptoms worse.

Sleep problems – After a concussion, some children have trouble falling or staying asleep. This can lead to feeling tired during the day. The best way to treat this is to follow good "sleep hygiene." This involves going to bed and getting up at the same time each day. It also means removing things from the bedroom that make it harder to fall asleep, such as light, noise, and screens. You can help your child by creating a relaxing bedtime routine to follow each night.

If your child still has symptoms after 3 or 4 weeks, they might need additional treatment. Along with a doctor who has experience treating concussions, your child might need to see other specialists, too. These include a physical therapist (exercise expert) and a person who is an expert on the brain and behavior.

When can my child return to sports and other activities? — 

Ask your child's doctor. It depends on your child's injury and symptoms, as well as the sports your child plays. Most children are back to normal within 4 weeks.

Do not rush it. Your child's brain needs to heal completely after a concussion. If your child gets another concussion before their brain has healed, it could lead to serious brain problems.

When your child does return to their usual activities, they might need to slowly ease into them. That might mean going for a half-day at school, or doing less schoolwork at first. The same goes for going back to sports. They might need to start with just light jogging and slowly add in other activities.

When should I call for help? — 

Call for an ambulance (in the US and Canada, call 9-1-1) if your child:

Cannot be fully woken up

Is acting confused or disoriented

Has a sudden and persistent change in behavior

Cannot walk normally

Has trouble speaking or slurred speech

Has severe weakness or cannot move an arm, leg, or 1 side of their face

Has a seizure, or jerking of their arms or legs they cannot control

Call their doctor or nurse for advice if your child:

Has concussion symptoms that are not improving or are getting worse, even with physical and mental rest

Has blood or clear liquid draining from their ears or nose

Seems weak or has numbness in an arm, leg, or other body part

Has a stiff neck

Has a headache that is severe, gets worse, feels different, or does not get better with over-the-counter medicines

If any of the above symptoms seem severe, or if you are concerned about your child but cannot reach the doctor or nurse, seek emergency help. These things don't always mean there is a serious problem, but seeing a doctor or nurse is the only way to know for sure.

More on this topic

Patient education: Head injury in children and teens (The Basics)
Patient education: Head injury in babies and children under 2 years (The Basics)
Patient education: Head injury observation in children (The Basics)
Patient education: Moderate to severe traumatic brain injury (The Basics)
Patient education: Headaches in children (The Basics)
Patient education: Postconcussion syndrome (The Basics)
Patient education: Good sleep hygiene (The Basics)

Patient education: Head injury in children and adolescents (Beyond the Basics)
Patient education: Headache in children (Beyond the Basics)

This topic retrieved from UpToDate on: May 11, 2025.
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