Medically reviewed
Patient Instructions/Care Plan Information
If you have any other questions about concussions or the management we discussed today, please let me know. Attached is a detailed care plan that includes more information about concussions as well as things you can do to help your child start feeling better. If your child has worsening vomiting or headache, seizure, or unusual behavior please take them to the ER for further evaluation. I hope your child feels better soon and thanks for using us!
What is a concussion?
A concussion is a term used to describe the signs and symptoms associated with mild head trauma. Concussions usually result from a direct blow to the head or face. In some cases it may involve loss of consciousness and a range of other symptoms that vary in severity and duration.
Common symptoms of a concussion include:
- Headache
- Confusion or disorientation; blank stare or “stunned” appearance
- Memory issues, forgetfulness, absent-mindedness
- Slow or incoherent speech
- Dizziness or vomiting
- Gait abnormalities or imbalance
- Emotional lability (extreme mood swings that are out-of-character e.g. uncontrollable laughing or crying, extreme irritability).
How are concussions diagnosed?
The diagnosis of concussion consists of first excluding brain damage and other potential diagnoses. Once brain damage has been excluded, a thorough medical history and physical exam is performed, using standard assessment scales.
Rule-out diagnosis
The first step is to rule out more serious head trauma like brain damage or bleeding by looking at the following:
- How the injury happened
- Whether there was loss of consciousness and if so, the duration of it
- Signs of fracture in the skull
- Mental and cognitive function
- The severity of symptoms like headache and vomiting
- Any signs of amnesia (a form of memory loss)
- Balance and vision
→ Children who are deemed to be at high or moderate risk usually go to the ER to have head imaging done and/or be observed for a prescribed amount of time.
→ Children, who are at low risk (or when brain damage/bleeding has been excluded) can be evaluated for concussion with a thorough medical history and physical exam.
Generally, if there was a head trauma or blow to another part of the body that resulted in rapid acceleration of the brain, and if the symptoms started soon after injury, the head trauma will get a ‘concussion’ diagnosis.
Note: Symptoms of concussion may be subtle and barely noticeable. A child might even be able to hide them. Nevertheless, playing it safe and identifying even minor concussions helps avoid serious brain injury that can result from additional head trauma before complete recovery.
Recommended treatment
Managing a concussion effectively includes the following:
Prevention of further injury – a concussed child should not participate in sports until full recovery. Similarly, recreational activities that might involve a risk for further head injury must be avoided
Physical rest – ensure your child goes to bed on time and takes naps when needed. A concussed child needs complete rest for 24-48 hours followed by a gradual return to activity. If symptoms recur with mild activity, ensure they return to rest until the next day.
Note: strict rest after 48 hours should be avoided as this might actually prolong recovery.
Cognitive rest – limit any activity that requires a lot of concentration or thinking, including school, tests, homework, reading, screentime, and even socializing.
*Children with clear concussion symptoms need 2-3 days off school. Children with fewer (or less severe) symptoms may only need 1 day, but must still be monitored carefully (see more info on returning to school below).
Nutrition – ensure your child drinks plenty of fluids and eats plenty of carbohydrates and proteins.
Symptom management
- Headaches – can be managed with tylenol or ibuprofen (do not use them for prolonged periods).
- Nausea – in some cases anti-nausea medication may be recommended (but should always be used sparingly and for short periods, specifically to address an inability to eat or drink)
- Sleep – short courses of melatonin may be recommended in some cases, but should always be discussed with a clinician first.
Expected recovery times
Most concussion symptoms noticeably improve with proper management within 7-10 days, but can last as long as 3-4 weeks. Prolonged symptoms or recurrent concussions require further evaluation with a concussion specialist.
Note: slower recovery times can be expected for children with a history of previous concussions or those suffering from chronic headaches (e.g.migraines), learning disabilities, ADHD, anxiety, depression, or another psychiatric disorder.
Gradual return to daily activities
School:
Once your child returns to school after the appropriate amount of rest:
- Notify teachers of the injury and advise that work load must be reduced and help with assignments might be required.
- Inform school personnel about the condition and ask them to be on the lookout for new issues concerning focus, attention, memory, and processing new information; increased difficulty completing tasks; mood swings, irritability, susceptibility to stress, or worsening symptoms.
Sports/play:
While still having symptoms, all physical activity must be strictly avoided. School personnel should always be made aware of the injury once your child returns to school to ensure they don’t partake in sports or any other strenuous physical activity. Return to sports/play should only commence once the child is symptom-free.
Fully returning to play or sports should be gradual and takes at least 5-7 days following the steps below.
- No physical activity.
- Low levels of physical activity e.g. walking (and where relevant – light jogging, light stationary biking, light weight-lifting).
- Moderate levels of physical activity involving body/head movement (e.g. moderate jogging, brief running, moderate-intensity stationary biking and weight-lifting.
- Heavy non-contact physical activity (e.g. regular running, stationary biking, and weight lifting – so long as there is no contact or risk of injury.
- Full contact in a controlled practice setting.
- Full contact in game play.
If at any point during these steps symptoms return, the child should rest and return to step 1.
Monitor your child’s symptoms and seek immediate care If
If symptoms worsen, or if your child starts experiencing any of the following concerning symptoms
- Worsening headache
- Seizures
- Neck pain
- Unusual behavior
- Extreme drowsiness/sleepiness
- Increasing confusion
- Recurrent vomiting
- Slurred speech
- Loss of consciousness
