After an injury, your child may experience concussion symptoms, while signs are visible indicators of these symptoms. It’s a natural part of the healing process, with symptoms varying from person to person, potentially changing during recovery, and being most severe immediately after the injury, especially differing according to your child’s age.

• Symptoms are unique for each individual
• May fluctuate throughout the recovery process
• Most intense shortly after the injury (usually within 1 to 2 days)
• Varies depending on your child’s age

It is important to note that signs and symptoms may not manifest immediately and could take hours or even days to become apparent. Identifying a possible concussion might be challenging, especially in young children and those with disabilities who might struggle to communicate their feelings effectively: 34

As a parent or caregiver, you are familiar with what is normal for your child. Maintain regular monitoring to observe any changes in behavior or wellbeing. If symptoms worsen, ensure to inform their healthcare provider promptly.

Symptoms: What your child may experience or report after a concussion

Physical

• Sensitivity to light or noise
• Issues with balance or dizziness
• Feeling fatigued or lacking energy
• Headaches
• Early occurrence of nausea or vomiting
• Vision disturbances

Thinking and remembering

• Difficulty concentrating or paying attention
• Feeling slowed down
• Foggy or groggy sensations
• Memory problems, either short-term or long-term
• Trouble with clear thinking

Social or emotional

• Anxiety or nervousness
• Irritability or increased anger
• Heightened emotional state
• Feelings of sadness

Sleep

• Less sleep than usual
• Excessive sleep compared to normal patterns
• Difficulty falling asleep

Signs: What to watch for according to your child’s age

For Infants, toddlers, and pre-school aged children (birth to age 4)

• Increased irritability and crying
• Seeking more comfort, like needing to be held
• Refusal to nurse or eat
• Changes in sleeping patterns
• Reluctance to engage in play or usual activities
• Requiring more assistance than usual
• Behavioral changes, such as frequent temper tantrums
• Altered speech patterns, slower than usual
• Vomiting after injury without other explanation
• Appearing confused, clumsy, or unsteady on their feet

For School-aged children and adolescents (ages 5 to 17)

• Appearing confused or dazed about recent events
• Sudden difficulties with memory or concentration
• Delayed responses to questions
• Clumsiness or unsteadiness
• Vomiting post-injury without other reasons
• Slowed reaction times
• Changes in mood, behavior, or personality

Concussion danger signs

If you suspect someone has a concussion but their symptoms do not require immediate A&E attention, you should:

• Prevent them from participating in any sports activities
• Have a responsible adult supervise them for 72 hours
• Restrict their driving or operation of heavy machinery
• Avoid alcohol consumption or recreational drug use
• Encourage them to rest and avoid activities that may worsen their symptoms
• Monitor for any worsening symptoms such as severe headache, repeated vomiting, seizures, or difficulty waking up
• If any of these danger signs are present, seek medical attention immediately

It is important to monitor the individual for any worsening symptoms, such as increasing confusion, persistent headaches, repeated vomiting, slurred speech, weakness or numbness in extremities, or seizures. If any of these symptoms occur, seek immediate medical attention.

It is also recommended to avoid giving the individual any medications, unless prescribed by a healthcare professional, as certain medications can potentially worsen a head injury.

Additionally, it is crucial to provide a calm and supportive environment for the individual to aid in their recovery process. Encourage them to rest, both physically and mentally, and ensure they are well-hydrated and well-nourished.

Following a concussion, it is common for individuals to experience symptoms such as irritability, difficulty concentrating, and sensitivity to light and noise. These symptoms usually improve over time, but if they persist or worsen, consult a healthcare provider for further evaluation and management.

Diagnosing concussion

There is no definitive test for diagnosing concussions. Seek medical advice if a head injury is suspected. Concussion diagnosis is typically made after ruling out other potential injuries.

If there is suspicion of a concussion but the individual has not received medical attention, treat them as if they have a concussion and follow the recovery plan. Contact NHS 24 at 111 for further instructions.

Do not make a concussion diagnosis without consulting a healthcare professional. If a concussion is suspected, manage it accordingly.

Recovery from concussion

During the recovery phase, emphasize rest, abstain from alcohol and drugs, and focus on proper nutrition. Headaches can be alleviated with paracetamol. Follow a gradual return to activity and sport (GRAS) plan for a safe recovery.

GRAS recovery plan

The GRAS recovery plan involves incrementally increasing activity levels over time. Recovery duration varies, with certain factors potentially extending the recovery period, such as age or previous concussions.

The minimum recovery period before resuming normal activities and sports is 21 days.

The GRAS plan consists of 6 stages, each involving light physical activity. Progress to the next stage if current activities do not worsen symptoms. In case of symptom aggravation, remain at the current stage and consult medical professionals.

Stage 1

Following the injury, it is advisable to rest for 24 to 48 hours and engage in gentle activities while limiting screen time. Minimize exposure to screens, including TVs, computers, and smartphones.

Stage 2

Stage 2 entails gradually reintroducing normal daily activities and increasing physical activities at home. Spend more time on screens, engage in reading, and play games.

Stage 3

During stage 3, individuals can begin activities requiring more mental effort, such as some schoolwork or home tasks with breaks. Longer and gentle activities, like extended walks, can also be initiated. Stage 4 allows for a return to school, work, exercising, and sports training, ensuring there is no risk of sustaining another head injury. Progressing to stage 5 permits a full resumption of regular life and complete sports training, including competitive sports activities, after being symptom-free for 14 days.

It is crucial to acknowledge the potential complications of poorly managed concussions, which can impact work and sports performance. Adhering to the 6-stage recovery process for at least 21 days is essential. Continuing to engage in activities with a concussion raises the risk of further injury, potentially leading to muscle or joint issues. In rare instances, second-impact syndrome may occur from consecutive concussions in close proximity, with fatal consequences possible.

Repeat or prolonged concussions can have enduring effects on daily life, including work, social interactions, and mental wellbeing. Some individuals may encounter post-concussion syndrome lasting beyond 28 days. Mismanaged concussions have been linked to conditions like dementia and chronic traumatic encephalopathy (CTE), underscoring the significance of careful management.

Nationwide Children’s Concussion Center is a prominent facility specializing in concussion management, providing education on concussion awareness for young athletes. Recognizing the severity of concussions is crucial as they disrupt normal brain function, with all concussions considered serious brain injuries. Monitoring concussion indicators and responding appropriately can help prevent severe outcomes.

Despite the seriousness of concussions in young athletes, underreporting is common, underscoring the importance of honesty in symptom reporting. Post-concussion, children should avoid activities with head impact risks. Monitoring and adhering to specific post-concussion guidelines are vital for recovery.

Concussion recovery necessitates a collaborative approach involving educators, coaches, and healthcare providers. Resting the brain from demanding cognitive tasks and activities post-concussion can aid in recovery. Limiting mentally taxing activities, such as using computers or driving, particularly in the initial 24-48 hours, can accelerate healing. Academic adjustments may be required for students recuperating from concussions to manage symptoms and facilitate learning.

Why Is Physical Activity Important to Recovery?

Engage in light physical activity within the first week post-injury to enhance recovery. Prevent physical deterioration and alleviate concussion symptoms by identifying suitable types and amounts of exercise that do not exacerbate symptoms significantly. Begin with walking and progress to more strenuous exercises as tolerated. Avoid activities posing a risk of another head impact until cleared by a healthcare professional.

When Can a Child Who Has Sustained a Concussion Safely Go back To Participating in Gym Class And/or Sports?

It is important for a child who has suffered a concussion not to engage in activities that could result in head impacts until they have been given the all-clear by a healthcare professional. The child should be symptom-free and fully involved in school before returning to such activities. Various tests, such as balance and neurocognitive assessments, may be used to assess their recovery progress. Once given the green light, the child can begin following the Return To Sport plan outlined below, preferably under the supervision of a certified athletic trainer.

Each stage of the plan should be completed in a minimum of 24 hours, so it will take at least a week to go through the entire protocol unless symptoms reappear. If symptoms worsen or return at any point, the progression should be paused and resumed the following day.

An example of this plan is based on the recommendations of the Amsterdam Consensus Statement on Concussion in Sport.

Graduated Return to Sport (RTS) Strategy

Steps 1-3 should be initiated while the child is still experiencing symptoms as part of the concussion treatment. Steps 4-6, however, should only be started once the symptoms have disappeared, along with any related cognitive or clinical issues, even when under exertion.