Concussion in children: What are the symptoms?

Most sports-related head injuries that can occur from a direct blow to the head, face or body are mild and result in complete recovery. The term concussion refers to a mild traumatic brain injury that can be sports related and can interfere with the way the brain works for a short period of time.

Symptoms of a concussion may include:

• Headache or a feeling of pressure in the head.
• Nausea or vomiting.
• Balance problems or dizziness.
• Double or blurry vision.
• Sensitivity to light or noise.
• Feeling fatigued, sluggish, groggy or dazed.
• Trouble paying attention.
• Memory problems.
• Confusion.
• Being slow to understand and respond to others.
• Sleeping problems.
• Mood changes and irritability.
• Changes in behavior.
• Changes in personality.

If there's any suspicion of a concussion, it's best not to return to play until symptoms improve. In other words, "If in doubt, sit it out." Children can have a concussion without losing consciousness. Also, a blow to the body that jars the head can result in a concussion. Make sure your child's coach knows if your child has had a concussion.

Head injuries take time to heal. After a concussion, children need to rest from both physical and mental activities for a day or two. They can return to activities gradually as their symptoms allow. If activities such as reading or brisk walking cause symptoms, such as a headache, they need to take a break. Later they may resume the activity for shorter periods. As symptoms improve, the children can gradually return to their activity levels before the concussion. A gradual return to learning and physical activity is key.

Common concussion symptoms can include:

• Trouble with thinking skills, such as memory and attention.
• Dizziness.
• Fatigue.
• Headaches.
• Irritability.
• Sleeping more or less than usual.

In rare cases, what is at first thought to be a concussion turns out to be a more severe brain injury with bleeding in or around the brain. Such bleeding can increase pressure on the brain and can be life-threatening.

If your child develops any of the following symptoms after a head injury, seek medical care right away.

• Behavior changes such as agitation, confusion or restlessness.
• Seizures.
• Not being able to recognize people or places.
• Loss of consciousness.
• One pupil that is larger than the other.
• Slurred speech.
• Unusual behavior.
• Being very drowsy or not being able to be woken from sleep.
• Vomiting.
• Crying that won't stop.

When returning to school after a concussion, your child may require classroom or workload adjustments. This may include a lighter course load, additional time for assignments or a shortened school day. When returning to physical activity after a concussion, your child needs to start exercising at low levels. Then your child can advance to more strenuous physical activity as symptoms allow. Don't allow your child to return to play until cleared by a health care professional. If participating in sports, follow a "return to play" plan guided by your child's symptoms. Formal return-to-sport plans are recommended.

Children might develop complications or delay healing if they have another injury before a concussion has healed. Another blow to the head while a concussion is healing can result in longer lasting or worse symptoms.

Researchers continue to study other potential long-term effects of concussions. Having one concussion puts children at higher risk of having another. The effects of repeat concussions over years can multiply.

Persistent post-concussive symptoms last longer than the usual recovery period. This is also known as post-concussion syndrome. It's not clear why some people develop this syndrome and others don't, though some risk factors have been identified. Some research suggests that having repeat concussions might increase the risk of persistent post-concussive symptoms.

To protect your child from head injuries, insist on appropriate and properly fitted protective equipment. This includes wearing a helmet during sports and other activities. However, even the best protective equipment can't prevent all concussions.

If you think your child has a concussion, seek medical care. A health care professional can determine the seriousness of the injury. The health professional also can determine when it's safe for your child to return to sports, school or other activities.