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Concussion in children and adolescents

Brain and nervous system
Children and teenagers

The content on this page has been translated using Artificial Intelligence (AI). If there are discrepancies in meaning between the English and Icelandic versions, the Icelandic version is the authoritative version.

The brain is well-protected within the skull, surrounded by cerebrospinal fluid that dampens impacts and equalizes pressure. Minor head injuries don't cause permanent damage, but a severe blow can lead to direct brain injury. The extent of the injury depends on the nature and force of the impact.

Causes of Concussion

The brain is well-protected within the skull, surrounded by cerebrospinal fluid that dampens impacts and equalizes pressure. Minor head injuries don't cause permanent damage, but a severe blow can lead to direct brain injury. The extent of the injury depends on the nature and force of the impact.

Causes of concussion:

  • Falls and blows

  • Car accidents

  • Cycling accidents

  • Sports injuries and collisions

Definition of Concussion and Symptoms

A concussion is caused by a direct impact to the head, face, neck, or indirectly to other body parts. The impact causes a temporary disruption of brain function, and symptoms can last from a few hours to several days, or even longer. Loss of consciousness may occur but isn't always present. Concussion symptoms can be physical, emotional, and/or cognitive, and sleep disturbances may be noticed.

  • Physical symptoms: Headache, visual disturbances, nausea, dizziness, sensitivity to sound and light.

  • Emotional symptoms: Mood swings, depression, anxiety, irritability.

  • Cognitive symptoms: Difficulty concentrating, memory problems (children may not remember the accident itself or events immediately before or after), slowed thinking, fatigue.

Diagnosis in the Emergency Department

A medical history and physical examination, with a special focus on brain function, are usually sufficient for diagnosis. It's important to get precise information about the accident from the child/adolescent, relatives, or witnesses. Most are discharged home the same day with recommendations if there's no indication of a severe head injury. Imaging studies like CT scans and MRIs of the brain are only performed if a more serious head injury is suspected.

Treatment

The most important treatment is to rest both mind and body. Most individuals recover completely within 7-10 days. While the brain is recovering from a concussion, it's crucial to avoid physical education and sports activities, as another head injury following a concussion can have severe consequences. It's advisable to take 3 days off from school.

Resting the Mind

  • Take it easy and stay well-hydrated.

  • Limit video games, TV watching, social media, mobile phone use, visits, and loud music.

  • School accommodation in consultation with teachers is important. It's good to start with a half school day for the first few days and skip or postpone important assignments and exams for now.

Resting the Body

Only when the child/adolescent can tolerate a full school day without problems should physical education and sports activities be allowed with a gradual increase in participation. Each stage takes one day.

  • Stage 1: Light exercise - Walking, swimming, stationary cycling.

  • Stage 2: Light sports activities - Jogging, no jumping or sudden movements.

  • Stage 3: Light sports activities without contact - Team sports, passing and dribbling a ball but no heading. Strength training.

  • Stage 4: Light sports activities with contact - Full participation in physical education and practice.

  • Stage 5: No restrictions - Full participation in sports and competition.

Each stage takes one day. If the child/adolescent can tolerate the physical activity involved in a given stage, they are ready for the next stage. If it doesn't go well, they need to rest for 24 hours and go back one stage.

Special instructions for participation in team sports (contact sports) for recurrent concussions:

  • Three months' rest if anything abnormal is seen on brain imaging.

  • Six months' rest for a recurrent concussion within three months.

  • One year's rest if a child/adolescent gets a concussion three or more times in one year.

  • Consider stopping participation in team sports (contact sports) if a child/adolescent gets a concussion three or more times in one year with chronic symptoms.

What to Monitor at Home?

If any of these symptoms appear, you need to contact a doctor or the Children's Hospital at phone: 543 1000

  • Headache, severe or worsening.

  • Severe nausea or vomiting.

  • Deep sleep, making it difficult to wake the child/adolescent.

  • Confusion, the child/adolescent is disoriented to place and time.

  • Amnesia.

  • Visual disturbances.

  • Sluggish movements.

  • The child/adolescent loses bladder or bowel control.

  • Clear or bloody fluid leaking from ears or nose.

  • Unequal pupils.

  • Loss of consciousness.

  • Seizures.

Concussion can be prevented by:

  • Always wearing helmets that fit properly when the child/adolescent cycles, skates, or skis.

  • Ensuring the child/adolescent knows traffic rules before being allowed into traffic.

  • Using car seats and/or booster seats according to the child's age and size.

  • Installing gates and barriers to prevent children from falling down stairs or out of windows.

About the Publication

  • Publisher: Landspítali. Women's and Children's Division. March 2019

  • Responsibility: Chief Physician and Head of Children's Emergency Department

References