Pediatric Concussion -Diagnosis and Management

The diagnosis and management of concussion is one of the most challenging treatment plans in pediatrics.  As a result of conflicting health recommendations, many parents are confused about what constitutes a concussion, treatment modalities and return to play/school criteria.   I believe when families understand that a concussion is a brain injury caused by mechanical forces such as a direct hit to the head, face, neck or body they are able to identify situations that need evaluation by a pediatrician for further management.  Children that play contact sports may have a higher risk of concussion, however children can experience concussions at school, on the playground or at home.  The following questions will address practical concerns about pediatric concussion and management.

What is a concussion? 

• A concussion is a traumatic brain injury. Similar to a pulled ankle ligament, the body will need time to heal and recover. If you think your child has experienced a brain injury they must not return to play until they have been evaluated. Repetitive brain injuries close in time are dangerous.

What are the symptoms of concussion?

• A concussion typically has a rapid onset of:

  • confusion

  • disorientation

  • loss of balance

  • headache

  • fatigue

  • loss of consciousness

How is a concussion diagnosed?

• Concussion is a clinical diagnosis made by a physician based on the history and physical exam.

How is a concussion managed?

• Most concussions improve in 1-2 weeks. The process of healing will vary with each child/teen based on her symptoms. Patients with traumatic brain injury need to have physical and cognitive rest in order to allow time for the brain to recover from the injury. Neurology referrals may be indicated for patients with prolonged or atypical symptoms. Children with concussions are followed closely until they are able to resume their full activities.

• Headaches may be a predominant symptom for children that have experienced a concussion. Headaches can be managed with ibuprofen, acetaminophen, avoiding triggers such as noise, bright lights, concentrating and looking at screens. Headaches may also improve with relaxation and mindfulness techniques.

• Headaches, fatigue, and lack of concentration may improve with vitamin and nutrient supplementation that support energy at the cellular level. Mangesium, Riboflavin and Co-enzume Q10 may benefit some patients.