Concussion Prevention & Recognition in Little Ones
June 15, 2021
By Lizabeth Jordan, PhD, Wee Chua, MD, & Sigrid Wolf, MD
Head Injuries & Falls
Source: CDC Heads Up
Toddlers often hit their heads. In many ways, they are quite resilient and quick to bounce back from minor bumps and bruises; however, some head injuries are more serious than others.
A concussion is one type of serious head injury. A concussion (also known as a mild traumatic brain injury or TBI) is a more serious head injury because it involves injury to the brain and how the brain functions.
Compared to all other age groups, children under the age of 4 years-old have the highest incident rates of traumatic brain injury. The leading cause of head injuries for babies and toddlers are falls at home, followed by car crashes. Babies and toddlers often fall because they stumble, trip, and bump into things. They can also fall when they are dropped, or a person carrying them falls.
Not all falls result in concussions; however, a child is more likely to have a concussion or other serious head injury when they:
- Fall from more than three feet
- Fall on a hard surface
- Fall with a fast speed.
These falls tend to be more serious because the force of the fall is more likely to move or injure the child’s brain. If you suspect your child has a concussion, they should receive immediate medical attention.
Babies and toddlers will likely be unable to explain or tell you about their concussion symptoms. So after a little one has a big fall, it is important that caregivers keep a close eye on their child and be able to recognize signs and symptoms of concussion.
Obvious signs of a concussion include:
- Difficulty waking from sleep
- Altered behavior
- Passing out
These are serious symptoms and should prompt you to take your child to the emergency room. Please read on to learn about how you can identify other symptoms and signs of concussions in young children.
What & How to Look for Signs of Concussions
After a child has a head injury, it may not be immediately obvious that something is wrong. Most children who have a concussion do not “pass out” or lose consciousness. It is common for infants and toddlers to immediately cry after a sudden or startling event, like a fall. Signs that the child has a head injury may not become clear until a few hours or days later.
Unlike older children, babies and toddlers may not be able to tell you when they are having a headache, dizziness, light/sound sensitivity, or other concussion symptoms. Caregivers need to keep a close eye out for physical, emotional, behavior, and sleep changes that may be signs of a concussion. If you notice any of the signs below, seek immediate medical attention.
- Bumps, bruises, bleeding: Physical injuries on your child’s scalp or head are not uncommon after falls. Swelling under the skin (known as “Goose eggs” or medically as a hematoma) can occur at the point of impact anywhere on the body. If your child has a large cut or a bump that is quickly getting larger, call your doctor or seek care at an emergency department.
- Vomiting, unusual movements, seizures, trouble talking: Your child throws up, is moving their body strangely, or is not talking like they usually do.
- Changes in balance and coordination: Your child is moving, crawling, cruising, or walking differently (e.g., stumbling, walking with feet/legs wider apart).
- Changes in mood: Your child is easily tearful/crying, “more emotional,” shows increased fussiness, temper tantrums, pushing, biting, or is unable to be comforted or soothed with typical strategies.
- Decreased engagement: Your child seems uninterested or less interested in regular toys/play. Your child’s play seems “quieter” than usual
- Changes in behavior: Your child seems dazed or confused, slower to respond, more “clingy,” or needs more adult help than normal.
- Changes in eating: Your child is nursing less, eating less, or refusing food.
- Headache or other signs of pain: Your child says or shows that they have a headache, stomachache, or “tummy ache” (e.g., frequent touching or rubbing of stomach or head).
- Changes in sleep patterns: Your child has trouble waking up from sleep, is sleeping more or less at night or during the day, is taking longer naps, shows increased daytime sleepiness, or has increased nightmares, night terrors, or sleepwalking
- Toileting accidents: Your child has new daytime or night-time accidents, and your child was previously toilet-trained.
What To Do When You Have Concerns
Source: CDC Heads Up
If you have any concerns that your child may have had a concussion or head injury, bring your child to an Emergency Department or Urgent Care for an evaluation.
Call your child’s pediatrician and ask for immediate recommendations.
General Recommendations For Rest & Recovery, If Your Child Is Diagnosed With a Concussion
- Rest at home: Your child should stay at home for the first 2-3 days after their injury. Keep your child away from preschool, playgrounds, and other busy school/play environments. Avoid taking your child on errands. For the first 2-3 days, your child should rest and sleep as much as they need to feel better. This will help their brain and body to recover.
- Create a calm place at home: While your child is resting for a few days, put away light-up and noisy toys. Similarly, limit your child’s access to tv, tablet games, and bright electronics if they seem to bother them.
- Encourage your child to stay hydrated: Give your child frequent drinks, such as water, milk, or Pedialyte.
- Prevent a second injury: While your child is recovering from a concussion, it is important that they do not have a second additional head injury.
- Your child should avoid rough-play and possibility of additional injuries/falls. They should have NO play with balls, running, wrestling, climbing, playground equipment, scooters, bikes, or trampolines.
- Slowly re-introduce your child to their regular play and learning activities after a few days of rest. Plan to take breaks or stop the activity if your child becomes fussy, upset, or shows any sign of headache or pain. If you are unsure if your child is having trouble tolerating their regular activities, stop the activity and give your child time to rest. “When in doubt, sit them out.”
- Monitor your child: Most children will recover within 2-4 weeks and go back to their normal activities without the return of symptoms. Your child’s doctor can help decide when it is safe for them to return to their normal activities. If your child continues to have difficulties beyond one month, ask your doctor if you should meet with a concussion specialist.
Ways to Prevent Head Injuries & Concussions
Source: CDC Heads Up
- Car Seats: When in a car, your child should be restrained in an approved car seat or booster seat that is correctly installed in your car and appropriate for your child’s age and size. Car seats, booster seats, and seat belts will help prevent injuries in the case of a motor vehicle crash. You can call “311” to arrange a free appointment with a Certified Child Passenger Safety Technician. These car seat inspections are available through the Chicago Police Department, Chicago Fire Department, and several other local organizations. Lurie Children’s Buckle Up Program also offers these free inspections in the South Loop neighborhood.
- Baby-proofing: Block stairs and access to high counters/surfaces that your child may try to climb. Keep walking areas and hallways clear from clutter. Make sure that bookshelves, chairs, and other furniture that your child may reach for or hold onto are blocked or secure so that the furniture does not fall if your child grabs it.
- Avoid risky situations: When you are holding a child, plan to walk slowly. Give yourself time and space to move the child to different places. Avoid trying to multi-task or rush through activities while holding a child.
- Supervise play: Never leave a baby or toddler unattended. An adult should closely supervise play—especially on playgrounds, tricycles, scooters, and sports equipment. Keep in mind too that toddlers should only participate in age-appropriate sports. For example, young children should play with soft, large balls. Find more playground safety tips here.
- Helmets & Protective Gear: Have a rule that your child needs to always wear a helmet when using tricycles, bikes and scooters, rollerblading, skateboarding, sledding, snowboarding, or skiing. Safety gear has been shown to help protect against severe head trauma.
To learn more about concussions in older children, including information about sports-related concussions, visit our Concussion Program webpage.
To learn more about parenting strategies and behavioral health interventions for babies and toddlers, aged 0-4 years-old, visit the Lurie Little Ones webpage.
About Our Experts
Dr. Lizabeth Jordan is a clinical neuropsychologist in the Pritzker Department of Psychiatry and Behavioral Health.
Dr. Wee Chua is an attending physician in the Division of Emergency Medicine.
Dr. Sigrid Wolf is an attending physician in the Division of Orthopaedic Surgery and Sports Medicine.