Concussions in kids and teens: A Q&A with our experts

Every year, millions of children in the U.S. sustain concussions, also known as mild traumatic brain injuries (mTBI). Young people are at most risk for complications from concussion since their brains are still developing.

The Concussion Program at Lurie Children’s ensures children who sustain a concussion get the most appropriate medical care for their needs, and guidance when it comes to returning to school and physical activities. A multidisciplinary team of pediatric concussion specialists evaluates all patients and tailors management of their care to each individual child.

Additionally, all Lurie Children’s concussion specialists are actively involved in pediatric concussion research to further global understanding of these injuries and improve treatment.

Read more below for answers to common questions about concussions and children and teens with some of our specialists, including Cynthia LaBella, MD, Medical Director of the Institute for Sports Medicine at Lurie Children’s; Dana Sheng, MD, Fellow with the Institute for Sports Medicine; and Jacqueline Turner, APRN-NP (Advanced Practice Registered Nurse-Nurse Practitioner).

1. How common are concussions in children and teens? Which age group is most affected?

Cynthia LaBella, MD: Mild traumatic brain injury, or concussion, in children is a significant public health concern and worry for many parents, especially of young athletes. From 2005 to 2009, children made up more than 2 million outpatient visits and almost 3 million emergency department visits for concussions, according to data from the Centers for Disease Control and Prevention.

Health records from a U.S. large private payer insurance group with a diagnosis of concussion between 2007 and 2014 found that about 32% were in the adolescent age group (10-19 years old). The most common age group reporting concussion was in the age 15-19 subgroup, followed by 10-14-year-old age group.

2. What are some of the most common causes of concussion?

Dana Sheng, MD: A concussion is a mild brain injury caused by either a physical trauma to the head, or by forces on the body, with either case causing the head and brain to move quickly under forces of acceleration, deceleration and rotation. Many concussions are sports-related, but many are also from falls, bicycle or motor vehicle accidents and inflicted harm.

3. What are the signs of concussion?

Jacqueline Turner, APRN-NP: Headache is the most common symptom.

Other symptoms include nausea, dizziness, change in vision or hearing, sensitivity to light or noise, fatigue, sleep disturbances, difficulty with attention, concentration, mental processing, memory, sensory changes and changes in mood or behavior. In general, they can be grouped into symptoms affecting how you feel, think, act or sleep. The onset of symptoms can be immediately after an incident or develop later. Usually, scans of the brain will appear normal.

Dr. LaBella: Depending on the age of the child, recognizing concussion in younger children can be more complicated if the child cannot fully explain and describe their symptoms. Some symptoms may be mistaken as a purely behavioral issue rather than a sign of concussion. If there is any concern, the child should be evaluated by a pediatric concussion expert.

4. What should caregivers do if they suspect their child is having/had a concussion?

Dr. Sheng: In general, after a concussion, the child should be watched for concerning signs and symptoms that would indicate they should get medical attention. These include prolonged loss of consciousness after the injury, or changing level of consciousness, unusual behavior, increased confusion, restlessness or agitation, seizure, increasing headache, repeat vomiting, weakness/numbness/tingling of arms/legs, slurred speech, poor balance or coordination, unequal size of the pupils (the black part in the center of the eye), blurry vision or other visual changes not resolving. For younger children, other concerning signs to look for include finding that the child won’t stop crying, is inconsolable, won’t nurse or won’t eat.

Jacqueline Turner: For concussion in the setting of sport, the athlete should be removed from play immediately and not return to sports until until evaluated and cleared by a physician or other licensed healthcare provider. The provider should look for concussive injury and neck injury. The athlete should not be allowed to return to play on the day of the injury. 

5. What is treatment like for a concussion? How long does it take to recover from a concussion?

Dr. LaBella: Treatment/management after concussion should be individualized based on the child’s situation and symptoms and may require the expertise of multiple disciplines. Immediately after the injury should be a brief period (24-48 hours) of cognitive and physical rest, followed by gradual return to school and activity with increases made as tolerated by the child (activity level should not bring on, or worsen their symptoms).  Research has shown that engaging in light aerobic activity during concussion recovery is not only safe but can reduce symptoms and shorten recovery time.

Dr. Sheng: Managing a child following a concussion involves symptom management as well as rehabilitation. Rehabilitation may involve physical therapy (e.g. for balance), occupational therapy, speech therapy, neuropsychology, psychotherapy, and neuro-ophthalmology. Neuropsychological testing can help determine what, if any, accommodations at school or individual education plans need to be put in place for the time being. Lurie Children’s Concussion Program has pediatric specialists in all of these areas.

After a concussion, it is also important to reduce the risk for additional head injury. Further head injury or repeat concussion can worsen symptoms, the child’s function and significantly delay recovery. Sleep is also key to healing, and any sleep dysfunction should be addressed.

For the majority of concussions, symptoms completely resolve within four weeks. In 20-30% of cases, however, symptoms can persist longer than four weeks. Treatment for cases where recovery is prolonged is symptom-targeted and individualized. These are best managed by a multidisciplinary team of experts in concussion care such as at Lurie Children’s.

6. What are long-term effects associated with concussion?

Dr. LaBella: Most concussions resolve completely within a few weeks, with no long-term consequences. However, sometimes the symptoms persist beyond this period. This is more likely to occur in adolescents and those with underlying anxiety. If this is the case with your child or teen following a concussion, our team can ensure they get the care they need.

7. How can the risk for concussion be reduced?

Dr. Sheng: Education and awareness of causes for concussion are important. Part of primary prevention of concussion within the realm of sports is modification of and enforcement of the rules and fair play. For youth ice hockey, the rule disallowing body checking under age 13 has reduced the risk of sports related concussion. In football, proper tackling techniques should be taught, and may reduce risk for head injury. See USA Football’s Heads Up Program for more information on safe football play.

Discouraging aggressive playing styles is also beneficial. A culture of safety in sports should also include wearing sports-specific protective equipment. Helmets – while not concussion-proof – should be in good condition and properly fit. Additionally, neck strengthening may also be helpful as weakness in the neck muscles has been found to be a risk factor for concussion.

Dr. LaBella: From my perspective, secondary prevention may even be more important than primary prevention. Secondary prevention means reducing the risk for more severe or persistent symptoms or longer recovery. Secondary prevention strategies include immediate removal from play after the injury and resting from contact sports following possible concussion until evaluated by a health care professional with experience managing concussions. Finally, return to contact sports and high risk activities should not occur until the athlete is fully recovered and all concussion symptoms have returned to pre-injury levels.

8. Why is Lurie Children’s the best place for concussion treatment and care?

Jacqueline Turner: Because concussions can affect children’s cognitive abilities in school, we’ve structured the Concussion Program to address our patients’ academic needs as well as provide them with appropriate guidance regarding safe return to sports and physical activities. Our team stays in contact with academic and athletic staff at the schools throughout the treatment process to make sure our patients have a smooth and appropriate transition back to both the classroom and to physical activities.

Dr. LaBella: All our patients are evaluated by a multidisciplinary team of concussion specialists, including pediatric sports medicine physicians, a pediatric advanced practice nurse, and certified athletic trainers and physical therapists. This team approach ensures comprehensive evaluation and management of each injury. Additionally, all our specialists are actively involved in pediatric concussion research to further global understanding of these injuries and improve treatment.

If you have any questions regarding whether your child should continue playing contact sports, we recommend evaluation in our Concussion Program! We have appointments available at our downtown Chicago location and in our suburban outpatient centers in Skokie, Northbrook, Clark/Deming (Lincoln Park, Chicago), New Lenox and Westchester.

If you'd like to schedule an appointment with one of our specialists, call 1.800.543.7362.