Approximately 1 in 220 pediatric patients seen in the emergency room is diagnosed with a concussion and 30-50% of these concussions are sports-related. With regards to high school sports, 9% of all injuries lead to concussion, and it appears that boys experience more sports-related concussions overall, but girls are at an increased risk when comparing similar sports.
Symptoms
Similar to adults, signs and symptoms of concussion in children and adolescents fall into 4 categories: physical, cognitive, emotional, and sleep related symptoms. Headache is the most frequently reported symptom, and sleep disturbances (excessive sleeping, daytime drowsiness, difficulty falling asleep, or nighttime waking), dizziness, balance deficits, fatigue, and difficulty thinking are very common as well. In more severe cases, loss of consciousness may occur in less than 10% of cases, as well as amnesia. Injury to the young developing brains may be associated with a greater risk of long-term functional impairments due to structural and functional changes in the brain.
Patients with pre-existing mental health issues such as anxiety, depression, or a pre-existing learning disability may experience more severe or prolonged presentation of their symptoms and may find it more difficult to manage their condition.
Recovery
Postconcussive symptoms for most children resolve in 1-2 weeks after injury, but 15%-30% of children may experience symptoms that persist for at least 3 months. The likelihood of developing persisting symptoms depend on the severity of the injury, pre-existing anxiety and depression, and a poorer perception of the impact of the injury.
Treatments
Rest is often prescribed to manage the symptoms, but there are 2 types of rest that children and adolescents should follow: physical and cognitive rest.
Physical rest is needed after experiencing a concussion because energy demand in the brain from physical activity may exacerbate symptoms and prolong recovery. Therefore, it is important to get adequate rest to promote a speedy recovery and manage the symptoms.
Cognitive rest is particularly important because concussions represent a functional rather than a structural brain injury. Many pediatric patients have difficulty focusing in school, reading, taking tests, and keeping up with school work, so some types of cognitive rest that could help manage these symptoms may include temporary leave of absence from school, shortening the school days, reducing workload, and allowing more time to complete tasks.
Prevention
It is difficult to prevent a concussion, but some measures can be taken to reduce the risk of a concussion in children. Since a large portion of concussions occur as a result of sport-related injuries, attempts to reduce the risk include using appropriate protective gear, changing rules to ensure the safety of the children, and identifying children and athletes at risk. It is crucial to educate children, parents, and teachers about the symptoms of a traumatic brain injury in order to quickly identify them and provide appropriate care.
Written by Lea Farah
References
Grubenhoff, J. A., Currie, D., Comstock, R. D., Juarez-Colunga, E., Bajaj, L, & Kirkwood, M. W. (2016). Psychological factors associated with delayed symptom resolution in Children with concussion. The Journal of Pediatrics, 174, 27-32.e1. https://doi.org/10.1016/j.jpeds.2016.03.027
Halstead, M. E., Walter, K. D., & The Council on Sports Medicine and Fitness. (2010). Sport-related concussion in children and adolescents. Pediatrics (Evanston), 126(3), 597-615. https://doi.org/10.1542/peds.2010-2005
Rose, S. C., Weber, K. D., Collen, J. B., & Heyer, G. L. (2015). The diagnosis and management of concussion in children and Adolescents. Pediatric Neurology, 53(2), 108-118. https://doi.org/10.1016/j.pediatrneurol.2015.04.003