Your kid takes a hard fall at soccer practice, gets up, shakes it off and finishes the session. At dinner she is quieter than usual. By bedtime she says her head hurts and the kitchen light is bothering her.
Is that a concussion? Possibly. This is how a lot of them present, and it is why so many get missed.
First, what a concussion actually is
A concussion is a brain injury caused by force transmitted to the head or spine. Two things about that definition surprise parents:
- There does not have to be a blow to the head. A hit to the body that snaps the head around can do it.
- Most concussions involve no loss of consciousness at all. Waiting for someone to get knocked out is the wrong test.
Symptoms can also take hours to show up, which is why the evening after a game matters as much as the sideline moment.
What to watch for in the first 24 to 48 hours
Signs tend to fall into four groups. A child does not need all of them, and one can be enough to warrant an evaluation.
Physical
Headache or head pressure, nausea, dizziness or balance trouble, blurred or double vision, sensitivity to light or noise, feeling unusually tired.
Thinking
Seeming foggy or slowed down, trouble concentrating, difficulty remembering the play or the drive home, answering questions slowly, repeating themselves.
Mood and behavior
Irritability, sadness, anxiety, or emotional responses that seem out of character or out of proportion. Parents often describe it as their kid not seeming like themselves, and that instinct is worth trusting.
Sleep
Sleeping much more or much less than usual, or trouble falling asleep.
Red flags: go to the emergency department
Some symptoms are not a wait-and-see situation. Call 911 or go to the nearest emergency department if you see:
- Severe headache, maybe the worst of your life
- Repeated vomiting
- A seizure or convulsion
- Increasing confusion, agitation or unusual behavior
- Slurred speech, weakness, numbness or loss of coordination
- Unequal pupils or ongoing loss of vision in one or both eyes
- Prolonged loss of consciousness at the event or sudden loss of consciousness later
When in doubt with a head injury, err toward being seen. Nobody is going to be annoyed with you for bringing your child in.
The rule that matters most on the day of the injury
If a concussion is suspected, the athlete comes out and does not go back in that day. Not for the rest of the quarter, not for the last few minutes.
Colorado has a youth concussion law, often referred to as the Jake Snakenberg Act, that requires coaches in organized youth sports to remove an athlete suspected of having a concussion from play and to keep them out until a qualified health care provider clears them to return. Coaches in the state also complete concussion recognition training. We will cover the specifics of what the law asks of coaches and parents in a separate article.
The reason behind the rule is straightforward. A brain that is still recovering is more vulnerable to a second injury, and returning too early is associated with worse and longer recoveries.
What the first couple of days usually look like
Guidance has shifted over the years, and some of what parents might remember is out of date.
- You do not have to keep a child awake all night. Sleep is generally fine unless a provider has told you otherwise for a specific reason. Otherwise, sleep is good.
- Weeks in a dark room is no longer the recommendation. Current guidance generally favors a short period of rest, then a gradual return to light activity as symptoms allow.
- Screens and schoolwork usually get dialed back, not banned. The goal is to stay under the level that makes symptoms flare.
Every injury is different, which is why an individual plan from a physician who examined your child beats anything you read online, including this page.
Return to learn comes before return to play
Getting back to the classroom is the first priority, often with temporary accommodations such as a reduced workload, extra time on assignments, or breaks during the day. Sport comes afterward, through a stepwise progression that adds activity gradually and only while symptoms stay settled.
How long all of this takes varies. Many young athletes recover within a few weeks, and some take considerably longer, particularly with prior concussions, migraines or a slower symptom course.
When to call your doctor
Short of the red flags above, reach out if you suspect a concussion at all, if symptoms are not improving, if school has become difficult, or if you need help deciding when it is reasonable to go back to the team.
Dr. Christopher Kroner is trained in both family practice and sports medicine, with sideline experience ranging from professional and Olympic sports to high school fields. Concussion evaluation and return-to-play planning are part of the sports medicine care offered at Ridgeview, and families can also read about care for kids and teens.
Get your questions answered
Ridgeview Direct Care is in Wheat Ridge, serving families across Arvada, Lakewood, Golden, Edgewater and west Denver.
Book a free meet and greet or call 720-807-9961. If your child has a head injury right now and you are worried, seek care today rather than waiting for an appointment.
This article is general education and is not medical advice, a diagnosis, or a substitute for evaluation by a physician. Please see our medical disclaimer.