Oct. 05, 2019
Children are at a higher risk of concussion than adults, due to spending more time in activities that incur risk, less ability to judge risk and greater impulsivity.
"Kids are just more likely to feel a little bit invincible," says Sherilyn W. Driscoll, M.D., pediatric physiatrist at Mayo Clinic's campus in Rochester, Minnesota, and division chair for pediatric rehabilitation medicine. "For adults, by and large, exercise is likely to include something less risky."
Young people ages 15-19 face the greatest risk of concussion, followed by children ages 10-14. Children under age 10 face the lowest risk of concussion. Common mechanisms of injury include concussion from sports or other physical activity in gym class or on sports teams, falls, or car crashes.
Discharge and recovery for concussed children
After a concussion diagnosis through a care process model as outlined in the AskMayoExpert online tool, trauma professionals should make parents aware that the majority of children will likely recover in a few weeks. Clear and thorough discharge instructions are crucial for a child's recovery and to avoid prolonging symptoms or re-injury. Dr. Driscoll suggests including the following:
- Limit activities in the first couple of days with cognitive and physical rest.
- In the first days after concussion, limit cognitive and physical activities if they make symptoms worse, but it is not necessary to entirely avoid screens or devices. Patients should not stay in bed all day.
- After one to two days of rest, gradually resume prior school and physical activities.
- Watch for red flags, such as worsening headache; confusion or disorientation; changes in physical coordination, speech, mental function or behavior; seizure; recurrent vomiting or dizziness; issues with the eyes or vision; or significant head bruising or bumps outside of the forehead. Return to the medical center if these signs and symptoms appear.
- Speak to the child's school about accommodations for schoolwork to avoid overload during recovery.
- Strictly avoid activities that would incur risk of a second concussion until completely recovered from the current concussion.
Time, taking rest breaks, and avoiding re-concussion are key components for a child's healing from a concussion.
A child's recuperation from a concussion involves primarily time, according to Dr. Driscoll. In 70% to 80% of cases, concussion symptoms will resolve in two to four weeks.
Recovery from concussion involves a careful balance of activity and rest, says Dr. Driscoll. How the patient is doing dictates the appropriate amount of activity and rest needed.
"If you don't do enough or do too much, it will prolong your recovery," she says. "Everything is limited to symptoms — walk or study a little bit, take a break, go back to it. Try to maintain the middle ground in terms of return to activities. Excessive rest by restricting all sensory input and social, cognitive and physical activities for a prolonged period has proven to be ineffective and even counterproductive to recovery. On the flip side, reentry into activities too soon can also prolong symptoms."
She cautions against sending a child back to a full school load too early in the rehabilitation process, as the child may struggle to perform and then lose confidence. Part-time attendance and modifications to assignments and expectations may be necessary in the first days to weeks of recovery.
An important rationale for children who’ve experienced concussion taking time out to recover afterward is to prevent a second head injury. If a child re-concusses before the first is fully healed, symptoms may be worse at the time of impact and the outcome may be less favorable.
Dr. Driscoll notes that children who have suffered a concussion are at higher risk of another concussion in general — even some time out from the first injury. This may relate to factors such as resuming former risky activities or a delayed reaction time post-concussion.
To prevent re-concussion, it's important to talk with the injured child's family about managing risk. Each family has to assess what level of risk it is ready to undertake. High-contact sports such as football, hockey and lacrosse have a particularly high risk of concussion.
For families with high levels of concern about re-injury, it may be appropriate to present the idea of investigating whether the child might be just as happy with a lower risk sport. Dr. Driscoll also encourages informing families that though helmets are protective for skull fracture, they do not protect against concussion.
Per Minnesota statute, to return to school-affiliated sports, a child who has been diagnosed with concussion must be cleared by a licensed medical professional and a return-to-activity protocol must be implemented.
Most concussed children should follow up with a medical professional post-concussion, such as a visit with a primary pediatrician in one to two weeks to ensure the symptoms are improving and the child is following a gradual return-to-play and learn schedule. Of children who suffer a concussion, 10% will experience post-concussive symptoms and need ongoing assistance to address them.
For more information
AskMayoExpert. Concussion: Child. Mayo Clinic.
2019 Minnesota statutes. 121A.38 Concussion Procedures Minnesota Legislature: Office of the Revisor of Statutes.