Parent’s Guide to Concussions

What Is a Concussion?

A mild traumatic brain injury (mTBI), often referred to as a concussion, is swelling of the brain commonly associated with a blow to the head — although it can be caused by hard contact to any part of the body.

During impact, the brain’s soft tissue brain collides with the hard skull. The subsequent swelling can cause numerous symptoms.

Concussion Symptoms

If your child exhibits any symptoms commonly associated with a concussion following a collision, IMMEDIATELY remove the child from play and seek medical care as soon as possible.

Symptoms may include:

• Loss of consciousness for any duration of time.
• Persistent headache or head pain that gets progressively worse.
• Nausea or vomiting, which may be a sign of more serious injury.
• Cognitive impairment, including problems following instructions, difficulty responding to questions or generally feeling “foggy.”
• Eye problems, such as blurred vision, double vision or one pupil larger than the other.
• Drowsiness, sleeping more than usual, finding it difficult to fall asleep or stay asleep.
• Balance problems and clumsiness, including jerky or uncoordinated movements.
• Forgetfulness of events directly before or after the injury, or ongoing trouble with remembering things.
• Light or noise sensitivity.
• Seizures (twitching, shaking or convulsing). While not common, this indicates a need for immediate medical attention.
• Emotional changes, such as mood swings, personality changes or generally feeling “not right.”

Testing for Concussion

Two common tools for assessing a suspected concussion are vestibular-ocular motor screenings (VOMS) and the Sport Concussion Assessment Tool 5th Edition (SCAT5). ImPACT testing may also be used, but it’s most useful when taken both before and after a concussion.

Vestibular-ocular motor screenings (VOMS) are increasingly common and can be done either on the sideline of a sporting event or in your care provider’s office. Given to children older than 10, this series of simple eye-movement tests assesses the function of both the vestibular (inner-ear) system and ocular (eye) system following a suspected concussion. Inner-ear system damage can cause dizziness or trouble with balance. Eye system damage can result in blurred or double vision.

The Sport Concussion Assessment Tool 5th Edition (SCAT5) can be done with or without a baseline test. It can be performed either on the sidelines or during a visit with your care provider within three to five days of injury. SCAT5 includes:

• A brief neurological exam
• Cognitive assessment
• Balance assessment
• Symptom checklist

ImPACT stands for “Immediate Post-Concussion Assessment and Cognitive Testing.” This computerized test is typically taken by non-concussed student-athletes prior to participating in their sport. The results are used as a baseline for comparison following a concussion. It doesn’t provide a diagnosis, which can only be done by a licensed medical professional.

Second Impact Syndrome

Research shows that someone who’s already had a concussion is more prone to future concussions. Continued play following a concussion increases a child’s risk of second impact syndrome (SIS).

Second impact syndrome is rapid brain swelling that occurs when a person suffers a second concussion before the first has fully healed. This can occur minutes, days or weeks after the initial impact. The resulting swelling can lead to serious complications and is often fatal.

If your preteen or teen already had a concussion, it’s extremely important to take steps to avoid subsequent injuries. Multiple concussions are linked to cognitive decline later in life and impaired neurological function.

Returning to Activity

While each case is unique and you should follow the guidelines given by your care provider, there’s a general pattern for returning to activity after a concussion. These steps are adapted from the Center for Disease Control (CDC) HEADS UP guide and Boston Children’s Hospital Sports Concussion Clinic.

These phases should not be used as a treatment plan. They are meant to provide a general idea of what to expect throughout the recovery process. Please consult a medical professional for your child’s individualized plan.

Returning to School

• Phase 1: Rest. A child in this stage should get plenty of rest, sometimes staying home for a few days. (If symptoms are mild, a doctor may approve returning to school earlier.) Keep TV and computer use, texting, reading and face-to-face interactions to a minimum. Think of this as a “brain rest.”
• Phase 2: Re-Entry. The student can attend school but may start with half days. This phase typically begins when symptoms have lessened and the child can concentrate for 30-45 minutes at a time. Since the student may require a classmate to take notes for them or may need extensions on assignments, keep teachers updated. Common supports include rest breaks at school, reduced homework load and rescheduling tests.
• Phase 3: Reintegration. The child may return to a full school day while continuing to update teachers on their progress. Self-advocacy and communicating with teachers can help your student from feeling overwhelmed. Some social activities, such as club activities, may be resumed as tolerated, and make-up work can begin.
• Phase 4: Return. Your student may return to school full time without restrictions. This is a good time to finish any make-up work.

Returning to Sports

Physical activity shouldn’t be resumed until your child receives medical clearance and is managing schoolwork well.

When physical activity is resumed, return to play should be gradual. During this time you and your preteen or teen should continue to monitor symptoms in case any reemerge. If symptoms reemerge during an increase in exercise intensity at any stage, the child should STOP IMMEDIATELY and wait 24 hours before reducing exercise intensity to the previous stage.

• Phase 1: No physical activity. If tolerated, some walking and stretching is OK to prevent deconditioning.
• Phase 2: Resume physical activity. Participating in sports is still not recommended, but non-contact physical activity is OK. This phase is further broken down into sections based on exercise intensity tolerated by your child. Exercise is reintroduced gradually, with at least 24 hours between increases. Typical phases include low levels of physical activity, including walking and light jogging; moderate levels, such as jogging, brief running and warm-up activities; and heavy non-contact physical activity, including sprinting and training drills. Slowly resume resistance training, beginning with reduced weight and fewer repetitions.
• Phase 3: Sports practice. After the doctor deems it safe, your child may return to sports practice. Begin with controlled contact and move up to full contact in practice.
• Phase 4: Return to full contact play, including games or matches.

Support Your Child’s Recovery

Because people with concussions don’t have a cast or brace, it’s easy to forget that they still require special care and patience during the recovery process.

Don’t expect your preteen or teen to immediately or even quickly return to previous levels of schoolwork, socialization and athletic activity. Research shows that not only are children more likely to suffer concussions than adults, but also that full concussion recovery is generally slower for children than for adults.

Depending on concussion severity, it could take weeks or months for your child to fully recover. But with patience, care and support, you’ll improve your child’s return to full health. 

Reviewed by: Tanya Nauenberg, MD, Matthew Ryan, MAed, ATC; Kelly Troiano, MD; Cara Barone, MD

Last reviewed: August 2019