Concussion in children and young people

Read about concussion in children and young people.

What is a concussion?

Concussion is a type of brain injury that can alter the way a child’s brain functions. It can be
caused by either:

  • a blow to the head
  • something that causes the head and brain to quickly move back and forth or in different directions.

Effects of a concussion are usually short-term and are often described as a mild brain injury.

With the appropriate care and rest, most children should recover within about four to six weeks.

However, concussions can sometimes require emergency treatment and some people can have long-lasting difficulties after a brain injury.

Are children more prone to concussion than adults?

Evidence suggests that children, and in particular teenagers, are more likely to suffer a concussion than adults. Younger children are also at risk of concussion because their heads are disproportionately larger compared to the rest of their bodies.

Children’s brains are still developing and important connections between cells are still being strengthened. This process is known as myelination. Myelin is a protective coating around part of the nerve cells. Myelin in the brain is a bit like a coating of electrical wires with plastic to protect the electrical signal as it travels along a circuit. And because children have less myelinated brains than adults, they may be more susceptible to concussion.

What happens to the brain during and after a concussion?

The brain is surrounded by fluid and protective tissue which cushions the brain from light bumps and knocks to the head. But during a more severe blow to the head, or something that makes the brain move rapidly, this cushioning may not be enough to protect the brain.

Concussions generally do not show up on CT or MRI scans as they can’t detect the microscopic injury including chemical changes in the brain and damage to nerve cell function.

Symptoms of concussion in children and young people

The symptoms of a concussion can be very subtle and not always immediate. This means that a parent, teacher or sports coach could easily overlook the signs that a child or young person has had a concussion.

The symptoms listed below are signs that a person may be concussed but not all of these symptoms may apply. If a child or young person is showing even one of these symptoms, it may indicate a concussion. And sometimes symptoms don’t occur until a later stage. 

It’s not always easy to grade symptoms and categorise them from mild to severe. The below bullet points are meant to act as a guide if you are concerned that a child in your care has suffered a concussion. If in doubt, and the symptoms don’t fit into the ‘call an ambulance’ category, call 111.

For the following symptoms, call for an ambulance: 

  • cannot be wakened, unconscious
  • difficulty staying awake
  • extremely confused state
  • problems in speaking, walking or balance
  • numbness or weakness in part of their body
  • vision problems with nausea or dizziness
  • clear fluid coming from ears or nose
  • bleeding from ears or bruising from behind the ears
  • a black eye that wasn’t the result of a blow to that area
  • a seizure or convulsion
  • neck pain. 

For the following symptoms, visit your nearest A&E department:

  • woken up after being knocked out
  • has memory problems
  • a headache that doesn’t go away
  • been vomiting since the injury
  • significant changes in behaviour.

For the following symptoms, seek medical advice by phoning 111:

  • headache 
  • feeling sick
  • slight dizziness
  • difficulty in concentrating
  • double vision. 

Subtle or delayed symptoms of concussion

Sometimes there are no immediate signs of concussion. However, symptoms can sometimes appear after a few hours or even days after the injury. It is therefore important to ensure that teachers, parents and anyone who cares for the child is aware of any recent bumps or accidents so that they can look out for warning signs in the following days.

What you should do if you think a child or young person may have suffered a concussion

  1. Remove them from play: As long as they haven't passed out and seem well enough to move, sit the child down, removing them from any sport or activity that they have been involved in.
  2. Talk to them: If they are at an age where they can hold a conversation, now is a good time to ask the child or young person a couple of questions about how they are feeling. The way in which they answer might help you determine if they have had a concussion. For instance, if they slur their words or seem confused, this would be a good indication that they are concussed.
  3. Get medical advice: While the NHS recommends that mild symptoms don’t require medical advice, it’s sometimes difficult to decide what might be mild. So, if there is even the smallest indication that they have suffered a concussion, it is a good idea to have them assessed by a GP or medic. Or you could call 111 for further advice on next steps. 
  4. Rest: If a child or young person has had a concussion it is important that they get some rest (both mental and physical) and don’t do anything that might worsen symptoms. 

Tips on preventing concussion in children and young people

Understanding concussion and its effects

It is important that parents, teachers and sports coaches know what to look for if a child has suffered a blow to the head. It is also equally important for children and young people to be aware of concussion. You can order a printed leaflet of this information to help explain the symptoms to help them better understand the condition and the importance of the recovery process.

Following the rules

Knowing how to play a sport or game safely and by the rules is an important factor in preventing concussion.

Wearing and using recommended equipment

Ensure that the correct equipment and suggested protective accessories are used when taking part in sports and games.

Road safety and car safety 

Encourage positive road safety habits in children from a young age and explain the importance of wearing a seatbelt.

Recovery

Research suggests that children and young people can take three times longer to recover from a concussion than adults. Here are a few things that can speed up the recovery process:

Rest

Some time off school can be a huge benefit to a child or young person who has suffered a concussion. Contact sport and excessive physical activity should also be avoided for at least 24-48 hours.

Observation

Look out for any changes in behaviour or difficulty in concentrating following a brain injury in the first few days. If changes do occur you should seek medical advice. Ensure that people around the child or young person are aware of the injury so that they can seek help if necessary.

Medication

A GP may advise that a child should have paracetamol for pain or headache. Avoid aspirin or anti-inflammatory medication as this could cause bleeding. If a child is in pain, seek advice from a GP.

Gradual return to school and activities

It is advised that children do not need to be completely symptom-free to start the process of going back to school but that modifications should be made to suit their needs following the concussion. This might mean longer breaks or shorter days. If school and activities bring on new symptoms or make current ones worse, activities should be decreased.

Trust your instincts

Don’t be afraid or embarrassed about getting more help, even if a GP or doctor has given the ‘all clear’. If you feel that something isn’t quite right with a child following a concussion or possible concussion, get further help from the GP or call 111 to explain your concerns. It’s often people closest to the child who realise that they are acting differently or suffering from the effects of concussion, and need further support in their recovery.

Returning to school

Experts have developed recommendations for the return to school and activity following a concussion.

The following guides are based on these recommendations by Canchild and can be used when a child’s GP or doctor is happy that they can gradually return to school, activity and sports.

An initial period of 24-48 hours of rest for the body and mind is recommended before starting the step-by-step guides on the following pages.

It is important that everyone involved understands the process – including parents, teachers, sports coaches and the child or young person.

A gradual progression is very important. If signs of concussion return or worsen during activity, it is an indication that the brain has not healed.

Step 1: Rest

24-48 hours off school. Rest and only do activity that doesn’t worsen symptoms. Activities such as watching television, texting or using a computer might make symptoms worse, so try to limit this as much as possible.

Step 2: Preparing for going back to school

Some reading, homework or other activities at home that involve some level of concentration. A short walk to the shops is a good opportunity to gradually increase physical activity at this stage.

Step 3: Return to school part-time

This could involve a half day or with longer breaks during the day.

Step 4: Return to school full-time

Gradually taking part in more school activities until a full day is possible.

Step 5: Full return to school and day-to-day activities

If no symptoms are present, the child should be able to return to normality at school and take part in everyday activities. 

*There should be a minimum of 24 hours between each step. For full details of these steps please refer to CanChild's website.

Returning to sport and activity

Step 1: Limited activity

Daily activities that do not increase symptoms. For example, a short amount of time reading a book.

Step 2: Light activity and exercise

Walking or cycling at a slow to medium pace. Or something similar that raises the heart rate.

Step 3: Return to sport-related exercise

Running, for instance, is an example of an appropriate exercise at this stage. But not games or sport that might lead to a blow to the head, such as football.

Step 4: Practice with the team, no contact training

Something that requires more concentration such as passing a ball in training. No heading the ball, tackling or scrumming.

Step 5: Full contact practice

If agreed by the child's GP or doctor, a return to normal participation in training activities. 

Step 6: Return to sport  

Normal gameplay and matches

Post-concussion syndrome

There are a few things that are sometimes linked to a longer recovery time for some children and young people. These risk factors include:

  • if a child has been concussed before 
  • a younger age
  • previous diagnosis of attention deficit hyperactivity disorder (ADHD)
  • mental health issues
  • if a child has had a prolonged loss of consciousness.

Sometimes a child who has suffered a concussion will develop a collection of symptoms which last weeks, months or possibly longer. This is called post-concussion syndrome and can lead to significant difficulties for a child.

If a child has suffered from a concussion and has been having some lasting difficulties or ongoing effects, they could possibly have post-concussion syndrome.

Symptoms include:

  • headaches
  • dizziness 
  • fatigue/tiredness
  • insomnia; where the child finds it difficult to sleep
  • irritability
  • anxiety
  • loss of concentration or memory difficulties
  • noise and light sensitivity
  • tinnitus; a ringing in the ears.

If a child is diagnosed with post-concussion syndrome, options should be discussed with the child’s GP. They may be referred to a specialist or rehabilitation service to support them in dealing with some of the effects or difficulties they are having.