Immediate Concussion Assessment in a Child After Football Impact
Remove the child from play immediately and use the Concussion Recognition Tool 6 (CRT6) for initial sideline assessment, followed by the Child SCAT6 (ages 8-12) or SCAT6 (ages 13+) if you are a healthcare professional. 1
Immediate Sideline Assessment (First Minutes)
For Parents, Coaches, and Non-Medical Personnel
Use the CRT6 to recognize concussion symptoms and signs 1. Look for:
Red Flags Requiring Emergency Care:
- Neck pain or tenderness
- Double vision
- Weakness or tingling in arms/legs
- Severe or increasing headache
- Seizure or convulsion
- Loss of consciousness
- Deteriorating conscious state
- Vomiting
- Increasingly restless, agitated, or combative
Observable Signs:
- Lying motionless on the ground
- Slow to get up after impact
- Disorientation or confusion
- Blank or vacant look
- Balance problems or unsteady gait
- Clutching their head
If ANY of these are present, remove from play immediately 1, 2. The child should NOT return to play the same day.
Healthcare Professional Assessment (Within 72 Hours)
Age-Appropriate Tool Selection
Critical Assessment Domains
1. Symptom Evaluation (Most Discriminating Feature) Both symptom number and severity are significantly elevated in concussed children 4. Document:
- Child-reported symptoms
- Parent-reported symptoms (especially for younger children)
- Symptom severity scores
2. Visio-Vestibular and Oculomotor Screening (High Priority) This is highly prevalent and associated with protracted recovery 3. For ages 5-9, use the VOMS-Child (VOMS-C) with binary symptom reporting 3.
3. Balance Testing
- Double stance errors (particularly discriminating) 4
- Tandem stance errors 4
- Modified Balance Error Scoring System
4. Cognitive Assessment
- Immediate memory testing (significantly impaired in concussion) 4
- Delayed recall
- Concentration testing
5. Mechanism of Injury Document how the impact occurred—this contextualizes the clinical picture 2.
Common Pitfall to Avoid
Orientation and digit backward tasks show NO significant differences between concussed and non-concussed children 4, so don't rely on these alone for diagnosis.
Subacute Office Assessment (3-30 Days Post-Injury)
If symptoms persist beyond initial evaluation, use the Child SCOAT6 (ages 8-12) or SCOAT6 (ages 13+) for comprehensive multimodal assessment 1, 3:
- Detailed clinical history
- Symptom evaluation
- Cognitive tests
- Orthostatic vital signs
- Cervical spine assessment
- Neurologic examination
- Balance assessment
- Timed tandem gait, complex tandem gait, dual-task tandem gait
- Visio-vestibular examination
- Sleep assessment
- Mental health screen
- Graded aerobic exercise tests
Key Clinical Considerations
Age-Specific Differences: Younger children (ages 5-12) require parent/teacher reports as they may not accurately self-report symptoms 5. The evidence base is stronger for adolescents than younger children, so maintain higher clinical suspicion in elementary-aged children 5.
Time Constraints: Research shows healthcare professionals feel they lack adequate time for thorough on-pitch assessment 6. Don't rush—when in doubt, sit them out. The CDC guideline emphasizes that no broad clinical guidance existed in the U.S. until 2018, underscoring the importance of following current evidence-based protocols 2.
Return to Learn Before Return to Sport: The 2024 Amsterdam consensus emphasizes that return-to-learn strategies should take precedence over return to sport 1. This is critical for protecting ongoing brain development in children.