What are the recommended steps for managing concussion symptoms in a pediatric patient?

Concussion Symptoms to Watch For in a Seven-Year-Old

Parents should monitor for physical symptoms (headache, nausea, vomiting, dizziness, balance problems, visual changes), cognitive symptoms (difficulty concentrating, confusion, memory problems, slowed thinking), emotional symptoms (irritability, sadness, increased emotionality), and sleep disturbances (drowsiness, difficulty falling asleep), with immediate medical attention required if symptoms worsen or new concerning signs develop. 1

Red Flag Symptoms Requiring Emergency Evaluation

Parents must seek immediate emergency care if their seven-year-old develops any of the following warning signs:

• Loss of consciousness or inability to wake up 2
• Severe or worsening headache that doesn't improve 2
• Repeated vomiting (more than once) 2
• Altered mental status including increasing confusion or unusual behavior 2
• Seizures or convulsions 2
• Visual changes such as double vision or pupils of unequal size 2
• Slurred speech or difficulty speaking 1
• Weakness or numbness in arms or legs 1

Common Concussion Symptoms by Category

Physical Symptoms

• Headache (most common symptom) 1, 3
• Nausea or vomiting 1
• Dizziness or balance problems 1
• Visual disturbances including blurred vision or sensitivity to light (photophobia) 1
• Sensitivity to noise (phonophobia) 1
• Fatigue or feeling tired 1

Cognitive Symptoms

• Difficulty concentrating or paying attention 1
• Memory problems (forgetting recent events or conversations) 1
• Confusion or feeling "foggy" 1
• Slowed thinking or processing 1
• Difficulty with schoolwork, particularly in math, science, and reading 1

Emotional/Behavioral Symptoms

• Irritability or increased emotional responses 1
• Sadness or appearing more emotional than usual 1
• Nervousness or anxiety 1
• Changes in personality or behavior 1

Sleep-Related Symptoms

• Drowsiness or sleeping more than usual 1
• Difficulty falling asleep 1
• Changes in sleep patterns 1

Timeline and Monitoring Considerations

Most children recover within 7-10 days, but pediatric patients typically take longer than adults to fully recover. 1, 2 Parents should understand that:

• 44-51% of children continue to have symptoms one week after injury 3
• Symptoms may worsen with physical or cognitive activity including schoolwork, reading, video games, or screen time 1
• Daily symptom monitoring is recommended using a symptom checklist for at least the first week 3

When to Contact Healthcare Provider

Parents should contact their child's healthcare provider if:

• Symptoms persist beyond 7-10 days 2
• Symptoms worsen instead of improving 1
• New symptoms develop during recovery 4
• The child cannot return to normal activities after 2 weeks 2
• Symptoms return during gradual activity resumption 1

Important Pitfalls to Avoid

A critical mistake is assuming the child is fine because they "look normal" physically—concussion is a functional brain injury that may not have visible signs. 1 Additionally:

• Never allow return to sports or physical activity on the same day of injury, even if symptoms seem to resolve 1, 2
• Do not underestimate cognitive symptoms—difficulty with schoolwork is as important as physical symptoms 1
• Avoid prolonged complete rest beyond 24-48 hours, as this may actually worsen recovery 1, 5
• Watch for delayed symptom onset—some symptoms may not appear until hours or days after the injury 4

Activity Modifications During Recovery

While monitoring symptoms, parents should:

• Limit screen time (television, computers, video games, phones) as these can worsen symptoms 1
• Reduce cognitive demands including reading, homework, and activities requiring concentration 1
• Avoid loud music or noisy environments if sound sensitivity is present 1
• Consider sunglasses if light sensitivity is significant 1
• Ensure adequate rest without enforcing complete inactivity beyond the first few days 1