What are the signs of concussion in pediatric patients?

From the Guidelines

Signs of concussion in pediatric patients include headache, nausea, impaired balance, difficulties concentrating, confusion, emotional lability, and fatigue, as outlined in the 2024 American Heart Association and American Red Cross guidelines for first aid 1. These symptoms can vary depending on the age of the child, with infants and toddlers exhibiting changes in eating or nursing habits, persistent crying, inability to be consoled, loss of interest in favorite toys, and altered sleep patterns. In older children, parents should watch for changes in behavior such as irritability, sadness, nervousness, or more emotional reactions than usual. Physical signs may include loss of consciousness, appearing dazed, answering questions slowly, and showing behavior or personality changes. If a child exhibits these symptoms after a head injury, they should be evaluated by a healthcare provider immediately. No medications should be given without medical advice, as some pain relievers like aspirin or NSAIDs could increase bleeding risk, as noted in the guidelines 1. The developing brain is particularly vulnerable to concussion, and children often take longer to recover than adults, highlighting the importance of physical and cognitive rest initially, with a gradual return to normal activities under medical supervision 1. This approach is supported by the Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children, which emphasizes the need for evidence-based recommendations for healthcare professionals 1. Key considerations in managing pediatric concussions include:

• Monitoring for symptoms and signs of concussion
• Providing cognitive rest and avoiding activities that exacerbate symptoms
• Gradually returning to normal activities under medical supervision
• Communicating with school nurses, administrators, and teachers to ensure understanding of the recommendations 1. By prioritizing these considerations and following the guidelines outlined in the most recent and highest-quality studies, healthcare providers can help improve outcomes for pediatric patients with concussions.

From the Research

Signs of Concussion in Pediatrics

• Concussions are a form of traumatic brain injury (TBI) that can result in a range of symptoms, including altered mental status, focal neurological deficits, and intractable vomiting 2
• The diagnosis of concussion can be difficult due to varying degrees of symptomatology and recovery, and neuro-radiologic imaging studies typically reveal no abnormalities 2
• Symptoms of concussion may include:
  • Altered mental status
  • Focal neurological deficits
  • Intractable vomiting
  • Headaches
  • Cognitive symptoms
  • Emotional symptoms
• Concussions can have serious complications, including second impact syndrome and chronic traumatic encephalopathy, if not properly managed 3

Management of Pediatric Concussions

• The management of pediatric concussions requires a multi-disciplinary and individualized approach, including medical and non-medical options for treatment of complex symptoms 4, 5
• Rest and exercise during recovery are important considerations, with most clinicians recommending a period of rest followed by gradual return to activity 6, 5
• Neuropsychological testing and neuroimaging may be used to evaluate and manage concussion symptoms, particularly in cases where symptoms persist 6, 4
• Medications, such as acetaminophen and nonsteroidal anti-inflammatory medications, may be used to manage symptoms, including headaches and cognitive symptoms 6

Return to Play and Return to Learn Guidelines

• Return to play and return to learn guidelines are important considerations in the management of pediatric concussions, with most clinicians recommending a gradual return to activity 2, 5
• The nursing role in concussion management is critical, with nurses playing a key role in educating patients and families about concussion symptoms and management 2
• Future implications for concussion management include the need for further research on effective interventions and outcomes in pediatric concussions 4