General Concussion FAQs

In most cases, check with the pediatrician first if at all possible. Emergency Department (ED) personnel can evaluate your child's neurological (brain) functions to determine whether additional tests are needed. Not all concussions require emergency care, but the ED can provide a diagnosis and rule out more severe injury.

The pediatrician may want to schedule an appointment to examine the child or adolescent, send them to the Emergency Room, or choose to refer them to a concussion specialist. However, he or she should be taken to emergency care if any of the following danger signs are demonstrated:

• Headaches that worsen
• Looks very drowsy or can't be awakened
• Can't recognize people or places
• Change in state of consciousness
• Focal neurological signs
• Increasing confusion or irritability
• Neck pain
• Seizures
• Slurred speech
• Repeated vomiting
• Unusual behavior change
• Weakness/numbness in arms/legs

There are different levels of severity of a concussion. Some professionals may use concussions grading systems to describe the early aspects of the injury. Grading systems, though, are not directly related to the length of time it will take to recover. The best way to judge the severity of the injury is based on how long it takes for the individual to recover, although other factors may be involved. Do not automatically assume that a more severe grade of a concussion given at the time of the injury will translate necessarily to a longer recovery time.

Yes, it is possible that the athlete did have a concussion. Loss of consciousness is not necessary for the diagnosis. It is only one sign of this injury and occurs in 10% of injuries or less. Most importantly watch for any of the signs and symptoms. If any of them are present, you should suspect a concussion.

No. CT scans are not used to diagnose a concussion. They can detect bleeding and swelling in the brain, usually signs of a more significant brain injury. A concussion, or mild traumatic brain injury, results in changes in the chemical and physiological properties of the brain that cannot be seen on a CT scan, so most scans are normal after concussion.

Under no circumstances should a child fully participate in practice if they are not yet recovered, and have not yet received clearance from a healthcare professional with training and experience in concussion management. In terms of attending a practice for non-contact activities, this may be recommended by your healthcare provider assuming that they can assure that they will not be at risk of being re-injured. Early mild-to-moderate exercise can be helpful for treatment, and may be recommended in a practice setting when it can be arranged safely. Contact-related activities, or activities with risk of contact, remain prohibited until the individual has fully recovered. 

The individual has fully recovered from a concussion when their functioning has returned to normal as determined by an appropriate healthcare professional trained in concussion evaluation and management. This means they have no concussion symptoms at rest or with normal cognitive and physical activity, and their cognitive and balance performance is normal. Children who have not fully recovered should not return to contact sports or put themselves in situations where they could be re-injured. When in doubt, sit them out!

Just like all injuries or illnesses, every concussion must be managed and treated individually. The evaluation of the child or adolescent is important in determining the treatment for that person.

• An active rehabilitation approach is the most effective means of managing a concussion. Maximizing careful reintegration into everyday activities while minimizing over-exertion (physical, mental) is the key to recovery. It is important to strike a balance between what activities are safe and do not significantly worsen symptoms. Significantly worsened symptoms are occurring when an individual is feeling worse over time, rather than feeling better, and when the increase in those symptoms are long lasting after the activity and affects the person’s ability to do other activities afterwards.
• Guidelines for managing concussions have been developed within the sports context due to the need for safe return to play in order to minimize the risk for re-injury. These guidelines are also relevant to the return of the child or teenager to any activity involving increased physical or mental exertion.
• The 2022 International Concussion in Sport (CIS) Group recommended the following new guidelines for returning athletes to play:

  • Emphasis on careful on-field evaluation

  • Restriction of play for symptomatic athletes: No athlete with any symptoms is to return to play.

  • Neuropsychological testing as the cornerstone to management

  • Once the athlete no longer has symptoms and their cognitive function has returned to normal, a graduated approach should be used in returning them to play, guided by careful individualized assessment and monitoring of post-concussive symptoms and neurocognitive functioning at each successive stage of activity, with the following progression:

    • Rest

    • Aerobic exercise

    • Sport-specific training

    • Non-contact drills

    • Full-contact training

There are two important things to do after a concussion to help your child or adolescent. First, make sure that they do not participate in any high-risk activities where they could take additional blows to the head. You may need to increase supervision (particularly younger children) to make sure that they are not too active or put themselves in situations where they could be re-injured. Second, after an initial period of rest for 24-48 hours, daily activities should be gradually reintroduced with attention towards worsening symptoms and ability to perform those daily activities successfully. In the first few days, parents should monitor the child or adolescent for symptoms regularly at least several times per day.

As the child recovers, monitoring should occur every few days, particularly as the child returns more fully to activities and symptoms are improving. Note that strict rest, which involves a reduction in all activities including any exercise, any social contact, no school-related work, and severely reduced stimuli like lights and noises, is not recommended beyond the first 24-48 hours, and only if symptoms are severe.

As symptoms lessen, it is good to gradually increase safe activities as long as symptoms do not significantly worsen. Only allow a higher risk activity (practices, scrimmages and competition) after a qualified healthcare professional evaluates and clears your child to do so.

Appropriate evaluation, management and treatment is the key to a safe outcome and allowing recovery to occur as quickly as possible. The symptoms of a concussion can cause problems when the child returns to school, home or community activities. The concussion evaluation assesses possible cognitive, behavioral or physical symptoms to assist in planning during recovery for all of these environments.

During an evaluation, a child or adolescent may be given tests of attention, memory, speed and balance. Test results are used to determine any needed interventions, as well as plan for return to school, sports and other physical activities. Children or adolescents with concussions sometimes experience prolonged symptoms, which interfere with their daily activities and sports. Clinicians will evaluate the child and help put a plan together that provides the necessary support for school, work and return to play decisions and keeps their recovery moving forward.

The decision to allow return to sports practices or games is to be made by an appropriate healthcare professional trained in concussion evaluation and management. That professional will help to direct the athlete's return to sports participation. An athlete who still has symptoms (at rest or with activity) or who is not performing at their baseline cognitively should NEVER return to a practice or game where there is a possibility they could be re-injured. The athlete can return to practice only after having successfully completed a graduated return to play program under the supervision of a trained healthcare provider, and received written clearance. This program can take several days (after resolution of symptoms and cognitive effects) to complete and sometimes longer, depending on the injury.

• The developing brain appears to be more vulnerable to brain injury.
• High school athletes may take longer to recover from concussion than college athletes and younger kids.
• Even seemingly “mild” concussions can have significant effects. A large number of youth (~30%) may continue to experience concussion symptoms for longer than a month after a concussion, and how long the concussion symptoms will last is very hard to predict at the time of an injury.
• Effects of multiple concussions can be cumulative when a prior concussion has not fully healed. Multiple concussions that occur close together may lower the threshold for the next concussion injury and increase symptom severity in subsequent concussions.
• Continued headaches that are different from pre-injury headache patterns may indicate incomplete recovery. Youth experiencing headaches one week post-injury are more likely to experience more overall symptoms and perform more poorly on neurocognitive measures than those who do not report headaches.
• Physical and/or mental exertion should be modified during recovery. Doing too much, too soon can lead to significant increases in symptoms. We don’t yet know how that relates to the time until recovery, but to manage symptoms and discomfort, some activities may need to be reduced or modified.

The time to recovery from a concussion can range widely, from days to weeks or months. It can be difficult to predict the length of recovery for any one person, especially right after the injury occurs. Parents and other professionals can help young people minimize their recovery time by balancing rest with a gradual increase in physical and cognitive (thinking) activity. Strict rest, which involves a reduction in all activities including any exercise, any social contact, no school-related work, and severely reduced stimuli like lights and noises, is not recommended beyond the first 24-48 hours, and only if symptoms are severe.

There are certain factors that may prolong recovery such as a prolonged loss of consciousness or amnesia (memory loss) for the event, repeat concussion before the first injury has healed, and multiple concussions that occur within a short period of time (within several months). Children or adolescents who have been diagnosed with ADHD, learning disabilities, headaches, sleep problems or emotional problems or who experience notable stress during recovery can also take longer to recover. Individualized treatments may also help symptoms to resolve more quickly. 

There is a lot of attention being paid to concussions in television and other media. There are several reasons for this increased attention, including better methods to identify the injury and a better scientific understanding of this brain injury and its risks. Increased awareness is always positive, although we continue to need to understand more about the injury.