Written By: Dr. Patricia McGuire
Three-year-old Chase was playing around on his older brother’s bunk bed. He wasn’t supposed to be up there, but Charlie liked to see the room from up high. He also enjoyed the excitement of his brother trying to get him down. Unfortunately, Charlie lost his balance and fell to the floor, hitting his head this time. He didn’t lose consciousness, but he had a big goose egg. His parents called their doctor, who asked them about symptoms. At that point, he wasn’t showing any problems other than the bump. The doctor discussed what to look out for and red flag signs requiring them to take Charlie to the Emergency Department. They made sure that Charlie easily awoke for the rest of the night. He complained of a headache and threw up once, but other than that, he had no issues. However, over the next six weeks, he continued to complain of his head hurting, was clumsier, as well as moodier and more irritable. They took him to his doctor, who diagnosed him with post-concussive syndrome.
How Common are Concussions?
Concussions are the most common injury in children and adolescents. Studies estimate that the numbers of concussions range from 2 to 3.8 million per year. Children ages 0 to 4 years make up the largest population to be seen for concussions in emergency rooms each year. Following that are adolescents and those in their early 20’s. Most children and adolescents who have a concussion will heal over two to four weeks. During that time, they may experience the following symptoms:
• Nausea and/or vomiting
• Blurred vision
• Concentration and memory problems
How Common is Post-concussion Syndrome?
10-20% of children and adolescents will have symptoms much longer, ranging from months to years. These youth have post-concussion syndrome. It is known that over 53% of concussions result from organized sports, 5.5% occur in homes, and 6.6% are from motor vehicle accidents. While it is not known for sure why some children and adolescents go on to have post-concussion syndrome while others don’t, there are some likely factors:
• a history of a previous concussion or other brain injuries,
• neurological or mental health disorders,
• learning difficulties,
• family and social stressors
What additional problems do you see with post-concussion syndrome?
In addition to the symptoms these children and adolescents experience from the concussion, they also have the following symptoms, making life at home and school harder:
• Being argumentative and stubborn
• Behavioral and emotional changes
• Noise and light sensitivity
These symptoms affect the child’s ability to keep up with daily activities, especially at school. The head injury leads to many skills, which used to be automatic, to now require extra time to think through and do. Many skills, especially related to remembering and concentrating, are limited. The child feels more anxious since he can’t keep up the way he could before. He gets frustrated quickly and may act out in class. Light and sound sensitivity worsens his headaches. He will be more tired in class due to nighttime sleep problems.
What can be done to help the child or adolescent with post-concussion syndrome?
The parents and school must understand that this child is not faking it. While the school may have made informal accommodations for the first few weeks after the concussion, they may feel that things should be back to normal by one month out. In this situation, the child’s physician needs to guide the rate of moving forward. Implementing a 504 plan, an educational plan of strategies, accommodations, and added services will likely be necessary. However, some of the services need to come under an IEP. The types of services the school may provide include:
- Occupational Therapy – May help with dizziness, light sensitivity, and visual tracking.
- Speech-Language Therapy – Better understand what he hears or reads, improve attention activity, and improve memory strategies
- Physical Therapy – Helping with eye-hand coordination and any neck/cervical issues that would affect headaches and dizziness, monitoring and adapting activities that require balance and exercise.
Either at school or through a community-based mental health center, the child will benefit from counseling to deal with the emotions, anxiety, depression, and frustration that having post-concussion syndrome may cause. Therapy is an essential resource to use since emotional stressors can slow down brain healing. It is important to provide the child or adolescent with a clear understanding of what is happening in his body to decrease the suspiciousness that builds up.
In addition, the child and adolescent should continue to focus on:
• nutritious foods that are high in antioxidants (found in berries, nuts, beans, and dark green vegetables), which aid in healing,
• getting aerobic exercise but at low risk for head trauma (walking, jogging, or a stationary bike), meditation to lower stress
• and plenty of sleep.
Can post-concussion syndrome last forever?
Most children and adolescents with post-concussion syndrome will recover in less than three years. A small number will continue to three years and beyond. They will likely have a permanent disability. A study out of Canada found that a percentage of these youth were noncompliant with recommendations to avoid activities that could lead to further brain damage. Another group had higher rates of mental health problems. Studies have shown that patients who already have mental health or learning problems are more susceptible to long-term issues from post-concussion syndrome.
While parents can’t completely prevent children and adolescents from getting concussions, they can make sure that they keep them as safe as possible. This would include using helmets for biking and skateboarding and sports such as football and hockey. It would also include ensuring that they always use seat belts in cars. If the child gets a concussion, it is crucial to follow the advice of medical professionals. Pushing the child or adolescent to go back to all his activities, including school and sports, too fast can lead to post-concussion syndrome, and the goal is to prevent this from happening.
Munson, Jessica, "Speech-Language Pathologists’ Knowledge, Confidence Levels, and Practice Patterns with Mild Traumatic Brain Injury in the Schools" (2021). Master's Theses. 215. https://digscholarship.unco.edu/theses/215
Post-concussive syndrome (pcs) clinical practice guideline: occupational therapy, Ohio State University
Post-concussive syndrome (pcs) clinical practice guideline: physical therapy, Ohio State University
Reed, N.*, Zemek, R.*, Dawson, J., Ledoux, AA., et al. (2021). Living Guideline for Pediatric Concussion Care DOI 10.17605/OSF.IO/3VWN9, www.pedsconcussion.com
Yaramothu C, Goodman AM, Alvarez TL. Epidemiology and Incidence of Pediatric Concussions in General Aspects of Life. Brain Sci. 2019 Sep 27;9(10):257. doi: 10.3390/brainsci9100257. PMID: 31569649; PMCID: PMC6827131.
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