What Does Post-Concussive Syndrome Look Like in Children? Dr. Jane Gillett, BrainLine

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What are the signs of post-concussive syndrome in kids and what is the best treatment?

Post-concussive symptoms in infants, children, and adolescents are similar and yet have their own unique presentations.

In infants, it can be difficult to recognize that a brain injury has occurred. The most obvious symptom is loss of consciousness but other signs include crying inconsolably and not being able to be comforted, vomiting, or excessive sleepiness. Refusing to eat, prolonged irritability, or unusual or prolonged periods of quietness or inactivity may also be signs of a concussion or more serious brain injury. Bulging of the anterior fontanelle — or the soft spot of the head — is also an ominous sign. If your child has any of these symptoms he should be checked immediately by a physician.

After the injury, caregivers may notice a temporary loss of the most recently attained developmental skills (for example, if injured at age 6 months, the baby may stop babbling or may no longer be able to sit independently). But the baby should regain these skills and acquire new skills. Caregivers may also notice that the child is more irritable, cries more, has become a fussier eater, and has a change in sleep patterns. If the child cries more in a particular position, then the parent should consider the possibility that vertigo or dizziness has developed from the injury and that position should be avoided for a few weeks. In a more severe brain injury, the child’s head circumference may stop growing for a few weeks and then resume growing. In most cases, the infant will return to normal over the space of several weeks. During this time, the infant should be kept in as normal a routine as possible with more time for naps and sleep.

For young children under age 6 or 7, it is sometimes hard to recognize a brain injury because limited short-term memory and brief attention spans are normal at these ages. With older children and adolescents, these markers are more telling. With older children and teenagers, these markers are more significant. In teens we also look for confusion and word-finding problems.

Aside from memory and attention span issues or changes, recognizing a concussion in children and adolescents may include the following signs and symptoms:

• Brief (less than 20 minutes) loss of consciousness
• Confusion or being dazed or stunned, or seeing stars
• Headache
• Nausea
• Emotional lability (cry or laugh unexpectedly)
• Anxiety or depression
• Sleep disturbance
• Fatigue and the vertigo

These symptoms are best treated initially by rest — both physical and mental. Recovery is faster when the child or adolescent rests often and consistently post-injury. For the first few days after an injury, almost complete rest is important. After the symptoms have disappeared, see what happens when the child walks on even ground at a relatively brisk pace. If no symptoms recur then the child can increase his physical activity as long as he remains symptom free. Parents and teachers should carefully monitor the child’s first few days, weeks, and months after the injury and return to school. If symptoms return or problems in school develop, the child should be taken to a physician and possibly a neuropsychologist.

If any of the symptoms get significantly worse rather than better, if new symptoms appear after a few days, if the child starts vomiting, or is difficult to arouse then he should be taken immediately for an assessment by an emergency physician.

Click here to go to About Ask the Expert.

Jane Gillett, MD, Dr. Gillett was a fully qualified neurologist certified by the Royal College of Physicians and Surgeons of Canada in both pediatric and adult neurology. She created and developed the Pediatric Acquired Brain Injury Community Outreach Program (PABICOP) at the Children’s Hospital of Western Ontario and was the medical director for four years. She was the medical director of the Acquired Brain Injury Program at Hamilton Health Sciences and was an associate professor at McMaster University. Dr. Gillett died unexpectedly of cancer in February 2011. She is greatly missed by her parents, friends, and her many colleagues in the pediatric TBI community.

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