When in Doubt, Sit Them Out: Recognizing Concussions in Children

My legs did not commit to the absurd request by mind to jump clear over someone, I never lifted off. Before I knew it — smack! Plastic pads and polycarbonate helmets crashed together as things went dark. Looking up at the bright stadium lights, I thought to myself, “Wow, really got my bell rung on that one.”

It wasn’t until that evening when the headache started. As I sat in the emergency room, I wondered, did I have a concussion?

According to the CDC, a concussion is a form of traumatic brain injury that results when there is a sizable hit that occurs to one’s head, face, neck or even body.

This example from my youth football days is just one instance where my experience as a patient continues to help guide many of my decisions as a resident physician.

Kids at Risk

Any type of head injury, including those from motor vehicle crashes or falls, can be a source of concussions. It is important to recognize the concussion risks that come with organized youth sports — including football, soccer, hockey, basketball, and lacrosse. Concussions are also not gender specific; female soccer players comprise a significant portion of concussion-related injuries.

Recognizing Symptoms

Previously, concussions were thought to only occur with head collisions resulting in a loss of consciousness. New research suggests this only occurs in as little as 10% of concussions.

A continued problem is the notion of “toughing it out” which can lead to underreporting and delays in diagnosis. To recognize symptoms, encourage your child to speak up! Symptoms include headache, dizziness, lightheadedness, changes in vision, confusion, and changes in speech or walking. Changes in sleep patterns, fatigue, and mood (irritable, anxious, etc.) also can be signs of a concussion.

Keep in mind, the symptoms can be delayed, so remaining vigilant is key. While on the sidelines, look for confusion or signs of disorientation. Someone who appears to be less coordinated or unsteady needs immediate attention.

Does my child need to go to the ER?

Any child who has had a head injury and is complaining of symptoms noted above should be evaluated promptly by a medical professional.

Treatment and Guidelines

If a child gets a head injury at a sporting event, it is imperative that a child be pulled from the game once a concussion is suspected. Repetitive sequential head traumas have led to young athletes developing significant neurologic injury.  This is why laws across the nation have been passed to protect youth with suspected head injuries.

As a result, nationwide a policy of “when in doubt, sit them out” has been adopted— an excellent guide to ensure your child’s safety.

After a concussion, while normal daily activities can resume, it is recommended that all sports or physically demanding related activity be restricted for at least 24 hours. Evidence suggests an earlier and gradual step-wise return to physical activity is superior to prolonged rest periods and activity restrictions.

As long as symptoms are not returning, your child can advance in their level of activity every 24-48 hours with a goal to return to full activities by 7-10 days. Any new or recurrent symptoms during their progression would necessitate re-starting the cycle.

Similarly, while no specific classroom restrictions need to be in place beyond 24 hours, decreased concentration, confusion and headache may cause difficulty with school work.

Develop a plan with teachers to ensure your child does not fall behind significantly. Despite treatment, approximately 15-20% of children will have symptoms 3 months out from the initial injury.

The CDC’s campaign called HEADS UP aims to increase awareness for athletes, parents, and coaches to better address safety in sports. The HEADS UP initiative provides flyers, factsheets and even has interactive apps for kids to learn more about concussions. To learn more visit: https://www.cdc.gov/headsup/index.html.


By Kayvon Izadpanah Resident Physician University of Virginia Health System, Department of Emergency Medicine Health Policy Elective Fellow, ACEP Washington D.C. Office

Read more about Doc Blog

Read more about Pediatric Emergency Care

Read more Know When to Go

Accidents & Injury Brain/Stroke Doc Blog Know When to Go Pediatric Emergency Care Public Education