Does your kid's concussion require a trip to the emergency room?

Kids and adolescents are a naturally active and on the move. From toddlers learning to walk to teens playing in the championship lacrosse game, children are often engaging in activities that can lead to trips, falls and injuries. What should you do if your child sustains a fall or hit to the head and they act or note they feel different? What if they aren’t able to communicate that they’re not feeling well? How do you know if it’s an emergency?

Some of the most common questions parents ask when their child has experienced a blow to the head or hard fall are:

“Is my child okay?”
“Should I take them to the emergency room?”

While not every head injury requires a trip to the ER, it’s important to know the signs and symptoms associated with the ones that warrant immediate medical attention. 

This concussion care guide can help you determine what level of care your child needs after a fall, trip or injury.

Monitor your child if they’re initially acting normal and reporting no symptoms

A child who is otherwise healthy, does not lose consciousness after hitting their head or falling, and is feeling and acting normal has probably just sustained a minor bump and is okay to continue activities. However, it is important to observe and check in with them over the course of the next 24-48 hours to look for signs and symptoms of concussion. If you have any concerns or questions, promptly call your child’s physician for help determining next steps.

If your child is showing concussion symptoms, remove them from activities and schedule a prompt appointment with their doctor

If your child shows or complains of any concussion signs or symptoms following a fall, injury to the body or hit to the head, remove them from activity (physical and cognitive) immediately and promptly schedule an appointment with a physician who is trained in concussion care. It’s important to remember that concussion symptoms are unique to each individual and present in various ways that can affect the way a person feels, thinks and acts. Even if your child has had a concussion before, a second concussion can present with different signs and symptoms than the first.

It’s also worth noting that the signs and symptoms of a concussion in kids can vary by age. Infants, toddlers and younger children may not be able to report symptoms like older kids. For younger children, symptom reporting is heavily dependent on parent/caregiver observation, so pay close attention to your child’s behavior and note any major changes that occur after falls or blows to the head.

Typical signs and symptoms of a concussion in school-aged children include:

• Headache or pressure in head
• Nausea or vomiting
• Stomachache
• Dizziness and balance problems
• Vision problems (double vision, blurry vision)
• Sensitivity to light or noise
• Feeling sluggish, hazy, foggy or groggy
• Feeling slowed down, trouble concentrating, difficulty thinking clearly
• Fatigue, drowsiness
• Feeling more emotional than normal
• Sleep disturbances (trouble falling/staying asleep and sleeping more/less than normal)
• Just “not feeling right”
• Not being able to recall events prior to or after a fall/blow to the head
• Moving clumsily or appearing off balance
• Answering questions slowly
• Appearing dazed or stunned
• Displaying odd behavior or personality changes
• Forgetting conversations or instructions (during sports, forgetting assignment, position, score or opponent)
• Losing consciousness or being knocked out (even briefly)

Typical signs and symptoms of a concussion in infants and toddlers include:

• Blank stare
• Loss of new skills (walking, toilet training, speech)
• Changes in appetite
• Swelling of the scalp or soft spot, persistent rubbing of the head
• Listless (child feels floppy in your arms)
• Answers questions more slowly
• Loss of balance, poor coordination
• Increased dependence or clinginess
• Cranky, irritable, defiance not related to comprehension
• Cries easily, difficult to console
• Child is quieter than normal
• Loss of consciousness
• Tiring easily
• Slurred speech
• Changes in play or loss of interest in activities
• Stomachache

When you see concussion red flags, call 911 or take your child to the emergency department immediately

Red flag signs and symptoms are those that indicate a more serious injury may be present. In the initial 24-48 hours after injury, monitor your child for worsening or red flag symptoms.  

Red flag concussion signs and symptoms in school-aged children include:

• Headache that gets worse and does not go away
• One pupil larger than the other
• Significant drowsiness or cannot be awakened
• Repeated vomiting or nausea             
• Slurred speech
• Convulsions or seizures         
• Suspected neck injury
• A dramatic change in personality
• Weakness, numbness or decreased coordination       
• Loss of consciousness (even if brief)
• Increasing confusion, restlessness or agitation
• Blood/clear fluid draining from the ear/nose
• Worsening symptoms

Red flag concussion signs and symptoms in infants and toddlers include those listed above AND:

• Repeated/uncontrolled vomiting
• Losing consciousness
• Difficulty waking up
• Skull deformity (large bump, bruise, soft spot and/or swelling)
• Crying that won’t stop; unable to console or calm

Learn more about concussion care. Or, give us a call at (804) 628-4878.

By Kassandra Kelly, M.S., LAT, ATC, athletic trainer