Written by Kimi Dunbar
Spoon Feed
Diagnosis of concussion in children < 8 years old is challenging, given unique and sometimes non-specific symptoms. Further research is needed to help clinicians diagnose early childhood concussion and provide appropriate management.
Synopsis
This review discusses early childhood concussion, highlighting distinct challenges in diagnosis, outcomes, and management for children under eight. Young children with concussions often display unique symptoms such as irritability, appetite changes, and sleep disturbances, which differ from those in older age groups. Physical and developmental characteristics, including rapid brain growth and limited communication skills, complicate diagnosis and recovery assessment. The review emphasizes the need for age-specific diagnostic criteria, assessment tools, and long-term studies to understand outcomes. Enhanced clinical guidelines could improve care and help mitigate potential long-term cognitive and behavioral impacts from early childhood concussion. (AI-generated)
Are they concussed, just a toddler, or both?
Diagnosis of a concussion at any age is based on history and report of symptoms. This is inherently challenging in early childhood (defined as <8 years), given that young children do not have the same ability to describe their symptoms as older patients, and their symptoms are challenging to differentiate from normal variation in behaviors. Many of the behavioral manifestations of concussion in early childhood could easily be attributed to normal toddler behavior, such as change in appetite, tantrums, clinginess, or distraction. Why does making the diagnosis matter? Despite research touting the plasticity of the early childhood brain, there is data that concussion at a young age has adverse developmental outcomes. Unlike their older counterparts presenting with concussion, younger children with head injury are likely to be diagnosed with “unspecified injury to the head” and aren’t given the same level of detail in discharge instructions or anticipatory guidance. This will change the way I approach children with early childhood head injuries. I’ll be looking for more non-specific and less “classic” signs of concussion, such as change in mood, appetite and comfort seeking. That said, vigilance in diagnosis is just the first step. Until we have the research to develop better follow-up guidelines for this population, diagnosis will only do so much.
Source
Early Childhood Concussion. Pediatrics. 2024 Nov 1;154(5):e2023065484. doi: 10.1542/peds.2023-065484. PMID: 39380506
