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What You Need to Know About Pediatric Concussion

June 19, 2024

Written by Joshua Belfer

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This new review summarizes the current evidence regarding diagnosis and management of mild TBI in children.

So many questions…any answers?
Concussion, or mild traumatic brain injury (mTBI), impacts one million children annually, and still remains a bit of a “black box.” Nonetheless, this review focuses on up-to-date evidence for timely diagnosis and approach to recovery for pediatric concussions.

Physical Exam and Diagnosis

  • Red flag symptoms: Altered mental status, seizures, limb paralysis/paresthesia, repeated emesis, ear/nose discharge
  • CT and MRI can be helpful in more serious TBI but are not needed to diagnose a concussion.
  • Risk factors for prolonged recovery: History of concussion, female sex, adolescent age, history of migraines.
  • Visual and vestibular abnormalities are common after concussions.

Acute Management

  • The majority recover from concussion within four weeks.
  • Relative cognitive and physical rest is recommended in the initial 24-48 hours after injury…BUT gradual return to activities should begin after this period
  • Studies have shown that strict and prolonged rest is associated with prolonged recovery.

Return to Learn and Sports

  • A Return-to-Learn guide can help the school reentry process, with attention to extra time for schoolwork and test-taking during recovery
  • A Return-to-Play protocol is crucial in allowing youth athletes to safely return to sport after a mild TBI


  • When visual symptoms persist, formal visual system rehab may be helpful.
  • Medication is used primarily for symptom management, not for recovery.
  • Short-term melatonin may be beneficial for children with sleep disturbances.

How will this change my practice?
When it comes to the challenging job of speaking with parents about the mystery of pediatric concussions, I will take all of the high quality evidence that’s out there! With the high volume of head injuries I see in the pediatric ER, I’m always assessing for red flag symptoms that may make me turn to brain imaging to evaluate for a serious TBI. I stress to parents that concussion recovery can be quite variable, and this article reviews some of the important steps that children and their parents can take to give them the best chance to recover quickly from a concussion.

Contemporary diagnosis and management of mild TBI (concussions): What you need to know. J Trauma Acute Care Surg. 2024 Jun 1;96(6):865-869. doi: 10.1097/TA.0000000000004297. Epub 2024 May 2. PMID: 38696496.

What are your thoughts?