Concussion in Children
- Jason T
- Aug 26
- 4 min read
Updated: Sep 12
Concussion in Children: What Nursing Students Need to Know
By Jason Tschetter, Retired EMT & Senior Instructor (Saving Grace Medical Academy)
Concussions—also known as mild traumatic brain injuries (mTBI)—are among the most common pediatric emergencies nursing students will encounter in both hospital and community settings. Understanding how to recognize, assess, and manage concussions is essential to protect children from potentially life-threatening complications.
What is a Concussion?
A concussion occurs when the brain is shaken inside the skull due to a blow, fall, or sudden acceleration/deceleration injury. This movement disrupts normal brain function, but unlike severe head injuries, concussions usually do not show structural damage on imaging scans.
👉 Key Point: Loss of consciousness is not required for a concussion diagnosis. Children may appear alert but still have significant neurological changes.
Common Causes of Concussion in Children
Falls (most frequent cause in younger children)
Sports injuries (e.g., hockey, football, soccer, gymnastics)
Motor vehicle collisions
Physical assault or Shaken Baby Syndrome in infants
Red Flags: When to Seek Emergency Care
The first 24–48 hours after a head injury are the most critical for detecting complications such as intracranial bleeding or swelling. Nursing students should educate parents to seek immediate care or call 911 if the child has:
Difficulty staying awake or unresponsive to stimuli
Repeated vomiting (>2 episodes)
Seizures or abnormal movements
Slurred speech or difficulty speaking
Unequal pupils, loss of vision, or double vision
Sudden weakness, especially on one side of the body
Fluid or blood from the ears or nose (possible skull fracture)
High-pitched or unusual crying in infants
Regression in developmental milestones (e.g., toilet training loss)
Management in the First 48 Hours
Rest is critical. The child should rest physically and cognitively (limiting screens, reading, bright lights, and loud sounds).
Observation. A responsible adult should remain with the child. Contrary to old practice, waking the child every 2–3 hours is unnecessary unless advised by a physician.
Hydration and diet. Begin with clear fluids and advance slowly to regular diet.
Pain management. Use acetaminophen for headaches. Avoid NSAIDs (ibuprofen, aspirin) within the first 48 hours due to risk of intracranial bleeding unless directed by a physician.
Recovery Timeline: The First 4 Weeks
Most children recover within 7–28 days, but symptoms can persist longer. Common post-concussion symptoms include:
Fatigue or sleep disturbances
Confusion, poor concentration, or delayed responses
Headaches (with or without nausea)
Sensitivity to light and sound
Dizziness or poor balance
Irritability, mood swings, or sadness
Ringing in the ears
Nursing Considerations During Recovery
Return to school: Gradual reintegration is recommended. Start with shortened days and avoid testing until cognitive symptoms improve.
Return to play: Children should not return to sports until cleared by a physician. Reinforce the concept of “when in doubt, sit them out.”
Family teaching: Encourage parents to monitor mood changes, concentration issues, and sleep quality.
Follow-up: Persistent symptoms beyond 4 weeks warrant medical reassessment and possible referral to a concussion clinic.
Clinical Case Scenario
Case: You are working in the emergency department when an 8-year-old boy is brought in after falling off his bike. He was not wearing a helmet. His mother reports that he was briefly dazed but did not lose consciousness. He has vomited twice and now complains of a headache and blurred vision.
Questions:
What is the most important initial nursing assessment?
a) Ask about his last meal
b) Check airway, breathing, and circulation (ABCs)
c) Administer acetaminophen for headache
d) Prepare for immediate discharge
Which of the following symptoms is considered a “red flag” requiring urgent intervention?
a) Mild irritability
b) Sensitivity to light
c) Blurred vision and repeated vomiting
d) Fatigue and difficulty sleeping
Which medication is safest for initial pain management in the first 48 hours post-concussion?
a) Acetaminophen
b) Ibuprofen
c) Aspirin
d) Naproxen
What is the recommended guidance for return to sports?
a) Resume after 24 hours if symptoms improve
b) Resume only after physician clearance
c) Resume as tolerated by the child
d) Resume once the parent feels the child is ready
ANSWERS AT BOTTOM OF POST
References
Alberta Health Services. Concussion (Mild Traumatic Brain Injury) in Children. 2023.
Canadian Pediatric Society. Management of Pediatric Concussion. 2021.
Centers for Disease Control and Prevention (CDC). HEADS UP to Youth Sports. Updated 2024.
McCrory P, et al. Consensus Statement on Concussion in Sport – Amsterdam 2022. British Journal of Sports Medicine.
Just Remember
⚠️ Protect Yourself – Call 911 – Don’t Waste Time
Concussions are treatable, but a missed diagnosis can have life-long consequences. As a nursing student, learning to identify red flags and educate families can save lives.
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Just Remember:
Protect Yourself. Call 911.Don’t Waste Time.
RESOURCES:
Author - Saving Grace Medical Academy Ltd
Jason T
Retired EMT - Heart & Stroke Foundation Senior Instructor
Answers & Explanations
b) Check airway, breathing, and circulation (ABCs).Always begin with primary assessment to rule out life-threatening issues before addressing secondary complaints.
c) Blurred vision and repeated vomiting. These are red flag signs of possible intracranial bleeding or swelling and require urgent medical evaluation.
a) Acetaminophen. NSAIDs (ibuprofen, aspirin, naproxen) can increase risk of bleeding and are generally avoided in the first 48 hours.
b) Resume only after physician clearance. Return-to-play should follow a stepwise, physician-supervised protocol to prevent second-impact syndrome.
