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Concussion Signs and Symptoms: Delayed Onset More Common in Children, Teens


Detecting a possible brain injury such as concussion can be relatively easy when there are obvious signs.  But not every young athlete who suffers a concussion playing sports will exhibit signs and/or symptoms of concussion immediately after injury.

Indeed, children, when compared to adults, appear more likely to experience a more pronounced delay in the onset of symptoms, so that the severity of the concussion - even the diagnosis itself - might not be fully apparent until days after contact. There are also studies that suggest that the younger the child, the more delayed their symptoms may be, and the longer it may take to recover from those symptoms.1

The reason, explains sports concussion neuropsychologist and MomsTEAM expert Rosemarie Scolaro Moser, PhD, in her new book, Ahead of the Game, is that the cascade of chemical reactions2 triggered by the temporary disruption of the brain's delicate electrochemical balance which occurs as a result of a concussion leaves the brain in an "energy crisis, which may escalate over the next twenty-four to seventy-two hours as the brain attempts to heal itself."

This is also why, says Moser, a child's recovery after concussion may differ from those of adults, with children more likely to feel better initially, only to worsen days later. 

Parent vigilance key

Parents are often in the best position to spot the often subtle signs or symptoms of concussion, Moser advises parents of athletes in collision and contact sports to be vigilent, not just during and immediately after sports, but over the course of a sports season:

  • become active observers at practices and games:
    • watch for blindside hits and rough tackles
    • pay particularly close attention if your child has experienced a concussion in the past.
  •  be on the lookout for any changes in speech, balance, thinking, behavior, attention, or emotional rsponse;
    • check for signs of confusion, headache, vision changes, dizziness, ringing in the ears, or nausea;
    • listen for slower-than-normal answers to any questions you ask
    • If your child says he feels "fine" or "okay" following a hard hit, he hasn't given you enough information, so ask more pointed questions: look your child directly in the eyes and ask, slowly and methodically, "Do you feel just as you normally would feel after a game? Does anything feel different than usual? "The answers to these questions can not only help you determine if an injury has occurred, but may also give you and your health care provider a better understanding of how your child usually feels," says Moser.
  • always be alert to any out-of-character changes in your child's cognitive abilities (e.g. unexplained drop in grades), emotional behaviors, physical symptoms, or sleep patterns, the presence of which should prompt a thorough examination for the possibility of post-concusson syndrome (PCS).  Sometimes these changes, Moser says, may seem to have appeared "out of the blue."  Indeed, she says, children with undiagnosed concussions can be misdiagnosed with attention deficit hyperactivity disorder (ADHD) or with a learning disorder, misdiagnoses that can "wound a child's sense of self, alter his or her academic career, and cut short athletic [careers].  In short, misdiagnosis can be devastating."

1. Field M, Collins M, Lovell M, Maroon J. Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes.  J of Pediatrics 2003;142:546:553.

2. Giza C, Hovda D. The neurometabolic cascade of concussion. J Ath Tr.  2001;36(3):228-325.

Posted July 9, 2012