What is concussion (mild tbi)?

A concussion is a kind of injury to the brain. It happens when the head or body receives a hard blow. The impact can jar or shake the brain against the skull. This interrupts the brain's normal activities. Although your child may have cuts or bruises on the head or face, your child may have no other visible signs of a brain injury. Your child may not have a CT or MRI scan. Damage to the brain from a concussion can't be seen in these tests. Also, CT and MRI scans have risks.

Any child who has had a concussion at a sports event needs to stop all activity and not return to play. Being active again before the brain recovers can raise your child's risk of having a more serious brain injury.

For a few weeks, your child may have low energy, dizziness, trouble sleeping, a headache, ringing in the ears, or nausea. Your child may also feel anxious, grumpy, or depressed. Your child may have problems with memory and concentration. These symptoms are common after a concussion. They should slowly improve over time. Sometimes this takes weeks or even months.

It is not always easy to know if someone has a concussion. You don't have to pass out (lose consciousness) to have a concussion.

Symptoms of a concussion range from mild to severe and can last for hours, days, weeks, or even months. If you notice any symptoms of a concussion, contact your doctor.

Symptoms of a concussion fit into four main categories:

Thinking and remembering.

• Not thinking clearly
• Feeling slowed down
• Not being able to concentrate
• Not being able to remember new information

Physical.

• Nausea and vomiting
• Headache
• Fuzzy or blurry vision
• Dizziness
• Sensitivity to light or noise
• Balance problems
• Feeling tired or having no energy

Emotional and mood.

• Easily upset or angered
• Sad
• Nervous or anxious
• More emotional

Sleep.

• Sleeping more than usual
• Sleeping less than usual
• Having a hard time falling asleep

Symptoms in young children

Young children can have the same symptoms of a concussion as older children and adults. But sometimes it can be hard to tell if a small child has a concussion. Young children may also have symptoms like:

• Crying more than usual.
• Headache that does not go away.
• Changes in the way they play or act.
• Changes in the way they nurse, eat, or sleep.
• Being upset easily or having more temper tantrums.
• A sad mood.
• Lack of interest in their usual activities or favorite toys.
• Loss of new skills, such as toilet training.
• Loss of balance and trouble walking.
• Not being able to pay attention.

Symptoms in older adults

Concussions in older adults can also be dangerous. This is because concussions in older adults are often missed. If you are caring for an older adult who has had a fall, check for symptoms of a concussion. Signs of a serious problem include a headache that gets worse, increasing confusion, or both. See a doctor right away if you notice these signs. If you are caring for an older adult who takes a blood thinner and who has had a fall, take them to a doctor right away, even if you don't see any symptoms of a concussion.

Right away

After being seen by a doctor, some people have to stay in the hospital to be watched. Others can go home safely. If you go home, follow your doctor's instructions. The doctor will tell you if you need someone to watch you closely for the next 24 hours or longer.

In the days or weeks after

Some people feel normal again in a few hours. Others have symptoms for weeks or months. It is very important to allow yourself time to get better and to slowly return to your regular activities. If your symptoms come back when you are doing an activity, stop and rest for a day. This is a sign that you are pushing yourself too hard. It is also important to call your doctor if you are not improving as expected or if you think that you are getting worse instead of better.

Rest is the best way to recover from a concussion. You need to rest your body and your brain. Here are some tips to help you get better:

• Get plenty of sleep at night, and take it easy during the day.
• Avoid alcohol and drugs.
• Avoid activities that are physically or mentally demanding (including housework, exercise, schoolwork, video games, text messaging, or using the computer). You may need to change your school or work schedule while you recover.
• Ask your doctor when it's okay for you to drive a car, ride a bike, or operate machinery.
• Use ice or a cold pack on any swelling for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
• Ask your doctor if you can take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.

Concussion and sports

A person who might have a concussion needs to immediately stop any kind of activity or sport. Being active again too soon increases the person's risk of having a more serious brain injury. Be sure to see a doctor before returning to play.

To reduce your chances of getting a concussion:

• Wear a seat belt every time you drive or ride in a car or other motor vehicle.
• Never drive when you are under the influence of drugs or alcohol.
• Make your home safer to prevent falls.

Wear a helmet for any activity that can cause a fall or impact to the head or neck. Examples include bike riding, football, baseball, ATV riding, skateboarding, skiing, snowboarding, inline skating, and horseback riding. Helmets help protect your skull from injury. But brain damage can occur even when a helmet is worn.

To reduce your child's chances of getting a concussion:

• Use child car seats and booster seats correctly.
• Teach your child bicycle safety.
• Teach your child how to be safe around streets and cars.
• Keep your child safe from falls.
• Teach your child playground safety.
• Help your child prevent injury from sports and other activities.

Any person who may have had a concussion needs to see a doctor. If a doctor thinks that you have a concussion, they will ask questions about the injury. Your doctor may ask you questions that test your ability to pay attention and your learning and memory. Your doctor may also try to find out how quickly you can solve problems. The doctor may also show you objects and then hide them and ask you to recall what they are. Then the doctor will check your strength, balance, coordination, reflexes, and sensation.

Neuropsychological tests have become more widely used after a concussion. These tests are only one of many ways that your doctor can find out how well you are thinking and remembering after a concussion. These tests can also show if you have any changes in emotions or mood after a concussion.

Sometimes a doctor will order imaging tests such as a CT scan or an MRI to make sure your brain is not bruised or bleeding.

Pain control

• Use ice or a cold pack for 10 to 20 minutes at a time on the part of your child's head that hurts. Put a thin cloth between the ice and your child's skin.
• Ask the doctor if your child can take an over-the-counter pain medicine, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Be safe with medicines. Read and follow all instructions on the label.

At home

• Help your child rest their body and brain. Most experts agree that children should rest for 1 to 2 days. Let your child know that rest—even though it can be hard—can speed up recovery.
  • Pay close attention to symptoms as your child slowly returns to a regular routine. Avoid anything that makes symptoms worse or causes new ones.
  • Make sure your child gets plenty of sleep. It may help to keep your child's room quiet, dark or dimly lit, and cool. Have your child go to bed and get up at the same time, and limit foods and drinks with caffeine.
  • Limit housework, homework, and screen time.
  • Avoid activities that could lead to another head injury.
  • Follow your doctor's instructions for a gradual return to activity and sports.

Back to school

• Wait until your child can focus for 30 to 45 minutes at a time before you send your child back to school.
• Tell teachers, administrators, school counselors, and nurses what symptoms your child has or could develop. Sign a release form so the school can coordinate care with your child's doctor.
• Arrange for any special changes your child needs. For example, depending on symptoms, your child may need to:
  • Start back to school with shorter days.
  • Take 15-minute breaks after every 30 minutes of classwork.
  • Have more time for assignments, postpone tests, or have another student take notes.
  • Avoid bright lights. (You can suggest dimmed lighting or that your child wear sunglasses.)
  • Avoid noisy places, like the gym or cafeteria.
• Check in with school staff often. Discuss how your child is doing, academically and emotionally. A concussion can make kids grouchy and emotional. And needing extra help or extra rest can be hard for some kids.
• If your child doesn't recover within 3 to 4 weeks, talk with your doctor and the school staff. They may recommend a 504 plan. It's a plan for kids who need ongoing adjustments at school.

Doctors and concussion specialists suggest steps to follow for returning to sports after a concussion. Use these steps as a guide. In most places, your doctor must give you written permission for your child to begin the steps and return to sports. This means that your child must have no symptoms, is back to school, and is no longer taking medicines for the concussion.

Your child should slowly progress through the following levels of activity:

1. Limited activity. Your child can take part in daily activities as long as the activity doesn't increase symptoms or cause new symptoms.
2. Light aerobic activity. This can include walking, swimming, or other exercise. No resistance training is included in this step.
3. Sport-specific exercise. This includes running drills or skating drills (depending on the sport), but no head impact.
4. Noncontact training drills. This includes more complex training drills such as passing. Your child may also begin light resistance training.
5. Full-contact practice. Your child can participate in normal training.
6. Return to normal game play. This is the final step and allows your child to join in normal game play.

Watch and keep track of your child's progress. It should take at least 6 days for your child to go from light activity to normal game play.

Make sure that your child can stay at each new level of activity for at least 24 hours without symptoms, or as long as your doctor says, before doing more. If one or more symptoms come back, have your child return to a lower level of activity for at least 24 hours. Your child should not move on until all symptoms are gone.

A concussion is a type of traumatic brain injury that is caused by a blow to the head or body, a fall, or another injury that jars or shakes the brain inside the skull. Although there may be cuts or bruises on the head or face, there may be no other visible signs of a brain injury.

You don't have to pass out (lose consciousness) to have a concussion. Some people will have obvious symptoms of a concussion, such as passing out or forgetting what happened right before the injury. But other people won't. With rest, most people fully recover from a concussion. Some people recover within a few hours. Other people take a few weeks to recover.

It's important to know that after a concussion the brain is more sensitive to damage. So while you are recovering, be sure to avoid activities that might injure you again.

In rare cases, concussions cause more serious problems. Repeated concussions or a severe concussion may lead to long-lasting problems with movement, learning, or speaking. Because of the small chance of serious problems, it is important to contact a doctor if you or someone you know has symptoms of a concussion.

Your brain is a soft organ that is surrounded by spinal fluid and protected by your hard skull. Normally, the fluid around your brain acts like a cushion that keeps your brain from banging into your skull. But if your head or your body is hit hard, your brain can crash into your skull and be injured.

There are many ways to get a concussion. Some common ways include fights, falls, playground injuries, car crashes, and bike accidents. Concussions can also happen while participating in any sport or activity such as football, boxing, hockey, soccer, skiing, or snowboarding.