Two young football players in full uniforms race down the field.

Concussion

Diagnose

When should I call a doctor?

If you suspect your child has a concussion, talk to your child's doctor. All head injuries should be taken seriously. In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away.

What is a concussion?

A concussion is an injury to the brain. It can be caused by a blow or bump to or around the head. This causes the brain to move inside the skull which can change how the brain works or processes information.

It is important to remember:

  • A concussion usually does not result in loss of consciousness. Only about 10 percent of concussions involve a loss of consciousness. 
  • Headache is the most common symptom, but you do not have to have a headache to have a concussion. 
  • Since a concussion does not involve a structural injury to the brain, imaging such as a CT scan or MRI will look normal.
  • Healing occurs over time and not right away.

How to identify a concussion

Your child's doctor will help determine if he has a concussion. Evaluations for suspected concussions may include:

  • Complete medical history and physical examination performed by a doctor
  • Review of post-concussion ImPACT evaluation scores

Learn more about ImPACT evaluations

Recognize the signs of a concussion

Your safety is our priority

Because the health and safety of our patients, visitors and staff is a priority, Children’s Healthcare of Atlanta is:

  • Screening all patients and visitors for illness including a temperature check. No sick visitors will be allowed in our facilities.
  • Allowing two caregivers with each patient. No other family or visitors are allowed.
  • Requiring everyone to wear a mask at all times during their visit.
  • Practicing social distancing by staying 6 feet away from other patients and visitors.
  • Enhancing cleaning measures.


Symptoms of a concussion

Your child may not have symptoms until a few days after the injury. A symptom is what is reported by the child. Your child may report one or more of these symptoms:

  • Confusion
  • Clumsy movement or dizziness
  • Nausea or vomiting
  • Memory loss
  • Tiredness
  • Upset stomach
  • Vision problems
  • Sensitivity to noise and light
  • Numbness or tingling anywhere on the body
  • Loss of balance or trouble walking
  • Mentally foggy, cannot think clearly or remember things
  • Slurred speech or other changes in speech
  • Irritable or more fussy than usual
  • Acts differently than normal - does not play, acts fussy or seems confused
  • More emotional, perhaps very sad or nervous
  • Different sleeping patterns 

New or worsening symptoms

You should watch your child very carefully in the first one to two days after a concussion. Call your child's doctor immediately, go to emergency room or call 911 if your child has any new symptoms or if symptoms get worse, such as:

  • Headaches that get worse
  • Clear drainage from the nose or ear
  • Scalp swelling that gets bigger
  • A seizure
  • Neck pain
  • Is hard to wake up
  • Vomits more than once
  • Acts differently than usual, such as if he does not play, acts fussy or seems confused
  • Cannot think clearly or remember things
  • Has weakness in the arms or legs or does not move them as usual
  • Cannot recognize people or places
  • Slurred speech
  • Passes out

Facts about concussion

  • It’s estimated that 1.6 to 3.8 million concussions occur every year — many of those go unreported or unnoticed.
  • Boys and girls respond differently to concussions. On average, girls take a few days longer to recover than boys. Younger athletes typically take longer to recover from concussions than older athletes.
  • Of any sport, football carries the highest risk of concussion. Next is soccer and basketball. As lacrosse grows in popularity, it may account for a significant number of concussions as well.

Concussion Conference Videos

Click here to view the Children’s Healthcare of Atlanta 2019 Concussion Conference Videos.

These videos include helpful information from our concussion experts around concussion recognition, prevention and strategies for returning to back school and sports. Listen to a real patient family experience of second impact syndrome, and hear keynote speaker Steve Wallace, former NFL player for the San Francisco 49ers, talk about his own experience with concussions.

This conference was made possible by the generous support of Andee's Army Child Brain & Spinal Cord Foundation. Andee's Army is an Atlanta-based 501(c)3 non-profit dedicated to funding the recovery and rehabilitation of children who have sustained brain and spinal cord injuries.

Concussion Conference Presentations

2019 Concussion Conference Welcome
Learn more about Children’s Healthcare of Atlanta’s concussion program and our tools, research and partnerships within the community.

Session 1: Pathophysiology, Recognition, Return to School

  • Overview and Brief Pathophysiology of Pediatric Concussion, David Marshall, MD
    What is a concussion? The concussion numbers have been rising rapidly over the past 10 years. It is time to increase awareness and educate people about concussions.
  • Recognition and Initial Steps, Joshua A. Vova, MD
    In this session you will learn the common diagnosis and symptoms of a concussion.
  • Return to School Strategies, Thomas G. Burns, PsyD, ABPP
    In this session you will learn about cognitive rest, educational accommodations, school transition and 5 steps to follow before returning to school after a concussion.
  • Pitfalls in Recovering Due to Headaches, Barbara M. Weissman, MD
    In this session you will learn how to identify, understand and distinguish risk factors and the appropriate approach in evaluation following a concussion.

Session 2: Return to Sports, Research, The Future

  • Strategies for Returning to Sports, David Marshall, MD
    In this session you will learn the steps and stages as to when it is safe to return back to sports and activities after a concussion.
  • An Introduction to Biomarkers for Concussion, Laura S. Blackwell, PhD
    In this session you will learn the latest in concussion research, treatment and management, including biomarkers.
  • Prevention/Protection: Where Are We Headed? Thomas G. Burns, PsyD, ABPP and Joshua A. Vova, MD
    In this session you will learn more about helmet selection, mouth guards, soccer head bands, neck collars and other ways to help reduce the risk of concussion in sports.

Session 3: Vestibular Therapy

  • Vestibular Therapy, Kelly Peczka, MSTP; Kaitlin Sipos, AuD; Kenneth “Allen” Jarratt, PT, DPT, OCS, MTC
    In this session you will learn the impact of concussion on the vestibular system and what happens when this system is disrupted.

2019 Concussion Conference Summary, Andrew Reisner, MD, FACS, FAAP
A special thanks to our conference supporter, Andee’s Army Child Brain & Spinal Cord Foundation.

Second impact and post-concussion symptoms

Athletes who suffer a concussion have a three to four times higher risk of suffering a second concussion. The second concussion may be caused by milder impact and the symptoms typically last longer than with the first one.

Second Impact Syndrome
We cannot stress enough how important it is that your child wait for full-recovery before getting back in the game. If an athlete suffers a second blow to the head before fully recovering from a concussion, the consequence can be catastrophic. Second Impact Syndrome (SIS) results in a massive rush of blood into the brain causing irreversible brain swelling, seizures, coma or death in one-half of all cases. Over 90 percent of survivors of SIS have permanent brain damage.

Post-concussive syndrome
When an athlete suffers from concussion symptoms for over six weeks, it’s called post-concussive syndrome. It’s difficult to predict who will get post-concussive syndrome, but kids with a previous concussion, ADHD, migraines or any other neurological condition may be at higher risk.

Take Action

Steps to get help

It's important to get your child evaluated if you suspect a concussion. If your child is participating in a sport at the time of injury, take him out of the game or practice. Your child should avoid activities that put him at risk for another head injury soon after the first one. A child should recover and be completely symptom-free at rest and with physical exertion before returning to sports or other activities. Before a youth athlete can return to play, he must be cleared by a healthcare provider trained in the management of concussions.

In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away.

1. Contact your pediatrician or visit a Children's Urgent Care Center or Emergency Department.

2. Get your non-urgent questions answered.

  • If a doctor has diagnosed your child with a concussion and you still have questions about his or her treatment contact our concussion nurse. Call 404-785-KIDS (5437) and ask for the concussion nurse.
  • The concussion nurse is available 8 a.m. to 3 p.m. Monday to Friday. If you call after 3 p.m. or on weekends or holidays, leave a message and the nurse will return your call the next business day.

3. Download our teaching sheet on concussions.

Helpful resources

Please view below all relevant national concussion guidelines.

Meet the Team

Our Concussion Program combines the expertise of specialists from Children's Physician Group as well as community physicians to help coordinate patient care. Our doctors and surgeons work closely with community providers to help ensure complete, coordinated care is delivered seamlessly.  Our program is led by Medical Director Andrew Reisner, MD, and Medical Director of Concussion Research, Thomas G. Burns, PsyD, ABPP, CN.

Children's Physician Group

Emergency Medicine

Hospitalist

Neurology

Neuropsychology

Neurosurgery

Physiatry

Sports Medicine Primary Care 

Remembering Dr. David Marshall

It is with great sadness that we share Dr. David Marshall, Children’s Medical Director of Sports Medicine and Director of Primary Care Sports Medicine with Children’s Physician Group—Orthopaedics and Sports Medicine, passed away suddenly Jan. 15, 2021. Dr. Marshall dedicated his career to caring for kid and teen athletes. We are deeply saddened by this news and our condolences are with his family during this difficult time. The Children’s Sports Medicine Program will continue to provide this same level of care to your children with the help of our wonderful staff of sports medicine physicians and advanced care practitioners.

Our Unique Approach

Concussion Program

Our Emergency Departments treat more pediatric patients with concussions than any other hospital in the state.* We have an entire team of pediatric specialists who understand how to care for concussions and can work with your child’s doctor to create a treatment plan just for him. Our concussion resources are endorsed by the Georgia Department of Public Health.

Comprehensive care

Several teams at Children's work together to treat concussion patients. This multidisciplinary approach helps make our program unique. Services include:

*Georgia Hospital Association (GHA) data 2016, Inpatient and Emergency Department Concussion primary ICD-9s

Treat

Each concussion is unique. Symptoms and recovery time are different for each child or teen. It's important to remember that rest for the brain and body is important when you are recovering from a concussion. Rest, both cognitive (for the brain) and physical (for the body), is the best treatment.

Your child’s doctor may keep your child out of sports, school or other activities. Depending on how severe the concussion is, it can take days, weeks or months for your child's brain to totally heal.

If you are a medical professional, please visit our physician resources for concussion section, which includes our concussion video series, concussion referral form and concussion toolkit.

Visit physician resources for concussion

Recovery guidelines

Here are some guidelines for helping your child recover from a concussion:

  • Limit physical activities like play. Don’t allow your child to return to gym class or sports until your doctor says it’s OK.
  • Don’t allow too many visitors. Keep visits short.
  • Keep surroundings calm and quiet.
  • Be sure to keep your child’s doctor appointments, even if he or she is feeling better.
  • Be patient. A concussion may temporarily make it hard for your child to focus, remember things or complete tasks.
  • Limit thinking activities to easy books and simple arts and crafts projects. Limit screen activities (TV, video games, computers and cell phones) to no more than two hours a day for no longer than 30 minutes at a time.
  • Have your child stop and rest any time symptoms get worse.

Serious problems after a concussion are rare, but can occur. That’s why a medical doctor should always be involved in a child’s care after a concussion.

Watch for new or worsening symptoms

You should watch your child very carefully in the first one to two days after a concussion. Call your child's doctor IMMEDIATELY, go to emergency room or call 911 if your child has any new symptoms or if symptoms get worse, such as:

  • Headaches that get worse
  • Clear drainage from the nose or ear
  • Scalp swelling that gets bigger
  • A seizure
  • Neck pain
  • Is hard to wake up
  • Vomits more than once
  • Acts differently than usual, such as if he does not play, acts fussy or seems confused
  • Cannot think clearly or remember things
  • Has weakness in the arms or legs or does not move them as usual
  • Cannot recognize people or places
  • Slurred speech
  • Passes out

Pain medications

  • Ask your doctor before giving your child any pain medicines
  • Don't give your child any medicines that can cause sleepiness - like cold medicines or medicines for itching - until you check with your doctor

Returning to school

After a concussion, your child should stay home and rest until the doctor tells you he or she can return to school. Most children will need to miss one to two days of school. Talk to the school nurse before your child returns. The nurse can help support your child’s slow return back to school work.

Download our Return to School and Activities Guidelines (en Español)

Download our guide to Mastering Virtual Learning

Returning to sports

Your child must stop playing all sports and rest until he has no concussion symptoms. He should return to normal school work and studies before returning to game play. Wait until your doctor says it’s OK for your child to resume sports or PE. When this occurs, your child should take it slow and stop if any symptoms return. If your child has a second concussion before recovering from the first, there can be serious consequences.

Download our workout diary to track the return-to-play (en Español)

Children's Rehabilitation Program

Concussions can result in vestibular disorders, which affect balance and movement. We provide rehabilitation tailored to children and teens with these disorders.

Learn more

Prevent

Concussions are not always avoidable, but here are some tips that can help keep your child safe. Prevention tips sourced using cdc.gov and safekids.org.

Babies and toddlers

  • Make sure your child rides in an approved child safety seat or booster seat in the car. Learn more about Georgia's booster seat law.
  • Don't allow other children to carry your baby.
  • Don’t leave your baby on a bed or couch.
  • Don't use baby walkers that have wheels since these are prone to tipping.
  • Always use safety straps on changing tables and in grocery carts and high chairs.
  • Secure large pieces of furniture such as bookshelves and TVs to the floor or wall to prevent them from tipping over on your child.
  • Keep windows and screens locked, or install safety guards to keep your child from falling out of them.
  • Use safety gates at the top and bottom of stairs.

Helmet safety

Wear a helmet when:

  • Riding a bike, motorcycle, snowmobile, scooter or all-terrain vehicle.
  • Playing a contact sport, such as football, ice hockey or boxing.
  • Using in-line skates or riding a skateboard.
  • Batting and running bases in baseball or softball.
  • Riding a horse.
  • Skiing or snowboarding.

Sport safety

  • Wear the right protective equipment for the activity such as helmets, padding, shin guards, and eye and mouth guards.
  • Protective equipment should fit properly, be well maintained and worn consistently and correctly.
  • Use good sportsmanship at all times.
  • Follow the coach's rules.

Safety in living and playing areas

  • Install window guards to keep young children from falling out of open windows.
  • Use safety gates at the top and bottom of stairs when young children are around.
  • Make sure the surface on your child's playground is made of shock-absorbing material, such as hardwood mulch or sand.