1 in 4 Kids Who Have a Concussion Will Have Prolonged Symptoms

Concussions have become a health concern, particularly for children in sports, but recent research published in Pediatrics is highlighting what families need to know about these head injuries even before kids put on cleats.

Researchers studied childhood concussions in patients aged 6 months to about 6 years and found that while most of the children recovered from their symptoms, such as dizziness, irritability, and headaches, within a few weeks, 28% continued to have symptoms a month after their injury. By three months, 24% of the kids still had symptoms. After one year, that number was 16%.

The possibility of long-lasting concussion symptoms might sound scary to anxious parents, especially those with little adrenaline-rush daredevils—like me.

My 5-year-old is constantly begging to ride her bike; my 2-year-old will climb anything; and my 10-month-old is toddling into every furniture corner. The thought of any of them getting a concussion is enough to keep me up at night. The idea of one of them having concussion symptoms for a year has me on the verge of putting them in helmets 24/7.

Sean Rose, MD, pediatric neurologist and lead author on the study, says this paper is important for both parents and medical providers who, for so many years, have lacked research on head injuries in young children. It can help families know what to look for and stay safe.

Why the Research on Concussions Matters

When it comes to concussions, Dr. Rose says the vast majority of attention is given to older kids and adults—especially athletes. This is unfortunate as, according to a study from 2024, nearly 350,000 young kids ages 0 to 6 in the U.S. go to the ER with a head injury every year.

Gregory Vitale, PsyD, a pediatric neuropsychologist at Orlando Health Children’s Neuroscience Institute, agrees that research has been lacking in this demographic. He says that young kids often aren’t able to communicate their symptoms, so treating them for head injuries comes with challenges. The lack of research adds another level of difficulty.

“This paper suggests pre-elementary kids [like older kids] have symptoms after their injuries, and they would benefit from tailored recovery recommendations,” Dr. Vitale says.

The article also studied potential predicting factors of long-term concussion symptoms. Dr. Rose says, interestingly, loss of consciousness and whether or not a child received a CT scan (an imaging test reserved for when doctors are particularly concerned about an intracranial bleed or skull fracture) did not predict whether or not a child would have long-lasting symptoms.

The only predictive factor was a child’s symptoms in the first 72 hours after the injury. “If the parents were reporting that their child was having a lot of symptoms, then they were more likely to have prolonged symptoms,” he says.

So while there’s still so much we don’t know about head injuries in young children, Dr. Rose hopes it’ll inspire more research dedicated to this age group.

“We need to study the effect of specific treatments in young children,” says Dr. Rose. “Knowing what to expect throughout the recovery process, as well as having proven treatments, would reduce the uncertainty experienced by both parents and doctors when addressing concussion in early childhood.”

What To Look for if a Child Hits Their Head

While studies on head injuries in young children are still limited, experts agree that caregivers should seek speedy medical attention if they suspect serious injury. But how do parents know if their child needs medical attention…or just an ice pack?

Jacob Snow, MD, a pediatric emergency medicine physician at Pediatrix Emergency Medicine of Nevada, says a child should be evaluated in the emergency department if they have any of these symptoms:

• Loss of consciousness
• Not acting normally
• Is confused or altered
• Has agitation
• Has persistent vomiting

But sometimes concussion signs are less obvious, especially in children who might not yet have the words to explain how they feel.

“A young child with a concussion may seem dazed and may indicate head pain by touching or holding their head,” Dr. Snow says. “Some will show sensitivity to light or sound by covering their eyes or ears. They may have nausea, vomiting, or a change in appetite.”

He adds that small children may be irritable, inconsolable, and unusually fussy. Others can be excessively quiet, sleepy, or clingy. Overall, he urges parents not to wait for kids to complain about a headache, as they might not have the language for it. “Actions speak louder than words in this age,” explains Dr. Snow.

He adds that there is a whole range of brain injuries beyond concussion, from skull fracture to bleeding in the brain. If a caregiver suspects serious injury, it’s important to see a health care provider immediately.

What To Know About Long-Term Care

After an injury, Dr. Vitale says it’s important that children have an opportunity to rest. He recommends sleep and a low-stimulating environment for the first day or two. But he warns parents not to hold their child back from activity too long.

He says sometimes parents want to keep their kids in a low-stimulation environment for several weeks post-injury (usually as they wait for an appointment in the concussion clinic), but this can be counterproductive.

“At this developmental level, they usually can’t internalize like, ‘Oh, I’m not doing this because of this reason,’” Dr. Vitale says. “When we see parents removing all stimulus and everything that a kid used to do and love, that can take an emotional toll on the kid.” 

He adds that if a child has been kept out of activities for an extended time, they may have difficulties returning to normal life. “When they do go back to doing something, their tolerance is going to be much lower because they’ve been deconditioned during this period,” he says, adding they may have light and noise sensitivity, reduced stamina, and fatigue.

“It’s appropriate to reduce a child’s stimulation and encourage them to rest for the first 24 to 48 hours after injury,” notes Dr. Vitale. But beyond that, he recommends gradually allowing the child to play outside, spend time back at school, or engage in other usual routines as symptoms allow.

If parents need guidance, Dr. Vitale recommends they consider visiting a multidisciplinary concussion clinic. There, medical professionals, psychologists, and physical therapists can work together to create personalized treatment plans to help guide a patient’s recovery. “Not all kids need to do this type of follow-up, but it can help parents get all their bases covered,” he says.

Are These Injuries Preventable?

While proper care is necessary once a concussion has occurred, Dr. Vitale says that protective measures are also important.

“Not that every injury is preventable, but the majority of the injuries that we see are due to riding a bike or scooter unhelmeted,” says Dr. Vitale. “I know wearing a helmet is not front page news, but that’s one of the biggest things that parents can do to avoid these types of injuries.”

But despite the best preventive measures, accidents will still sometimes happen. For small children, Dr. Rose wants to make sure parents know what to expect in the weeks and months after. He says some kids may have longer-lasting symptoms, but help is available. 

“That may be treatment for headache or pain. It may be early intervention services for being ready for kindergarten, or counseling for behavioral changes,” he says. “I want parents to know that services may be needed so these kids can get the treatment that they may need.”