How to Tell If Your Child Has a Concussion

Recognizing a concussion in a child is harder than it sounds. Children, particularly younger ones, often cannot accurately describe what they are experiencing. A five-year-old may not be able to tell you that light feels too bright or that their thoughts feel slow. A ten-year-old athlete may minimize symptoms to avoid being pulled from a game. Parents and coaches are frequently the first line of recognition, which means knowing what to look for matters as much as knowing what a concussion is.

A concussion is a mild traumatic brain injury caused by a bump, blow, or jolt to the head or body that causes the brain to move rapidly inside the skull. That movement disrupts normal brain function. A child does not need to lose consciousness for a concussion to have occurred. According to the Centers for Disease Control and Prevention, loss of consciousness happens in fewer than 10 percent of concussions.

How Concussion Symptoms Present Differently in Children

Adult concussion symptoms and pediatric concussion symptoms overlap significantly, but children have some important differences in how those symptoms appear and how long they last. Children's brains are still developing, which makes them more vulnerable to the effects of concussion and, in some cases, slower to recover than adults. The CDC's Heads Up program notes that children may take longer to recover than adults even from concussions of similar severity.

Infants and toddlers cannot report headaches or visual disturbances. In this age group, caregivers should watch for changes in behavior such as unusual irritability, altered sleep patterns, loss of a recently acquired skill, or persistent crying that cannot be soothed. Any witnessed head impact in a child under two warrants prompt medical evaluation.

School-age children may report headache, but they may frame it vaguely as their head "feeling weird" or simply become quieter and less engaged than usual. Changes in school performance, difficulty following instructions, or complaints about noise and light sensitivity in a child who did not previously have those complaints are worth taking seriously.

Adolescents are more likely to underreport symptoms, particularly in athletic contexts. Research published in the Clinical Neurosurgery journal found that high school athletes frequently continue playing after sustaining a concussion because they do not recognize their symptoms as injury-related or because they are reluctant to leave the game.

Physical Symptoms to Watch For

Physical symptoms are often the most visible immediately after a head impact. A child who has sustained a concussion may appear dazed or stunned in the moments following the injury. They may move unsteadily, seem clumsy, or have difficulty walking in a straight line. Headache is the most commonly reported symptom across all age groups. Nausea and vomiting can occur, though vomiting once shortly after a head impact is not automatically a sign of severe injury. Repeated vomiting is a red flag that requires emergency evaluation.

Sensitivity to light and noise frequently appears within the first few hours after injury. A child who wants to sit in a dark, quiet room after a head impact is showing a meaningful symptom. Blurred or double vision, ringing in the ears, and balance problems are also physical indicators that the brain has been disrupted.

Cognitive and Behavioral Symptoms

Cognitive symptoms can be subtler and may not appear immediately. A child may seem slower to respond to questions than usual, have difficulty remembering what happened before or after the impact, or appear confused about where they are or what they were doing. Asking a child simple orienting questions after a head impact, such as what day it is, what game they were playing, or what they had for lunch, can help identify confusion that may not be obvious on observation alone.

Behavioral changes are particularly important to track in younger children. Increased irritability, emotional sensitivity, crying more easily than usual, or uncharacteristic clinginess can all reflect the neurological disruption of a concussion. These symptoms are easy to attribute to tiredness or mood, which is why they are frequently missed in the hours after an injury.

Sleep-Related Warning Signs

Sleep changes are common after concussion and can appear in both directions. Some children become excessively sleepy and difficult to keep awake. Others have significant trouble falling or staying asleep despite appearing fatigued. A common question parents ask is whether a child with a concussion should be kept awake. Current guidance from the American Academy of Pediatrics states that it is generally safe to let a child sleep after a head injury, provided they were alert and responsive before falling asleep and do not have any red flag symptoms. Waking a child periodically during the first night to confirm they can be roused and are responsive is a reasonable precaution.

Symptoms That Require Emergency Care Immediately

Most concussions do not require emergency room evaluation, but some symptoms indicate a potentially serious injury that cannot wait for a routine appointment. Take a child to the emergency department immediately if they experience any of the following after a head impact.

• Loss of consciousness, even briefly
• Repeated vomiting (more than once)
• Seizure activity
• Significant worsening of headache over time rather than gradual improvement
• Slurred speech or difficulty speaking
• One pupil larger than the other
• Extreme drowsiness or inability to be woken
• Clear fluid from the nose or ears
• Weakness or numbness in the arms or legs

These symptoms can indicate bleeding or swelling inside the skull that requires immediate medical intervention. When in doubt, err on the side of evaluation.

What to Do While You Are Watching and Waiting

If your child sustains a head impact and does not have emergency symptoms, remove them from activity immediately. No child should return to play on the same day they sustained a suspected concussion. This is not a precaution that can be safely skipped based on how the child feels in the moment. Symptoms can worsen over the first several hours, and a child who feels fine at halftime may feel significantly worse by bedtime.

Keep the child in a calm, low-stimulation environment. Reduce screen time, bright lights, and loud noise while symptoms are present. Physical and cognitive rest in the first 24 to 48 hours supports recovery. Contact your child's pediatrician to report the injury and receive guidance specific to your child's age, health history, and symptom profile. Most pediatricians will want to evaluate a child with a suspected concussion within one to two days of the injury.

Document what you observed. Note the time of the impact, what caused it, what symptoms appeared and when, and any changes in the hours following. That information is useful to the medical provider evaluating your child and helps establish a clear timeline if symptoms persist.

Further Reading

• What to Do After Your Child Hits Their Head: A Parent's Guide
• Return to School After Concussion: What Parents Need to Know
• Concussion and Post-Concussion Syndrome Hub
• Youth Concussion: Resources for Parents and Families
• TBI Symptoms: A Complete Guide for Families

Resources

• CDC Heads Up: Concussion in Youth Sports
• American Academy of Pediatrics: Concussions
• Robbins Nest Alliance: Guides and Printables

References

• Centers for Disease Control and Prevention. (2023). Concussion Signs and Symptoms. U.S. Department of Health and Human Services.
• Halstead, M. E., Walter, K. D., & Moffatt, K. (2018). Sport-related concussion in children and adolescents. Pediatrics, 142(6), e20183074.
• Zemek, R., Barrowman, N., Freedman, S. B., et al. (2016). Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED. JAMA, 315(10), 1014–1025.
• Meehan, W. P., & Bachur, R. G. (2009). Sport-related concussion. Pediatrics, 123(1), 114–123.
• Chrisman, S. P., Quitiquit, C., & Rivara, F. P. (2013). Qualitative study of barriers to concussive symptom reporting in high school athletics. Journal of Adolescent Health, 52(3), 330–335.