Concussion symptoms such as headache, fatigue, and dizziness typically start immediately after a child is injured, but a new study shows that mental and emotional symptoms may appear and persist weeks or even months later. Issues such as frustration, irritability, and difficulty concentrating develop later in many patients, and even as physical symptoms resolve, emotional symptoms may appear and linger.
The study, from Boston Children’s Hospital’s emergency medicine division, was published today in the journal Pediatrics. A research team headed by Dr. Matthew Eisenberg tracked 235 children and young adults who had sustained concussions and gone to the emergency room. The study followed the participants, aged 11 to 22, for three months or until all symptoms were gone, questioning them about symptoms, sports activities, and athletic and school performance.
Although the common concussion symptoms tended to start immediately, most of the injured study participants also had mental issues that included taking longer to think and difficulty concentrating. Emotional symptoms such as irritability and frustration developed later for many. Dr. John Kultz, who is the director of traumatic brain injury at Miami Children’s Hospital, said that it takes longer to fully recover from a concussion than people think, and that in his experience kids who are still experiencing symptoms two weeks after the injury are going to have a hard time.
Kultz recommends keeping kids who have suffered a brain injury out of school for a few days and then gradually working them back into their normal routine, since if kids go back to school too soon they frequently fail. He adds that kids should not start sports again until all their symptoms have disappeared, and then only gradually.
According to the Centers for Disease Control and Prevention (CDC), symptoms commonly associated with concussions at any age include physical problems such as headache, nausea, fatigue, and dizziness. They also include mental and emotional symptoms such as difficulty concentrating, sadness, and irritability. The CDC information also shows that while some of these symptoms appear right away, others may not be noticed for days or even months after the injury. Sometimes the symptoms do not come on until the person attempts to resume normal activities and have more stress and demands placed on them. However, the new study is one of the first to focus on children and mental problems after the head injury.
Eisenberg says concussion is one of the most common reasons for children to need medical care in the U.S., but little has been known about the progression of symptoms and the effect on developing brains. The researchers excluded patients from the analysis if they had moderate to severe brain injuries, skull fractures or other broken bones, or internal injuries. The Rivermead Post-Concussion Symptoms questionnaire was used to evaluate symptoms. The scale is a 16-point checklist that patients use to rate their symptoms. The study participants completed the questionnaire at the time of injury, and at one, two, four, six, eight, and 12 weeks after their emergency room visit, or until their symptoms resolved.
The study authors recommend that parents and physicians be aware of the possibility of kids developing emotional and mental symptoms weeks after sustaining a concussion injury. They say this knowledge may help children effectively work back into normal activities, and reduce unnecessary testing and evaluations since the symptoms are known to be typical.
By Beth A. Balen