Concussions | Diagnosis & Treatment

How is a concussion diagnosed?

There’s no way to see a concussion. So instead, the doctor will look for signs of injury to your child’s brain function. He or she will examine your child and getting a full medical history. The doctor may also check your child’s balance, coordination, and ability to think and process certain types of information. Your child may also need other tests depending on his or her symptoms.

Who needs baseline testing?

If your child plays sports, a baseline test can measure your child’s normal brain function and balance before any injury. This baseline measure can then be used as a comparison to help diagnose a concussion after an injury.

We recommend that all student athletes—especially those who play high-concussion-risk sports like ice hockey, football, rugby and soccer—get baseline testing before the start of the season.

Here at Boston Children’s, we offer a baseline testing system called ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) to track a child’s progress and get the child back to the same point he or she was at before the concussion.

What are the treatment options for a concussion?

The most important treatment for concussions is physical and mental rest. This gives the body a break from moving and thinking, so the brain can heal. Depending on your child’s symptoms, he or she may need to stay home from school for a few days.

Physical and mental rest includes:

  • getting plenty of sleep
  • taking a break from the computer, phone and reading
  • keeping stress levels low
  • modified or no homework
  • no contact or collision sports, limited physical activity and/or no gym class
  • for older teens, no driving or operating any type of machinery
  • Doing too much before the brain has fully healed can slow recovery. Your child’s doctor will tell you when it’s safe for your child to resume normal school, home and sports routines.

Medication

Although no medication can “cure” a concussion, your child's doctor may prescribe medication to help with any symptoms, such as headaches or trouble sleeping. If you have questions about any medication or are concerned about side effects, call or see your doctor right away.

What to expect after a sports-related concussion

Michael O’Brien, MD, director of our Sports Concussion Clinic, and Marilou Shaughnessy, PsyD, sports psychologist from the Sports Medicine Division, offer some advice about what to expect after a concussion.

Complications with concussions

The most common complication of a concussion is a delayed or lengthy recovery. If your child's symptoms aren't getting any better after the first few days—or if they are becoming worse—call your doctor. 

If your child has any of the following symptoms, seek emergency care right away:

  • blood or fluid coming out of her nose or ears
  • symptoms of a seizure
  • loses consciousness (passes out)
  • worsening headaches
  • vomits repeatedly
  • trouble breathing
  • trouble walking or standing
  • a change in pupil size (one is bigger than the other, or both are unusually large)
  • slurring words or trouble speaking
  • noticeable bruising or a large bump anywhere on the head

Returning to sports

Returning to sports after a concussion is a gradual process that takes place over a series of steps. Your child’s doctor will explain the specific steps for your child’s recovery, but they usually include:

  1. A period of total rest from all physical activity, until all concussion symptoms have disappeared. This may take anywhere from a few days to several weeks, depending on your child's symptoms. 
  2. Clearance to start light aerobic activity, such as walking or riding an exercise bike. 
  3. Clearance to resume warm-up activities related to the child's sport (for example, jogging on a training track or swimming laps). 
  4. Clearance to take part in non-contact training drills. 
  5. Clearance to resume resistance training, gradually upping the level of difficulty with each session. 
  6. Clearance to return to full-contact training/practice. This can only begin after your child’s doctor has deemed it safe.  
  7. Clearance to take part in games or meets. 

If concussion symptoms start again, your child should see the doctor right away. He or she may need to go back to the previous step (or several previous steps) until the symptoms go away and the doctor gives the OK to move forward. 

Remember, it's critical that your child not rush back to the playing field before the concussion has healed; this increases the risk of another concussion and more serious problems. Don’t let your child's coach, trainer or fellow athletes pressure him or her to returning to play too soon.

Follow-up care after concussion

How often your child will need to see the doctor for follow-up care—and for how long—depends on your child’s specific injury and symptoms. Some children need only annual check-ups, while others may require ongoing assessments and testing. Ask your doctor for a detailed follow-up plan.