BLOG: Concussion looks different in infants, young children
Click Here to Manage Email Alerts
After a concussion, patients are typically asked about their symptoms and then followed to see if those symptoms resolve with time or with specific interventions.
Young children experience concussions at rates similar to teens and adults, but their symptoms can be more difficult to assess, especially in very young children who are pre-verbal or who lack the vocabulary or life experience to describe their symptoms well. For example, an adult would easily recognize the terms, “dizzy” or “nausea,” while a 3-year-old might not. Additionally, some symptoms of concussion, such as vomiting or irritability, can occur in healthy babies and young children.
As reported in a recently published paper (Dupont et al.), we studied 98 children from infancy up to 8 years old who were seen at two urban children’s hospitals after mild traumatic brain injury (mTBI), or concussion. The children were assessed in the acute (48 hours), subacute (7-14 days), and/or persistent (25-35 days) stage post injury. Our goal was to develop an assessment tool (called REACTIONS) that would be better suited to evaluating the symptoms experienced by young patients.
We provided an inventory of the types of manifestations caregivers or clinicians might observe in association with common cognitive, physical and behavioral symptoms in children. In testing the assessment tool, we found a clear separation in how symptoms present in infants and toddlers (age 0-2) compared with the older children in our study.
In the youngest patients, comfort-seeking behaviors, such as wanting a pacifier or favorite blanket more frequently, or only sleeping in a parent’s arms when the child normally sleeps in a crib, are common. The tool aims to document observations about these behaviors, as well as many others that could indicate concussion symptoms, such as a child laying his head down or covering his eyes.
The 3- to 8-year-old children in the study also had some behavioral changes, such as crying more or wetting the bed when they had already been potty-trained. Cognitive and physical symptoms in this age group may be expressed by playing less, sleeping more or being unusually clumsy.
We know that visual disturbances are common after concussion in school-age children. They may report seeing double or have trouble focusing on a book or the TV, for example. These symptoms seem to be less common in very young children, but it is not clear whether that is because young children’s vision is truly unaffected or because they engage in fewer near tasks that provoke symptoms. More research is needed to understand how to assess the impact of mTBI on vision in very young children.
In fact, we hope this study will prompt much more research into mTBI in children overall. It has long been thought that young children were unlikely to have long-term effects from concussion, due to the greater plasticity of young brains. However, because of the difficulty of assessing young children to obtain accurate baseline and progress reports, we can’t say for sure that this assumption is true. Few studies have included children younger than age 5 years, so there is still much to learn about how young children experience and recover from concussion.
We are still in the process of refining and validating our assessment tool. Eventually, we hope that it can be widely available for use by hospitals, primary care and daycare providers, and parents. But even without the final assessment tool, our findings provide important information for anyone who is managing the care of young children who have suffered a head injury.
Parents and doctors can be more aware that behavior changes can occur in the wake of a head injury and may be associated with well-known post-concussive symptoms. They can watch for and be more tolerant of comfort-seeking and other subtle symptoms in the weeks after a fall or other head injury. And they can take heart — children are resilient, and most will recover fully.
For more information:
Miriam H. Beauchamp, PhD, is professor of neuropsychology at the University of Montreal and director of the ABCs Developmental Neuropsychology Laboratory at the Sainte-Justine Hospital Research Center, which conducts research on concussion and social development in children. She holds the Canada Research Chair in Pediatric TBI.
Dominique Dupont, MSc, is a doctoral student in neuropsychology at the University of Montreal.
Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.
Collapse