A 3-year-old boy arrived at the emergency department of Meuhedet in Ashdod unresponsive and with his eyes closed after falling and hitting his head. The ER team managed to wake him after several long minutes, and after initial tests showed a concussion, the child and his mother were transferred for further tests and observation at the hospital. The case demonstrates the importance of alertness and quick response by medical teams in cases of head trauma, especially among young children.
According to Dr. Valery Fikhman, head of the Family Medicine Department and Director of the Primary Care Division in the Southern District of Meuhedet, the most common cause of concussion in children is falling. “Toddlers may fall from a bed, sofa, stroller, or high chair, and children of kindergarten and elementary school age are exposed to falls in playgrounds, when climbing on equipment, slides, or swings, and sometimes even from a simple stumble at home or on the street,” explains Dr. Fikhman.
“Another common cause is injury during sports activity. Ball games such as soccer, basketball, or volleyball may lead to collisions between players or direct hits to the head by a ball. Riding a bicycle, scooter, skateboard, or rollerblades without a helmet also increases the risk. In addition, children who participate in martial arts or wrestling classes are exposed to collisions that can cause a concussion.”
A concussion is defined as a temporary functional brain injury caused by a blow to the head, usually without evidence of structural damage on brain imaging. It is a reversible disorder, but sometimes it can have significant consequences that require careful medical attention. In children, concussion is considered relatively common, mainly due to their exposure to various risk situations.
What are the symptoms of a concussion in children?
“The clinical symptoms vary and include headaches, dizziness, imbalance, nausea and vomiting, blurred vision, sensitivity to light or noise, confusion and difficulty concentrating, slowed thinking processes, unusual fatigue, and changes in sleep patterns. In very young children, there may be excessive crying, restlessness, or refusal to eat, which sometimes serve as the first signs of injury. Alongside these symptoms, there are warning signs that require immediate medical attention: Loss of consciousness, even briefly; repeated vomiting; significant worsening of headache; seizures; changes in consciousness or behavior, including unusual drowsiness and severe confusion; weakness or loss of sensation in one limb; speech or walking disturbances; and the appearance of blood or fluid discharge from the ear or nose.”
According to estimates, five to ten percent of all head injuries in children result in a concussion. This figure reflects the high exposure of children to various trauma situations and the increased sensitivity of childhood to such injuries.
How should you act if a concussion is suspected?
In the event of a suspected concussion, the parents’ initial response should include the immediate cessation of physical activity or play and close observation for 24–48 hours, paying attention to warning signs. Returning to sports or physical activity is only allowed after receiving medical approval.
According to Dr. Fikhman, treatment for concussion focuses on physical and cognitive rest, which includes reducing physical activity, limiting screen exposure and academic load, and avoiding sports until all symptoms disappear. If necessary and as recommended by a doctor, simple painkillers can be considered. Returning to routine should be gradual, according to the rate of symptom disappearance.
Hospitalization is not required in most cases but is recommended when symptoms such as prolonged loss of consciousness, repeated vomiting, seizures, abnormal neurological signs, severe injury, or a dangerous injury mechanism occur, as well as in situations requiring close observation, especially for young children.
In most cases, children recover from a concussion within one to three weeks, but in a small number of cases, post-concussion syndrome may develop, characterized by headaches, difficulty concentrating, and irritability lasting weeks or even months. A recurrent injury before full recovery can lead to more severe brain damage, which is why educating parents, teachers, and sports staff is extremely important.
Symptoms of concussion in children
• Headaches, dizziness, imbalance
• Nausea and vomiting
• Blurred vision, sensitivity to light or noise
• Confusion, difficulty concentrating, and slowed thinking
• Unusual fatigue and changes in sleep patterns
What to do in case of suspected concussion?
• Immediately stop physical activity or play!
• Close observation for 24–48 hours, paying attention to warning signs.
• Physical and cognitive rest.
• Reduce screen exposure.
• Avoid sports until all symptoms subside.
• Simple painkillers may be considered according to a doctor’s instructions.
• Gradual return to routine according to recovery progress.