UNC Health Care
Baby who has been crying being comforted by a caregiver

Spotting Concussions in Babies and Toddlers

It’s no secret that babies and toddlers are clumsy. As they learn to crawl or walk, they trip, fall and roll—and it’s not uncommon for them to hit their heads in the process.

But with more and more research about the traumatic long-term effects of concussions, many parents are concerned about whether their kids’ small tumbles could lead to serious head injuries that impair development.

Concussions can affect a child’s abilities to think, learn and develop socially. Compared with adults, it can take longer for small children to heal after a concussion, which means symptoms such as memory loss, attention problems and irritability can linger longer than they might in someone older. Children who suffer a concussion are also more likely to get another concussion, the consequences of which can be more significant—and might not be as obvious until they get older, when they are faced with more complex cognitive situations.

Here, Edward M. Pickens, MD, medical director of UNC Pediatrics at Southpoint, explains how concussions can be identified in small children.

When Concussions Happen

The reality is that although concussions in small children aren’t likely, they also aren’t impossible. Dr. Pickens says the most common causes of concussions in small children are being carried and dropped or someone falling while holding them, followed by other accidents such as car crashes.

“It’s rare for an infant to get a concussion unless they’ve been dropped, in a car accident or unless there is some form of non-accidental trauma going on,” Dr. Pickens says. “They don’t get concussions just by rolling over and banging their head against the wall or hitting their heads on the sides of their cribs.”

Toddlers are more likely to get a concussion from falling into something—the corner of a table, a door frame, other furniture and so on—or falling off something, which makes baby-proofing an important part of concussion prevention.

“Part of being a parent with a toddler is you have to constantly be there and ready to spot them to keep them from falling,” Dr. Pickens says. “The main thing is having to take extra time to do things. If you’re walking with a baby, slow down, take your time and just be extra careful.”

Diagnosing a Concussion

Unfortunately, no specific tests can identify whether someone has suffered a concussion—adult or child.

“Whenever someone has a head injury and we’re doing a scan, we’re actually looking for other things that might be more serious: signs of bleeding around the brain or bleeding between the brain and the skull,” Dr. Pickens says. “A concussion typically gives you a normal-looking scan, and any injury is on a more microscopic level. When we do a scan and get normal results, that can still be consistent with a concussion.”

Because concussions impair brain function, in many cases an accurate diagnosis relies on symptomatic information given to a doctor. But concussions in babies and toddlers can be hard to diagnose because they lack verbal skills. A 2-year-old can’t tell you that he’s having difficulty concentrating or that his vision is blurry.

With small children, “you have to look for changes in behavior, and sometimes it can be very hard to recognize,” Dr. Pickens says.

Symptoms of a Concussion in Small Children

Determining whether to take your child to the doctor after he hits his head can be complicated. “Any child who hits their head is going to hurt. They may be fussy because they have a headache, but is that headache a concussion? Not necessarily,” Dr. Pickens says.

So, if concussions are hard to diagnose in small children, what are the warning signs?

In infants, if parents can see or feel a bump on their child’s head, it’s an automatic sign to seek medical attention. Babies might also experience:

  • Irritability
  • Crying when you move the baby’s head
  • Difficulty feeding or sleeping
  • Vomiting

In addition to those symptoms, toddlers might also experience:

  • Behavioral changes, such as a disinterest in playing or regular activities
  • Headaches
  • Excessive crying

Other common concussion symptoms, such as dizziness and problems with coordination, are harder to see in small children. “It’s really hard to tell if a toddler is having trouble with coordination because they are always stumbling around and falling. That’s just part of being a toddler,” Dr. Pickens says.

Treatment for Concussion in Small Children

If your child has been diagnosed with a concussion, it’s important to give him time to heal. Although there’s no specific treatment for concussions, rest is key. “When a child is recovering from a concussion, they really have to be inactive,” Dr. Pickens says. For small children, that means giving them a quiet, calm and comforting environment without a lot of stimulation.

For infants in particular, parents should avoid traveling and taking them on errands. “Babies often go along for the ride to what parents do, but you really have to minimize that as well,” Dr. Pickens says. “Babies can become overwhelmed with a lot of sensory input, so avoid loud situations and cut out the visitors.”

It can be hard to keep toddlers still, but Dr. Pickens recommends avoiding playground visits and other physical activities.

Remember, it can take about a week before concussion symptoms go away. If your child is still experiencing symptoms beyond that, talk to your pediatrician about further evaluation.


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