Concussion in kids: Managing beyond the injury

Symptoms of concussion in children can vary from headaches or lack of sleep to withdrawal and isolation

Children who suffer concussions are at increased risk of mental health problems. The risk varies from child to child and is typically a result of some combination of persistent symptoms leading to withdrawal, avoidance, and loss of identity and social support that can follow.

Talin Babikian, PhD, ABPP, associate director of the UCLA BrainSPORT Program, wrote about risk factors and ways parents and coaches can help youth manage the aftermath, in a commentary published March 7, 2022, in JAMA Network Open.

Her piece was in response to a large study, published in the same edition, in which Canadian researchers found that youth who experienced a concussion were more likely to develop mental health issues, self-harm or psychiatric hospitalization than peers who had an orthopedic injury.

Dr. Babikian’s analysis focused on the complexities and factors that may account for the increased risk.

“What kids need – with or without a concussion – is a sense of safety and agency,” said Dr. Babikian, a clinical neuropsychologist and associate clinical professor. “They need to feel protected, nurtured. They need to feel they have control over their situation and a sense of belonging and connecting.

“Any disruption to that, whether it’s a concussion or some other condition, puts them at risk for mental health problems.”

Dr. Babikian said post-concussion factors that can spark mental health challenges in some youth can vary from persistent headaches or lack of sleep to withdrawal and isolation. Symptoms may, somewhat artificially, be categorized as either physiological or psychological but they all stem from one’s nervous system.

“If a patient has migraines or if they’re super worried that they may not return to their sport and lose a scholarship, that’s going to impact their sleep,” she said. “All of these can interfere with their attention in the classroom and make them moody and irritable. These symptoms are so tightly wound together because we’re talking about that one system.”

While a concussion may cause short-term symptoms of difficulty regulating mood or irritability, those are not considered mental health disorders, Dr. Babikian said.

“If there is any impact on the brain because of the injury itself, that change in brain physiology and functioning is temporary in a majority of concussions,” she said. “When we look at the more prolonged mental health consequences, we’re likely not looking at temporary changes in physiology, we’re most likely looking at how their life has changed.”

New life challenges

A concussion can introduce a number of ongoing challenges to a young person’s life. For instance, athletes are suddenly sidelined from their sport, which can impact their social lives and identities at school. Their parents may not want them to play anymore because of fear of another injury.

In some cases, concussion management can be overly restrictive, which also impacts young people.

“Every once a while we see patients for second opinions who have been told to stay home or stay in a dark room or not use any electronic devices,” Dr. Babikian said. “You can imagine what it’s like to tell a teenager not to use any devices and not go out or socialize – no wonder they’re irritable and depressed, because we’re depriving them of the very things that help them stay connected.”

Additionally, some youth have other risk factors that may make them more vulnerable to mental health challenges.

“Children come to a concussion with their histories, their conditioning, their background and their various risk factors and resiliencies,” Dr. Babikian said. “Everything a child brings to a concussion is going to have an effect on how they come out of the concussion.”

Research shows that mental health problems can develop or worsen after a concussion, ranging from feeling anxious, withdrawn or depressed all the way to feeling suicidal, she said.

“Kids who are at risk may come to the concussion already with a diagnosed condition like depression or anxiety,” she said. “They may also come from fragile environments, for example kids who come from backgrounds that are adverse in nature, whether that’s poverty or a home environment where there is a lack of a parental figure.”

Teens doing their own research can come across alarming media reports such as about permanent brain damage among NFL players. Media coverage without proper context can be misleading and even frightening, Dr. Babikian noted, adding that most youth make full recoveries after a concussion.

“We see kids who sit up at night and search the Internet and read lots of scary headlines about concussions and their grim outcomes,” she said. “There needs to be some balance and some facilitation of how information is disseminated, especially when all of this is at the fingertips of young patients.”

Tips for parents and coaches

In the commentary, Dr. Babikian called for extra intervention for children who lack tools and resources to deal with the aftermath of their concussion. Parents and coaches play vital roles in helping children recover and stay connected.

Parents should take steps such as:

  • Seeking help from concussion management experts
  • Staying in communication with school, coaches and therapists
  • Listening to their child and problem-solving together
  • Looking for any concerning signs such as behavioral changes
  • Encouraging a return to normalcy, as safely as possible
  • Using clear and concise language that will let the child know what to expect, even if they don’t have all the answers
  • Avoiding catastrophizing a concussion

Coaches should take an active role in:

  • Taking concussions seriously and following proper protocols
  • Talking to players openly about concussions and normalizing reporting throughout the season
  • Having honest, hopeful, practical discussions with players about next steps if an athlete is injured
  • Finding ways to keep students connected with their sport and team as they recover, even if they can’t play
  • Avoiding catastrophizing a concussion

Learn more about the UCLA Steve Tisch BrainSPORT Program and make an appointment.

Courtney Perkes is the author of this article.