Your child has suffered a concussion. Their initial symptoms have gone away. But are they fully healed? Or should your family be prepared for long-term effects?
I wish I could tell you that your child will recover fully and quickly, but unfortunately, it’s not so straightforward. It’s not usually possible to see any damage that a concussion has done to the brain, which can be significant. (Remember that the “mild” in “mild traumatic brain injury” – another name for a concussion – refers only to the fact that loss of consciousness was less than 30 minutes or the period of amnesia or confusion was relatively short compared with more severe injuries. It doesn’t mean that the injury itself, or its consequences, are necessarily “mild.”)
In the previous blog, I covered how quickly you can expect your child to recover from symptoms of the initial injury and from symptoms of post-concussion syndrome. In this blog, we’ll look at potential effects that can last long past the initial injury.
Possible Long-Term Effects From Childhood Concussion
Do concussions affect the brain long-term even after other symptoms are gone?
Researchers don’t know for sure. While there is plenty of research on short-term effects of brain injury, follow-up studies that examine data across several years are difficult to do and therefore scarce. That leaves us with an unfortunate dearth of data and no widespread consensus in the medical community. “Conventional wisdom”, that is what most experts think and what most guidelines say, is that children typically can expect to make a full recovery after a concussion with no lasting effects. Some research backs up that assumption, while other research challenges it.
A recent study from 2012 (PDF here), followed very young children for 10 years into adolescence and found similar cognitive effects for children who had sustained severe brain injuries, and stated that “children with less severe TBI appear to recover to function normally.” The researchers concluded that, at least for severe brain injuries in young children,“early injury has long-lasting effects, with no evidence for enhanced recovery or underlying plasticity or cerebral reorganization.”
It may be that basic cognitive functions return fully, but more complex cognitive functions either don’t return or don’t develop, if the concussion was sustained at a young enough age. Some researchers describe the concept of the “neurocognitive stall,” where a child recovers very well in the year after a TBI but then seems to hit a wall and doesn’t develop cognitively as fast as their peers any longer.
What’s clear is that a lack of symptoms does not mean that the brain is back to its pre-injury self. A 2015 study (here) followed children post-concussion for only four weeks, but in that time found that over a third of them reported trouble with school despite . Difficulties they encountered included needing finding it hard to study, needing more time for homework, and needing to take more notes in class. This study provides initial evidence of a concussion’s adverse effects on academic learning and performance across all grades, including heightened levels of school- related concern and amplified postinjury academic difficulties experienced by symptomatic students relative to their recovered peers.
What You Can Do As A Parent
This information is not meant to scare you, and I want to reiterate that there’s no widespread consensus on exactly how concussions can affect cognition and behavior long-term or how common those effects are. I just want you to be aware that there is some evidence that even “mild” TBI may have unwanted effects long after the headaches go away. If you’ve ever held the attitude that a concussion “isn’t a big deal,” I hope you’ve changed your mind.
Now that you know more about the potential long-term effects of concussions on your child’s long-term development, you have an opportunity to discuss it with the family. Avoiding brain injury should be the number one goal. Family members can pledge to always use children’s car seats properly, wear seat belts themselves, for example, to reduce chances of injuries in a car crash. This is also a time to discuss whether your children should be allowed to take part in high-risk activities, and if yes, what they need to know about prevention if they do participate. After all, their brain’s future health is on the line.
Learn More About Children and Concussion
Factors that affect recovery and long-term support for children after a concussion are just two of the many topics I cover in my interview this month with Dr. Maya Evans. Dr. Evans is a physical medicine and rehabilitation (PM&R) physician at Shriners Hospital for Children – Northern California in Sacramento. One of her clinical interests is helping children with brain injury. Learn more on this topic by watching the interview here.