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Concussion Program

What is a concussion?

A concussion is an injury caused by a blow or a jolt to the head that results in a change in brain function. Concussion symptoms can include loss of consciousness or memory, headache, dizziness, and confusion, as well as other physical symptoms and changes in emotions, sleep, and/or cognition. .Symptoms from a concussion may last less than a day but it is not uncommon for children to have symptoms for a week or more. Most of the time, however, there are no lasting effects from a concussion, especially when it is properly treated.

Concussion treatment should include brief rest, symptom management and a carefully guided return to activities. This is especially important for teens and children, as the brain of a young person is continuing to develop.

What are the signs of a concussion?

A concussion isn’t always obvious. Watch for these signs of concussion in your child or teen, especially while they are participating in contact sports. Remember: Symptoms may not be apparent immediately after an incident, so when in doubt, sit it out. Continuing to play after a concussion occurs puts you at higher risk for a prolonged recovery.

Concussion symptoms may include:

Physical Symptoms

  • Headache or head pressure
  • Nausea or vomiting
  • Balance problems
  • Dizziness
  • Visual problems
  • Fatigue
  • Sensitivity to light or noise
  • Numbness/Tingling

Emotional Symptoms

  • Irritability, sadness, or nervousness
  • Feeling more emotional
  • Feeling dazed or stunned


  • Fatigue or drowsiness
  • Sleeping less or more than usual
  • Trouble falling asleep

Cognitive Signs

  • Feeling mentally “foggy” or slowed down
  • Difficulty concentrating or remembering
  • Forgetful of recent information or conversations
  • Loss of consciousness
  • Loss of memory of events before or after the injury
  • Answers questions slowly
  • Repeats questions

Less commonly:

  • Loss of consciousness
  • Seizure

When to Seek Emergency Care for Concussion

If your child or teen displays any of the following concussion symptoms, seek immediate medical care at an emergency department near you:

  • Unconsciousness for any length of time
  • Changes in alertness
  • Convulsions or seizures
  • Muscle weakness on one or both sides
  • Persistent confusion
  • Repeated vomiting
  • Unequal pupils
  • Unusual eye movements
  • Walking problems

Concussion Treatment: A Complete Approach to Concussion Care

CHOC’s Concussion Program includes concussion-trained pediatricians, neurologists, neuropsychologists and neurosurgeons, as well as physical, occupational and speech therapists. Together, we partner closely with area coaches, school nurses and community providers to evaluate and treat every child and teen who experiences a hit to the head.

Concussion-Trained Pediatricians: Your First Line of Defense

Most concussions are not severe, but they should still be taken seriously. They are best treated by a pediatrician with experience in concussion management. If your child or teen has symptoms of a concussion, talk to your pediatrician.

Expert Specialists: For Severe Pediatric Concussions and Persistent Post-Concussion Symptoms

For children and teens who have severe concussions or symptoms that aren’t improvingafter four weeks or longer, we offer a higher level of care through our neuroscience team. Patients seen at the CHOC Neuroscience Center receive comprehensive concussion care from our pediatric neurologists, pediatric neuropsychologists, and s our pediatric neurosurgeons for injuries that may require surgery.

ImPACT® Testing

We use ImPACT® testing for patients that have a new concussion as part of their neurocognitive assessment. This is a computer-based tool that examines different areas of cognitive functioning such as memory, attention, and processing speed. In addition, for athletes who don’t have a history of concussion, our specialists use ImPACT® to establish a baseline of cognitive function. If an athlete then sustains a concussion, we are able to monitor the patient’s recovery by comparing the ImPACT® results post-concussion to the patient’s baseline.

Rehabilitation Therapy

Ongoing concussion symptoms may be best managed with physical, occupational and speech therapy. Our rehabilitation team has unique experience treating patients with concussion and is ready to help overcome any problems your child or teen may be experiencing. Learn more about our concussion rehabilitation program and services.

Coordination with Schools

Our concussion team partners with high school sports programs to mentor coaching staff and help manage an athlete’s post-concussion care. We also have developed concussion recovery guidelines with tips for school staff on returning students to school, sports and activities after concussion.

Pediatric Concussion Emergency Care

Our pediatric-dedicated emergency department and Level I trauma center is equipped and ready to treat any child or teen who sustains a concussion and requires immediate medical attention.

After-Hours Hotline

The CHOC Concussion Hotline is a resource for coaches, trainers, physicians and medical providers to consult with a pediatric neurologist and to coordinate an appointment for their athlete or patient. Our concussion experts provide immediate response, even on nights and weekends. Please call 714-509-4054 and press 1 for the Concussion Hotline. Please note the Concussion Hotline is not intended for patients and families. Learn more about making an appointment here.

Concussion Recovery Time

The majority of patients with concussion recovery completely in the first days to weeks following the injury. Rest is important immediately following a concussion. For 24-48 hours after the injury, your child should stay home from school and get quiet time and mental rest. This includes limiting activities like television, texting, social media, reading, doing homework, driving, attending loud events and social interaction. After the first 24-48 hours, your child should start gradually and safely increasing their physical activity. Download our complete Road to Concussion Recovery guide here, or view recovery recommendations below.

Most children should be able to tolerate some school or even full days of school after a few days. However, returning a student to school while they are still experiencing symptoms can result in learning problems and poor academic performance. Too much cognitive exertion can lead to or worsen headaches, problems concentrating, fatigue and trouble with emotional control. The student may feel overwhelmed or irritated. So, when is the right time for a student who had a concussion to return to school?

A health care professional can help offer guidance following an evaluation. The school must be notified that the student with a concussion is returning, so the student can be observed and monitored. Schools may need to make some short-term adjustments for a returning student, as he or she recovers.

It’s normal for the student to feel frustrated, embarrassed, isolated or sad, particularly as there are often no outward signs of injury, so consider having a school psychologist or counselor talk to the student to offer support and encouragement as needed.

View the six stages for returning a student to school after a concussion.
In addressing a student’s abilities when returning, school officials should consider the following symptoms:

• Do some classes or tasks at school, such as looking up or down to take notes, cause the student greater difficulty than others?
• For each class, is there a specific time frame after which the student appears fatigued?
• Does the student have a harder time concentrating after a certain amount of time or as the day progresses?
• Do specific things at the school or in the classroom distract the student or exacerbate their symptoms?
• Are any behavioral problems or symptoms linked to a specific event or setting, such as loud noises in the hallway or bright lights in the cafeteria?

Cognitive Strategies

• Adjust the student’s schedule as needed to avoid fatigue, such as a shorter school day, reduced course load or holding the most challenging classes earlier in the day.
• Adjust the environment to reduce distractions or minimize triggers like bright lights, talkative peers, and loud places. Move the student closer to the teacher.
• Give the student extra time to finish classwork and take tests.
• Help the student create a to-do list or get organized.
• Give the student assistance: assign a peer to take notes for the student and/or allow the student to record classes.
• Break down assignments into smaller chunks and offer recognition cues.
• Provide alternate methods for a student to show mastery of a subject, such as allowing a multiple-choice or verbal test vs. an essay exam.
• Focus on what the student does well and expand the curriculum to more challenging content as symptoms subside.
• Adjust school load to prevent “piling-up” of assignments.

Behavior, Social and Emotional Strategies

• If the student is frustrated with failure in one area, redirect him or her to other curriculum areas where he or she can succeed.
• Reinforce positive behavior and academic success.
• Set reasonable expectations.
• Provide structure and consistency; make sure all teachers use the same strategies.
• Remove a student from a problem situation, but don’t characterize it as a punishment.
• Involve the family in any behavior management plan.
• Acknowledge that the student may be having a hard time. Be empathetic, encouraging and patient.
• Have the student work with you to make decisions about schedule changes or prioritizing tasks.
• Irritability, low frustration tolerance or “short fuse” are common. Approach student in a non-judgmental way.
When it comes to returning to sports, symptoms must be resolved first. Be sure to get medical clearance from your child’s doctor before they get back in the game. Final clearance is determined by a health care professional and may be based on a provider’s clinical assessment and the athlete’s ability to tolerate the return to activity. The student will be monitored for returning symptoms during each step along the recovery.

Retirement from contact sports may be considered on a case-by-case basis. If your child has suffered multiple concussions and/or experienced repeated prolonged recoveries, consider discussing this with a concussion specialist.

View the six stages for returning a student to sports and physical activity after a concussion.

Frequently Asked Questions

Concussion symptoms may include:
  • Headache
  • Nausea or vomiting
  • Balance problems
  • Dizziness
  • Visual problems
  • Fatigue or drowsiness
  • Sensitivity to light or noise
  • Numbness or tingling
  • Dazed or stunned
  • Irritability
  • Sadness
  • More emotional
  • Nervousness
  • Sleeping less or more than usual
  • Trouble falling asleep
  • Feeling mentally “foggy”
  • Feeling slowed down
  • Difficulty concentrating or remembering
  • Forgetful of recent information or conversations
  • Confused about recent events
  • Answers questions slowly or repeats questions.
Seek emergency care immediately if your child or teen has experienced unconsciousness for any amount of time or has changes in alertness, convulsions or seizures, muscle weakness, persistent confusion, repeated vomiting, unequal pupils, unusual eye movements, or problems walking.
You should always wear a helmet while riding a horse, motorbike, bicycle, skateboard, or snowboard, or while playing contact sports like football, hockey and lacrosse. Although helmets cannot prevent a concussion, they do protect you from more severe traumatic brain injury and skull fractures. Helmets should fit appropriately and be in good condition. In sports, student athletes should be taught safe playing techniques, equipment maintenance, and to follow the rules of the game.

Also, every athlete should know it’s critical for them to tell their coach, athletic trainer, or parent if they have hit their head or are experiencing symptoms of a head injury and stop play immediately. A head injury or impact to the head should NEVER be ignored and must always be taken seriously.
The majority of concussions heal fine if managed well in the first few weeks following the injury. This is why it’s so important for coaches, parents, and others to recognize the symptoms and act quickly to remove the child from a game if an injury has occurred.

Parents should encourage their children to rest in the first 24 to 48 hours after the injury. During this period ensure that your child rests and limit mental and academic stimuli as well as physical activity. This includes limiting everything from television and texting to reading and doing homework. Your child should avoid loud events like sports games, practices, or parties during this time. After 24-48 hours, gradually reintroduce physical and cognitive activities to promote your child’s recovery.
Yes. The most significant complications associated with a concussion are brain swelling and increased intracranial pressure. If left untreated, this pressure can cause brain damage by preventing blood and oxygen circulation throughout the brain. This typically occurs when there is bleeding in the brain and more often associated with moderate or severe traumatic brain injuries. In addition, a child or adolescent that suffers a second head injury before they recovered from an initial concussion is at risk for more significant or long-term complications.

Make an Appointment for Concussion Treatment

We recommend a timely follow-up with your child’s pediatrician if they have experienced a minor concussion. If your child or teen does not have a pediatrician or primary care doctor, find one here in our directory.

When concussion is severe or symptoms won’t go away, talk to your doctor about a referral to the CHOC Concussion Program, which offers pediatric sports medicine specialists, neurologists, neurosurgeons, neuropsychologists and rehabilitation therapists who are all trained in concussion management.

Please call 888-770-2462 to schedule an appointment with a CHOC specialist. A referral from your child’s pediatrician or primary care doctor may be required.

The Concussion Team

Chris Koutures, MD, Pediatrician and Sports Medicine
Kelly Davis, MD, Pediatrician and Sports Medicine
Suzanne McNulty, MD, Pediatrician
Matthew Kornsweit, MD, Pediatrician and Sports Medicine
Joffre Olaya, MD Neurosurgery
William Loudon, MD, PhD, Neurosurgery
Rachel Pearson, MD, Neurology
Tami Paone, NP, Neurology
Mary Maginas, NP, Trauma
Kelcie Bragg, NP, Trauma
Grace Mucci, PhD, Neuropsychology
Heather MacEwen, Rehabilitation Services