Symptoms such as headache, dizziness and blurry vision typically show up right after a child suffers a concussion. In a study from the emergency medicine division at Boston Children's Hospital, researchers have found that emotional and mental symptoms, such as irritability and frustration may show up much later and hang around longer.
"Patients and their families should expect the physical symptoms that they experience after a head injury to get better over the next few weeks, but that emotional symptoms may come on later, even as the physical symptoms subside," said lead researcher Dr. Matthew Eisenberg.
"Only by knowing what symptoms can be expected after a concussion can we help reassure patients and families that what they experience is normal, know when to seek additional help, and make sure that children are taking appropriate precautions in regard to school and sports to achieve a full recovery," Eisenberg added.
For the study, 235 children and young adults, ages 11 to 22, who were treated for concussion at a pediatric ER, answered questionnaires about their injury and were followed for three months after their visit. Patients were monitored until all their symptoms were gone. During that time they were asked about symptoms, sports activity and school and athletic performance.
The most common physical symptoms were headache, dizziness and fatigue, which tended to start right after the injury and got better over time. Researchers found that most of the children also had mental symptoms, such as difficulty concentrating and taking longer to think.
Eisenberg's team noted that a majority of the children recovered within two weeks, however, 25 percent still had headaches a month after their injury. More than 20 percent said they were fatigued and 20 percent reported taking longer to think.
For many, emotional symptoms -- such as frustration and irritability -- were not as common right after the injury, but developed later, the study authors noted.
Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children's Hospital, said, "It takes longer than people think to fully recover from a concussion. My experience is that kids who still have symptoms two weeks after a concussion are going to have a very hard time, and it's going to be a struggle to get them to the point where they have no symptoms."
Kuluz recommends that parents make sure concussion symptoms are not ignored and their kids receive prompt and continued treatment. He suggests physical therapy to work on balance and helping with any vision problems.
He also recommends keeping children out of school for a couple of days after the injury and then gradually letting them get back to normal activities.
Kuluz tries to get kids back to school for half a day or as much as they can tolerate until they get better. Children should not start sports again until all symptoms have disappeared and then only gradually, he added.
This study was published online and in print in the journal Pediatrics.
Another recent study looked at the effects of concussion and years of repeated hits to the brains of college football players.
Researchers found that players who had been diagnosed with concussions and those who had been playing football for years had smaller hippocampuses – a part of the brain that is critical to memory. A smaller hippocampus has been linked to depression, schizophrenia and chronic traumatic encephalopathy (CTE).
The symptoms of CTE, which tend to set in years after the last traumas, often include memory loss, aggression and dementia.
"Boys hear about the long-term effect on guys when they're retired from football, but this shows that 20-year-olds might be having some kind of effect," said Patrick Bellgowan, the study's senior author from the Laureate Institute for Brain Research in Tulsa, Oklahoma.
Concussion studies seem to be popping up everywhere, and for good reason. For too many years, a concussion injury wasn't given much attention. The common train of thought was that if you play rough sports and you get hit - you shake it off and get back in the game. That philosophy applied whether you were 10 or 30 years old.
Then professional players began to exhibit early onset dementia and depression. Teens began to complain of constant headaches and feeling out of sorts. College players had difficulty concentrating and vision problems.
Parents demanded answers and researchers began looking at concussion and its long-term impact on the brain. The new studies shed a bright light on why these symptoms were troubling.
Most young athletes will not become professional players in their chosen sport or even play on college teams. Eventually, the helmets and pads will be passed on to the next group of excited young athletes and children will choose other activities or graduate into the "real world".
What these types of studies tell us is that long after the games are over, children who suffer concussions may experience serious long-term effects.
The symptoms can be so similar to typical teen behavior that they get overlooked. Kids get headaches, they get tired, they forget things and they have emotional outbursts. But if your child has suffered a concussion or even a very hard hit and you notice these symptoms don't go away, take him or her to see a concussion specialist. They may or not be related to a more serious brain injury, but a missed opportunity for treatment may change your child's future in ways that no one ever expected.