Concussion Awareness in Children

"In our study girls across age groups were more symptomatic [of concussion] than boys, and adolescent girls' symptoms change was slower than that of adolescent boys."
CHEO Research Institute/University of Ottawa study

"It's important to start figuring out what's causing these differences between male and female adolescents, because this is really significant."
"[Researchers] need to tease out exactly what's going on [to enable improved concussion treatment for young patients]."
"When you look at a pediatric brain, the brain of an 18-year-old is very different from the brain of a five-year-old. So the question is: Are the recovery patterns going to be the same?"
"Are they the same between males and females?"
Dr. Andree-Anne Ledoux, Research Associate, Children's Hospital of Eastern Ontario

uOttawa  New Research Shows Symptom Improvement after Concussion in Children Varies Across Age Groups and Sex

According to senior scientist at the CHEO Research Institute, and co-author of the study Dr. Roger Zemek, the findings give doctors a track to guide them in understanding whether a child's recovery from concussion is within expected ranges. One other finding out of the study was its acknowledgement that the rate of reported head injuries in North America during the past decade has increased two to fourfold. Making it even more important for treating physicians to try to fully understand all the variables of recovery from concussion.

This discussion resulted from a large, national study taken on by CHEO Research Institute and the University of Ottawa investigators. They concluded from the evidence they studied that over half of adolescent girls (aged 13 to 18) experience post-concussion symptoms following 12 weeks after the initial injury. Over half of all adolescent boys after four weeks following a concussion were free of symptoms, by contrast.

The study, published recently in the medical journal JAMA Pediatrics found as well that age was a factor in concussion recovery, that symptoms had a tendency to last for a longer period in adolescents than they did in younger children. As the latest published research on the matter, it adds to a growing body of evidence suggesting girls are more vulnerable to concussions and slower to recover from them.

Data from 2,716 children and adolescents diagnosed with concussions at nine pediatric hospitals across Canada was examined by the researchers. Individuals were followed through the research period for up to a year, with patients reporting their symptoms based on a standardized questionnaire. Both the rate of change in symptoms and the point where patients claimed to be fully recovered were tracked. Across all age groups, the first week of recovery was the most critical, according to the study, with many symptoms resolving themselves within the first seven days post-concussion. 

In the youngest patient cohort (ages five to seven) individuals being tracked reported most improvement in the first week. Within that group, 63.8 percent noted their concussion symptoms had abated. Headaches, nausea. anxiety, depression, sleep disturbances, memory or concentration issues and sensitivity to light or noises ranked among the symptoms identified.

In the older age group representing preteens (ages eight to 12) and adolescents (ages 13 to 18), symptoms had a tendency to improve markedly over the first two weeks, then for another two weeks, to plateau. Irrespective of their ages or sex, at least half of all patients fully recovered following four weeks post-concussion. Adolescent girls represented the sole exception as their recovery tended to be substantially protracted, most not free of symptoms a full three months following injury.

The reason for the differences between adolescent males and females in their recovery remains elusive to scientists. Dr. Ledoux hypothesized that testosterone may offer the brain protection of a kind, or that the hormones that puberty releases makes female more vulnerable to the concussion's effects. Other scientists are known to have theorized that adolescent girls are more likely to report their concussion-related symptoms than their male counterparts.

Concussion symptoms

Cognitive (thinking):

• Difficulty concentrating and paying attention
• Trouble with learning and memory
• Problems finding words and putting thoughts into words
• Easily confused and losing track of time and place
• Slower thinking, acting, reading and speaking
• Easily distracted
• Trouble doing more than one thing at a time
• Lack of organization in everyday tasks

Physical:

• Headache, neck pain
• Nausea
• Lack of energy
• Dizziness, light-headedness, loss of balance
• Blurred or double vision and sensitivity to light
• Increased sensitivity to sounds
• Ringing in the ears
• Loss of sense of taste and smell
• Change in sleep patterns, especially waking up at night

Social and emotional:

• Mood changes: irritability, anxiety, depression
• Less motivation
• Easily frustrated, overwhelmed, tearful
• More impulsive and lacking normal inhibitions
• Withdrawn, wanting to avoid social situations with lots of people
• See your family doctor if your child or teen is having trouble coping with moods and emotions. If things don’t improve, you may need to consult a mental health specialist.