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If a child suffered a serious blow to the head or is experiencing any of the symptoms listed on the previous page, do the following:

  1. Rest the child. A concussion is bad, but two concussions in a row is even worse. Such consecutive blows can lead to more severe long-term complications, or in rare cases, even death. (See our section on second impact syndrome in the ‘What Happens During A Concussion’ chapter of our eBook.)

Not only are concussed athletes at risk if they take another blow to the head, but they are more prone to injury in general, since their sluggish mental state means less coordination and an overall lack of body awareness. So follow this age-old advice from Dr. Robert Cantu, a neurosurgeon and concussion expert: “When in doubt, sit them out.”

  1. Make an appointment with your doctor to have your child evaluated for a concussion.

  1. Continue to monitor them over the next 24 to 48 hours.. lf a child shows any of the following symptoms, parents should bet their child to an emergency room IMMEDIATELY, as these can be signs of a potentially fatal brain bleed:

  • Continued loss of consciousness
  • Altered consciousness (Seeing things that aren’t there or feeling like they’re on drugs)
  • A clear fluid leaking form the ears or nose
  • Deteriorating symptoms or significant confusion or mental impairment


How long do I need to monitor a child after a concussion?

Since symptoms of a concussion are often delayed, parents should continue to monitor their child for the next two days or so to see if any symptoms show up. If they do, have them evaluated by a doctor. But what most parents are concerned about when they ask this question is the potential for dangerous or deadly outcomes.

Generally speaking, a child who doesn’t exhibit the more serious symptoms within the first 4 to 6 hours is in the clear. One large Canadian study that followed 18,000 pediatric concussion patients found that after a six hour period, the chance that patients without the symptoms of altered consciousness or severely impaired cognition would have a brain bleed was a percent. (Shrock-Simring, 2016) If a child does show such symptoms, get them to the ER immediately. If not, they should be okay.

Do I need to keep my child awake? Is it dangerous for someone with a concussion or head injury to fall asleep?
The idea that you need to keep a child awake after a head injury is based on outdated information and procedure. This advice was given because doctors can’t assess a patient’s mental state if that person is unconscious, and evaluating the child through observation and symptoms monitoring used to be the only way anyone could tell whether a child’s symptoms were progressing and getting worse. Parents would assume a child was fast asleep while an internal hematoma was slowly killing them. They’d put the kid to bed at night and wake up to a dead child.

This advice was NEVER given because sleep is somehow dangerous to people with head injuries. With modern technology, doctors can conduct a CT scan if they have reason to suspect internal bleeding, and these are easier to do on an unconscious child anyway. We also know more about what symptoms are likely to be associated with internal bleeding. So there’s much less concern about keeping a child awake, especially if he or she isn’t showing any of the high-risk symptoms. Doctors may still ask you to keep a child awake until they’ve had a chance to evaluate them (or because they want to know if a child is losing consciousness as opposed to sleeping), but it’s not as though there is a sudden increased danger if a child falls asleep.

As physician Danny Thomas, a concussion researcher at the Medical College of Wisconsin, states: “Observing a person after a head injury for four to six hours is a very helpful and useful strategy, but the advice to ‘wake a person up every so often to check on them’ is more aggressive than necessary.” (ibid, p. 54)

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