How Pediatric Brain Injuries Differ From Adult Concussions

A concussion or traumatic brain injury can affect anyone, but diagnosing and treating a child presents unique challenges.

Young children may not be able to explain that they have a headache, feel dizzy, or are struggling to concentrate. Their brains are also still developing, which can support adaptation while making certain injuries more concerning.

During this episode of Mind Matters: Navigating Head Injuries and Concussions, legal nurse consultant Kiley Como spoke with Dr. Ruby Backsh of Family First Pediatrics about pediatric brain development, delayed symptoms, diagnostic testing, and safely returning children to school and sports.

A Child’s Brain Is Still Developing

Children are often described as resilient, but their developing brains require special consideration after an injury.

Dr. Ruby explained that a newborn’s brain is only a portion of its eventual adult size and grows rapidly during the first few years of life. Development continues throughout childhood and adolescence.

That ongoing growth gives the brain an ability to adapt, sometimes referred to as neuroplasticity. However, an injury during a critical developmental stage may also affect skills that are still forming.

A young child may not yet have fully developed language, memory, emotional control, attention, or problem-solving abilities. This can make it harder to determine whether a later difficulty is related to the injury or ordinary development.

Children May Be Vulnerable in Different Ways

A child’s skull is different from an adult’s skull.

Infants and young children have softer skulls and structures that are still forming. Their brains and surrounding anatomy continue changing as they grow.

These differences may influence how force affects the brain during a fall, collision, or other traumatic event.

Dr. Ruby discussed serious injury patterns such as diffuse axonal injury and injuries associated with violent shaking. The potential effects depend on the child’s age, developmental stage, and the nature of the trauma.

Because the child’s brain is developing, the full impact of an injury may not always become clear immediately.

Diagnosing a Brain Injury in a Nonverbal Child

Adults can often describe where they hurt, when symptoms began, and what makes them worse.

Infants and younger children cannot always do that.

Providers may need to rely on physical signs, behavior, and information from parents or caregivers. Important questions may include:

Is the child eating and drinking normally?
Have feeding habits changed?
Is the child sleeping more or less?
Are they waking repeatedly during the night?
Can they calm or soothe themselves?
Are they unusually fussy or inconsolable?
Have bathroom habits changed?
Is there a new sensitivity to sounds, lights, or movement?

Parents often understand their child’s normal habits better than anyone else. A mother or father may recognize that a cry, sleep pattern, or behavior is significantly different from what they typically see.

That information can be valuable during the medical evaluation.

Symptoms May Appear Later

A child may appear normal immediately after an accident and develop symptoms later.

Dr. Ruby discussed delayed behavioral changes such as aggression, irritability, agitation, and defiance. These behaviors may be the child’s way of responding to pain, fear, confusion, or a headache they cannot describe.

Other delayed or worsening symptoms may include:

Vomiting
Increasing headaches
Excessive sleeping
Difficulty waking
Twitching
Seizure activity
Nightmares
Increased startle response
Changes in appetite
Unexplained crying
New problems with siblings or peers

Parents should continue monitoring the child after the initial evaluation and report meaningful changes to a qualified medical professional.

Why Imaging Decisions Are Different for Children

Medical providers must balance the need for diagnostic information against the risks and practical challenges of testing.

Dr. Ruby emphasized limiting unnecessary radiation exposure in pediatric patients. In non-emergency situations, an MRI may be preferred because it does not use the same type of ionizing radiation as a CT scan.

However, an MRI requires the child to remain still.

Some facilities can complete faster scans, but a young or frightened child may not be able to remain motionless long enough to produce useful images. The provider may need to consider the child’s age, behavior, symptoms, and ability to tolerate the test.

Emergency situations may require a different approach based on the child’s condition and the need to quickly identify a serious injury.

What Is Diffusion Tensor Imaging?

Dr. Ruby also discussed diffusion tensor imaging, commonly called DTI.

DTI is a specialized MRI technique used to examine patterns involving the brain’s white matter and nerve pathways in greater detail.

Routine imaging may be unremarkable in some mild traumatic brain injury cases, even when the child continues to experience significant symptoms. DTI may provide additional information in selected cases, although its availability and suitability can vary.

Dr. Ruby noted that completing this type of imaging may be more realistic in older children who can remain still and follow instructions.

Imaging is only one part of the evaluation. A normal scan does not automatically rule out every effect of a concussion.

Treatment Begins With Gradual Recovery

Most pediatric brain injuries discussed in the episode were mild traumatic brain injuries or concussions.

Treatment may involve a gradual return to normal activities rather than immediately resuming a full schedule.

Dr. Ruby recommended an initial period of rest and reduced stimulation. Depending on the child’s symptoms, this may include limiting screen time and staying home from school briefly.

The child can then gradually return to school, social activities, and physical exertion as symptoms improve.

The process should be adjusted to the individual child rather than following one rigid schedule.

Returning to School

School places several demands on the recovering brain.

Reading, screen use, classroom noise, concentrating, remembering instructions, and completing assignments may cause headaches, nausea, fatigue, or confusion.

Dr. Ruby explained that children may need one or two days away from school immediately after a mild injury, depending on their symptoms and medical guidance.

After returning, the school may need to make temporary changes, including:

Shorter school days
Reduced assignments
Additional rest breaks
Limited screen use
Extra time for work
A quieter classroom setting
Permission to visit the nurse
Temporary removal from physical education

Parents should communicate with teachers and school staff so they understand that the child is recovering from a brain injury.

Returning to Sports

Teen athletes may be especially eager to return to practice or competition.

Dr. Ruby emphasized the concern for another injury while the brain is still recovering. Children should not attempt to push through headaches, nausea, dizziness, or cognitive symptoms.

A gradual return-to-play process may begin only after symptoms have improved and the child has been cleared appropriately.

The progression may move from rest to light activity and then to limited practice before a full return.

Parents, coaches, trainers, teachers, and medical providers should communicate throughout the process.

The goal is not simply getting the athlete back into the game. It is helping the child return without unnecessarily increasing the risk of another injury.

Collaboration Is Essential

Pediatric brain injury care requires teamwork.

The medical provider may diagnose and monitor the injury, but parents observe the child at home. Teachers see how the child handles learning. Coaches and trainers observe balance, movement, reaction time, and physical tolerance.

Each person may notice something different.

Sharing that information can help the treatment team understand whether the child is improving or struggling in a particular setting.