A child may look physically healthy after a concussion while still struggling with memory, attention, emotions, sleep, or schoolwork.
Because children do not always have the words to describe what they are experiencing, parents, teachers, coaches, and medical providers must pay close attention to changes in behavior and daily function.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, legal nurse consultant Kiley Como continued her conversation with Dr. Ruby about therapy, school accommodations, mental health, and long-term monitoring after a pediatric traumatic brain injury.
Children May Process Trauma Through Play
Adults often process a frightening event by discussing it directly. Younger children may express the same emotions through toys, drawings, stories, or repeated play.
A child involved in a car accident might repeatedly arrange toys to recreate the collision. Another child may avoid discussing the crash entirely.
Both reactions may be attempts to process what happened.
Dr. Ruby explained that play therapy can help younger children express emotions they may not yet understand or know how to describe. A trained therapist may use stuffed animals, drawing, tactile activities, or storytelling to help the child work through the experience.
Older children may benefit from trauma-focused cognitive behavioral therapy, which can help them recognize emotional reactions and develop healthier coping strategies.
Repeating the Story May Be Part of Processing
Some children talk about the accident constantly.
They may describe where everyone was sitting, how the cars moved, what they heard, and what happened immediately afterward. They may repeat the story to parents, teachers, friends, or therapists.
Although repetition can be normal, the child may need help processing the memory in a more structured way.
A therapist might encourage the child to write down the story, draw how the experience felt, or identify which parts continue to cause fear.
The goal is not to erase the memory. It is to help the child understand it without becoming overwhelmed by it.
Recovery Time Is Different for Every Child
Dr. Ruby explained that many children with mild traumatic brain injuries improve over approximately three months, but there is no universal timeline.
Some children progress quickly. Others require longer treatment, medication, therapy, or additional evaluations.
Parents should avoid comparing their child’s recovery to someone else’s.
Continuing symptoms beyond three months may raise concerns about persistent post-concussion symptoms. However, the child’s medical provider must evaluate the symptoms and determine whether another condition may also be contributing.
Emotional Changes Can Be Easy to Miss
A child recovering from a brain injury may become quieter, more irritable, less interested in activities, or unusually dependent on a parent.
These changes may be mistaken for defiance, laziness, or ordinary childhood behavior.
Parents should watch for:
- Withdrawal from friends or family
- Loss of interest in favorite activities
- New fears or anxiety
- Frequent crying or irritability
- Sleep problems
- Repeated discussion of the accident
- Avoidance of cars, sports, or similar situations
- Sudden changes in school performance
These symptoms do not automatically mean the child has post-traumatic stress disorder, but they should be discussed with a qualified provider.
School May Reveal Hidden Difficulties
Academic problems may become one of the first signs that a child has not fully recovered.
A child may seem comfortable at home but struggle to follow instructions, remember assignments, read for extended periods, or concentrate in a busy classroom.
Parents may notice that homework takes much longer than it did before the injury. Teachers may observe confusion, inattentiveness, fatigue, or slower processing.
Schools may be able to provide temporary or long-term accommodations through a 504 Plan or Individualized Education Program.
Possible accommodations include:
- Extra time for assignments and tests
- Shortened school days
- Reduced homework
- Breaks during class
- A quieter testing space
- Help organizing assignments
- Modified physical education requirements
- Additional support in difficult subjects
Dr. Ruby emphasized that parents, teachers, coaches, and healthcare providers should communicate throughout the recovery process.
Early Intervention Can Change the Trajectory
A child’s brain is still developing, which can make long-term outcomes difficult to predict.
Some problems may not become apparent until the child reaches a new developmental stage that requires more advanced planning, emotional control, memory, or problem-solving.
Early intervention gives the care team an opportunity to identify physical, cognitive, behavioral, and emotional concerns before they become larger problems.
That may include involving:
- Pediatric medical providers
- Neurologists
- Physical or occupational therapists
- Mental health professionals
- School counselors
- Teachers
- Coaches
- Speech or cognitive therapists
No single provider may be able to address every part of the child’s recovery.
Mental Health Should Be Part of the Treatment Plan
Anxiety and depression can affect the length and difficulty of concussion recovery.
A child with an existing anxiety disorder may repeatedly worry about the accident, another injury, or the possibility of symptoms returning.
A traumatic crash may also cause acute stress reactions or eventually lead to post-traumatic stress disorder.
Dr. Ruby explained that therapy may initially occur as often as twice a week. As the child progresses, sessions may transition to weekly or every-other-week appointments.
The appropriate schedule depends on the child’s symptoms, existing mental health concerns, and response to treatment.
Returning to Sports Requires Caution
Young athletes may be eager to return to practices and games before they have fully recovered.
They may minimize symptoms because they do not want to lose their position, disappoint teammates, or miss an important event.
Parents and coaches should take complaints of dizziness, confusion, headache, vision changes, or feeling “off” seriously.
Dr. Ruby discussed the risk of another concussion, particularly among teenage athletes. A second impact during recovery may cause more serious symptoms and complications.
Children should follow medical return-to-play guidance and use appropriate protective equipment. Helmets may reduce certain injury risks, but they cannot prevent every concussion.
Telemedicine Can Remove Barriers to Care
Regular medical and therapy appointments can be difficult after a family car accident.
The family’s vehicle may be damaged, a parent may also be injured, or the appropriate provider may be located far away.
Telemedicine can help children receive follow-up care without requiring frequent long-distance travel.
This can be especially valuable for families living in rural communities. Some therapists may also provide services in schools, homes, or other accessible settings.
Virtual care will not replace every in-person examination, but it may prevent transportation problems from interrupting treatment.
Children Need Someone in Their Corner
Children are resilient, but resilience does not mean they should recover without help.
Young patients may describe symptoms in unusual ways. A child may say that a parent appears to spin, the room moves, or their head feels strange.
Parents and providers must listen carefully and consider what those descriptions may mean.
A successful recovery often depends on adults who notice changes, communicate with one another, request school support, and make sure the child receives appropriate care.
When physical, cognitive, academic, and emotional symptoms are all considered, the child has a stronger support system for returning to everyday life.
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