Slower Recovery for Kids' 2nd Concussion

Children who have had a concussion before may take a much longer time to get well after a second concussion, a new study finds. And the more recent the first concussion was, the longer the recovery time. The study included 280 children and young adults who came to a hospital emergency room with concussion symptoms. Their ages ranged from 11 to 22. About 60% were injured playing sports. Researchers kept track of them during recovery. Those who had a prior concussion took about 24 days to recover. That was twice as long as the average of 12 days for other patients. If the earlier concussion was in the last year, recovery took even longer -- about 35 days. Average recovery was 28 days for those with 2 or more prior concussions. The journal Pediatrics published the study online. HealthDay News and USA Today wrote about it June 10.

By Claire McCarthy, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

If your child has had a concussion, it will take him longer to recover from another concussion -- especially one that occurs within a year.

That's the finding of a new study in the journal Pediatrics, the official journal of the American Academy of Pediatrics. Researchers from Boston Children's Hospital did the study. They assessed the symptoms of children coming into their emergency room with concussions. Then they kept track of the children to see how long it took for the symptoms to go away.

Here's what they found:

• Children who had a previous concussion took longer than other children to recover. Their average recovery time was 24 days, as opposed to 12 for children with no prior concussion.
• If that concussion occurred in the last year, recovery took even longer, about 35 days.
• Recovery time was about 28 days for children who had multiple previous concussions.
• Not surprisingly, children who had more severe symptoms when they got to the emergency room took longer to recover.
• Children who were ages 13 or older took longer to recover. This might be because they were more likely to get severe head injuries than younger children.
• Children who lost consciousness actually had shorter recoveries. The researchers weren't sure why. It's possible that they were more likely to go to the emergency room, even if their other symptoms were not that bad. Also, we know that passing out in and of itself isn't necessarily a bad thing. It's also possible that the fact they had passed out made them more likely to follow instructions afterward. This might have made their recovery quicker.

We have certainly known for a while that repeated concussions are bad for the brain. However, this study is helpful in that it gives us information about all ages of children. Most studies before have been in older children and young adults.

This study also gives us specifics about how long it took the children to recover -- and about what does and doesn't make that recovery take longer. For example, some have thought that children with migraine headaches, depression, ADHD or anxiety might take longer to recover. But that didn't happen in this study.

What Changes Can I Make Now?

More and more, we are learning about the dangers of concussion. It is particularly worrisome for the developing brain. It's really important to know the symptoms of concussion. They can include:

• Headache
• Nausea or vomiting
• Excessive sleepiness
• Having trouble with balance or with normal activities
• Trouble seeing
• Sensitivity to light or noise
• Difficulties with concentration or memory
• Mood changes

If any of this happens to your child after a bump to the head, call your doctor right away -- or go to an emergency room. If this happens during a sports competition, it's very important that the child stop competing.

Be sure to follow all of the doctor's instructions. Resting, both physically and mentally, may help speed recovery. It also may help limit the long-term damage that can happen after a concussion. As this study points out, the next concussion may lead to a more difficult recovery. And other studies suggest that it may increase the risk of permanent brain damage.

What Can I Expect Looking to the Future?

With more and more young children taking part in competitive sports, many of which carry the risk of concussion, this study is worrisome. We need to heed its warnings and the warnings of lots of other medical research about concussion. If we don't, more children will have longer recoveries and a higher risk of brain damage.

This is clearly not what we want for our children. To learn more about concussion and what you can do to recognize and prevent it, visit the Concussion page of the Centers for Disease Control and Prevention website.