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How to Tell if Your Child Has Post-Concussion Syndrome

Image of Kathryn Severs BSN, RN
Updated on 17 March, 2023
Medically Reviewed by

Dr. Alina Fong

Could Your Child Have Post-Concussion Syndrome?

It’s normal for kids to get bumps and bruises when playing and participating in sports, but it’s always worrisome when your child hits their head. How serious is it? Could they have a concussion? Do they need to see a doctor?

Usually, it’s a good idea to have a head injury examined by a medical professional, even if they don’t show the signs of severe traumatic brain injury. Even seemingly minor head injuries can cause problems. A doctor may be able to identify signs of injury that are easy to miss and give you a list of symptoms to look for, along with what to do if those symptoms appear. And, if they do start showing symptoms later, you’ll know it’s probably from the head trauma.

Parents and caregivers don’t always know that a child has had a head injury. When their behavior suddenly changes as a result, it can seem like there is no logical reason for it. What if a smart kid suddenly starts struggling in school or getting headaches all the time?

When searching for possible reasons for changes like these, it’s worth asking: “Could it be from a hit to the head?”

It is possible — symptoms that don’t go away after a concussion are due to post-concussion syndrome (PCS). Persistent post-concussion symptoms can happen to anyone at any age after a head injury. For the most part, the symptoms of concussion and post-concussion syndrome are the same; when concussion symptoms don’t resolve, we call them post-concussion syndrome.

Unfortunately, it’s hard to spot PCS in kids, especially when they’re young. I would know — my own daughter suffers from post-concussion syndrome, and I didn’t even realize it until she started to fall behind in school. And I work with post-concussion syndrome patients every day!

That’s why I’m writing this guide to post-concussion syndrome in children. I want you to be able to:

If you think your child might be suffering from post-concussion syndrome, schedule a consultation with our team. We’ll look at their medical history and determine if they are eligible for treatment at our clinic. 95% of our patients show statistically verified restoration of brain function after treatment at Cognitive FX.

Note: Any data relating to brain function mentioned in this post is from our first generation fNCI scans. Gen 1 scans compared activation in various regions of the brain with a control database of healthy brains. Our clinic is now rolling out second-generation fNCI which looks both at the activation of individual brain regions and at the connections between brain regions. Results are interpreted and reported differently for Gen 2 than for Gen 1; reports will not look the same if you come into the clinic for treatment.

The Symptoms of Post-Concussion Syndrome in Children

Kids may have trouble focusing during school

A concussion is a mild traumatic brain injury (mTBI). The most common causes of mTBI in children are falls, motor vehicle accidents (MVA), and sports. According to the Centers for Disease Control and Prevention (CDC), falls and car accidents are the most common reasons for head injuries that send kids to the hospital.

Obviously, if your child is in an MVA, you’ll know about it. But falls and contact sports injuries can be easier to miss, especially when they happen during unsupervised play.

Either way, here are some common symptoms of concussion your child might experience:

Immediate or Early


Early or Delayed

  • Amnesia (about the traumatic event)
  • Brief loss of consciousness
  • Balance problems
  • Car sickness or nausea with motion
  • Confusion
  • Change in (or loss of) taste or smell
  • Dazed appearance
  • Delayed response to questions
  • Dizziness or “seeing stars”
  • Difficulty finding things
  • Difficulty reading
  • Feeling of pressure in the head
  • Easy to distract
  • Feeling of overwhelm
  • Getting lost
  • Irritability
  • Low energy or motivation
  • Ringing ears
  • Temporary loss of consciousness
  • Tired eyes
  • Vomiting
  • Slowness to decide, think, speak, or act
  • Tired for seemingly no reason

Go to the emergency department or children's hospital immediately if your child:

  • Is increasingly confused, restless, or agitated.
  • Doesn’t recognize certain people or places.
  • Exhibits excessive drowsiness/sleepiness or does not awaken.
  • Exhibits strongly unusual behavior.
  • Has convulsions or seizures.
  • Has vomited more than twice in an hour after the head injury.
  • Has one pupil that is larger than the other.
  • Has a worsening, severe headache.
  • Loses consciousness.

These severe symptoms could indicate more serious brain damage than just a concussion. An emergency room doctor can determine whether they need additional medical attention and can order imaging such as an MRI or CT scan.

Further reading: Can an MRI detect post-concussion syndrome? and Can a CT scan detect post-concussion syndrome?

If concussion symptoms last for longer than three months, then we treat it as post-concussion syndrome. Previous concussions are a risk factor for developing PCS.

How to Spot the Symptoms of Concussion and Post-Concussion Syndrome in Kids

Could Your Child Have Post-Concussion Syndrome 2

There’s a difference between knowing what the symptoms of a concussion are and actually recognizing them in your child. Kids (even adolescents) may not be able to articulate what’s wrong — or even realize there’s been a change. Their symptoms will confuse and frustrate them, so it will help if you can figure out what’s happening and explain it to them at a level they can understand.

So what do these symptoms look like from the outside? In general, the changes will be a sudden departure from their normal. Ask yourself if they’ve undergone any of the following changes in a relatively short time frame (less than three months):

  • Do they no longer like school when they used to love it (or reading, parties, shopping, etc.)? 

  • Do they complain of headaches during or after cognitive or physical activity, or insist that they don’t want to do them anymore?

  • Are they having frequent emotional outbursts (out of the blue) that they never used to have, and you can’t figure out why?

  • Are they exhibiting symptoms of attention deficit hyperactive disorder (extra fidgeting, poor impulse control, short attention span, etc.)?

  • Are they struggling to learn and retain information? Do they have difficulty reading?

  • Do they suddenly get grumpy whenever they play video games?

  • Are they getting dizzy and nauseated in cars?

  • Does their balance or coordination seem off?

  • Do they complain of blurry vision or changes to their vision? 

  • Do they now prefer quiet places and seem more withdrawn? 

  • Do they have sleep problems like trouble falling asleep and/or trouble staying asleep?

Any one of these changes could be a sign of acute concussion or post-concussion syndrome. The more you answered “yes” to the question list, the more likely those behaviors are linked to a concussion.

My own sweet baby girl is an example. We didn’t know she hit her head. I just thought she was born clumsy. But when she still couldn’t read after first grade, I wondered if she had dyslexia. So we took her to Dr. Devan Duval, an optometrist who specializes in functional vision evaluation and vision therapy. He told us that she had double vision, no depth perception, and trouble with tracking and focusing — likely from a head injury we knew nothing about.

It was a bit of a shock for me when he uttered those words. How did I not know? How did I not recognize this in my own child?

The problem is that children are still developing. They’re still trying to find their “normal” or baseline. Neither of us knew what her normal was, so it took some delays in reading before we noticed it. Thankfully, she’s making great progress in her recovery now that she’s getting the right therapy.

That’s why it’s so important to investigate further if your child develops learning difficulties, ADHD-like symptoms, or sudden changes in temperament. Post-concussion symptoms are treatable, but you have to know they stem from a head injury to treat them effectively.

How Long Does Concussion Last in a Child?

Most children will recover from a concussion within two weeks. But if their symptoms don’t go away after three months, they might not get better without treatment. Kids have better recovery rates from mild TBI because their brains are more plastic than adult brains (meaning, it’s easier for them to rewire and bounce back from a problem). But that doesn’t mean they won’t need treatment to start feeling better.

If you think your child might be suffering from post-concussive syndrome, schedule a consult with our team. We’ll look at their medical history and determine if they are eligible for treatment at our clinic. 95% of our patients show statistically verified restoration of brain function after treatment at Cognitive FX.

Treatment Options for PCS in Children

Consult a doctor for head injuries

If you go to a sports medicine practitioner or a pediatrician for persistent symptoms, you may or may not get a helpful diagnosis for your child. Many pediatric doctors and even neurology doctors don’t know to look for post-concussion syndrome and may chase specific symptoms (“Let’s get this depression under control” or “Let’s fix the dizziness they’re having”) rather than identifying and treating the root cause. While it is helpful to get symptoms under control, it isn’t a long-term solution for concussion recovery.

It’s really easy to miss past head injuries and super common for primary care doctors and other treating physicians to misdiagnose kids with a learning disability, attention-deficit hyperactivity disorder, behavioral problems, and so forth.

Scrutinize the need for medication very carefully. Many of the children we’ve treated were incorrectly diagnosed with ADHD and given medication to help them through school along with meds to help them sleep at night. The combination of ADHD meds (an “upper”) and sleep meds (a “downer”) will give your child’s brain the chemical equivalent of whiplash. It can make their symptoms worse and inhibit their recovery. 

Also, be cautious with antidepressants and other medication for anxiety or depression. It’s OK for kids to take them when it’s truly needed for their mental health, but it often takes time and experimentation to find one that will work well for them. Pay close attention to which type of antidepressant is being used; most SSRIs come with an increased risk of suicidal thoughts in children. On top of that, these drugs change the chemical landscape of the brain — a brain that is already disrupted from having post-concussion syndrome.

Also remember that over-the-counter medications can have an impact, too. For example, even pain relief meds like acetaminophen (Tylenol) or NSAIDs (Ibuprofen, Aleve) can cause rebound headaches when taken over time or in too high doses. And they still put stress on the liver, which may already be strained from post-injury metabolism changes and any other medications your child is taking.

Medications do have their place, but we urge caution around a) which types and combinations of medications kids are taking and b) the total number of meds acting on their brains. It’s much better to treat the root issue and remove the need for those medications altogether.

Further reading: Medication for post-concussion syndrome

If your child is on medication, make sure you follow up regularly with their healthcare professional about how they tolerate the medicine, whether it’s working, and if there’s a plan to wean them off. If they develop new, concerning symptoms after starting a medication, seek medical advice quickly.

Post-Concussion Syndrome Treatment at Cognitive FX

Could Your Child Have Post-Concussion Syndrome 4

At Cognitive FX, we evaluate each patient thoroughly before starting therapy. In addition to looking at your child’s medical history, we conduct in-person physical and neuropsychological testing and give every patient a functional neurocognitive imaging (fNCI) scan. We treat children age 8 and up (or third-grade reading level).

fNCI is a type of functional MRI that can show us which brain regions were affected by the brain trauma and in what way.

(You can learn more about how fNCI is different from a regular MRI and why it works here.)

We then create a treatment plan based on the fNCI findings. 

After the evaluation process, we start an intense period of therapy tailored to your child’s needs. A few of the therapies we employ during treatment might include:

All of our patients also meet with a psychologist for evaluation of their mental health. If we determine they need additional care, we’ll make additional recommendations. For example, many post-concussion syndrome patients with depression or anxiety respond well to cognitive-behavioral therapy (as long as they’re old enough).

An example of an EPIC treatment exercise at Cognitive FX.
We take the same treatment approach with kids as we do with adults, with a few key differences:

  1. We tailor content in therapy to the child’s interests. If they like soccer, then we’ll incorporate a soccer ball. If they like dinosaurs, those will show up in the word games and other cognitive activities we do with them.

  2. When it comes to therapy, every child is different. Some thrive and do well with their parents right by their side while others need a bit of space to really let go and push through therapy. My child usually does better without me in the room. I also notice that I have a hard time watching and waiting for her to remember letters. Communication is key, and we need your help as much as your child needs ours. We'll coach you on how to reach the best outcome, and you can help coach us by teaching us about your child, what motivates them, their likes and dislikes, and what they fear (if anything). We will work as a team.

An example of an EPIC treatment exercise at Cognitive FX.

We’ll also train you on some therapy techniques to use with your children at home. Your child will have “homework” from the clinic to help them continue their recovery after treatment, so it’s important you understand how to help them with it.

  1. We want your child to feel like they are heard and supported during treatment. We elicit feedback and monitor the well-being of all our patients, but we do this even more attentively with children since they can’t always express themselves well.

Why This Approach Works

An example of an EPIC treatment exercise at Cognitive FX.
The main cause of persistent head injury symptoms is dysfunctional neurovascular coupling, though post-injury dysautonomia, hormone dysfunction, vestibular dysfunction, and vision dysfunction often also play a role. Our treatment program takes all of these factors into account.

Neurovascular coupling (NVC) is the relationship between neurons and the blood vessels that supply them with oxygen and micronutrients.

In a healthy brain, blood vessels provide a sustained surge in oxygen when neurons demand it. But if NVC is dysregulated, affected neurons (or whole brain regions) may not get the right amount of oxygen at the right time. This causes them to short out during the tasks they’re responsible for, such as making a decision or encoding a new memory.

At Cognitive FX, our treatment regimen is designed to promote neuroplasticity, which is your brain’s ability to change and to heal itself. The therapy we provide follows a repeating cycle of preparation, activation, and recovery to restore healthy neurovascular coupling.

Could Your Child Have Post-Concussion Syndrome 5

Cardiovascular exercise improves blood flow, bringing oxygen and other nutrients to the brain. This means your brain has the resources it needs for the intense therapy we do next. Therapy is full of multidisciplinary exercises that challenge your child’s memory, motor skills, executive thinking, and more. We also provide set times throughout the day for kids to recover and relax before jumping back into therapy.

This cycle of activating multiple brain regions pushes them to engage in healthier neurovascular coupling again. We also weave in therapy for vision problems, vestibular issues, and autonomic nervous system dysfunction.

One of our patients, Sam Pembleton, was injured by a soccer ball and spent five years trying to find a concussion clinic that could treat her. She found the healing she needed at Cognitive FX because of the system we just described.

You can read about Sam’s journey to recovery here.

What You Can Do at Home

Could Your Child Have Post-Concussion Syndrome 6

Here are a few things you can do before and after treatment during your child’s recovery journey:

  • Be patient. Recovering from post-concussion syndrome is a long process. Your child is suffering from these symptoms and will benefit from all the grace you can give them.

  • Let your child struggle and even fail sometimes. The process of trying and failing will help their brains make progress (it’s part of how neuroplasticity works).

  • Be present for them when they’re frustrated and encourage them.

  • Watch for their triggers, and have a plan to help them take a break and de-stimulate. Monitor their TV and game time, pull them out of social situations after it becomes too much, help them pace themselves during schoolwork, etc. But don’t shun those activities completely. Say things like, “You’ve been staring at a screen for 20 minutes. It’s time for a 20-second eye break.” Or break up long car rides into shorter segments if they can only handle 15 minutes at a time. Kids don’t know their bodies’ limits as well as adults know theirs, so you have to watch your child’s symptoms for them.

  • Play cognitive games when their symptoms allow. You can use this list of cognitive exercises to do at home.

  • If they play sports, work with their regular healthcare provider to monitor when they’re ready to return to play. You can read more about the emotional, physical, and mental aspects of recovery of young athletes from sports-related concussions here.

  • Visit an endocrinologist and check their hormone levels. Growth hormone, thyroid hormone, sex hormones, cortisol levels, and more can be affected by a concussion. Pharmacological interventions can help them get their body back on track if this is the case.

  • Let them exercise and move their body around. Play is good as long as it isn’t causing their symptoms to skyrocket. Balancing movements are particularly helpful (as long as you’re supervising to prevent a fall). Try playing a game of who can stand on one foot the longest, or who can pick up something off the floor while on one foot. Heal-to-toe walking or yoga poses can help their brain and body start to communicate better again.

  • Work with your child’s school to help with any accommodations your child may need (longer test times, more breaks, half school days, resources to catch them up, and so on). Embrace a gradual return to school and sports.

Finally, remember this: If your child has been struggling with post-concussive symptoms, you don't have to accept that this is how it’ll always be. There’s always room for your child to make progress with the right treatment and effort.

Further reading: Support groups for post-concussion syndrome patients and How to help a family member with PCS

If you think your child might be suffering from post-concussion syndrome, schedule a consult with our team. We’ll look at their medical history and determine if they are eligible for treatment at our clinic. 95% of our patients show statistically verified restoration of brain function after treatment at Cognitive FX.


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