A pediatrician’s guide to concussion management

Concussions are one of the most common injury-related diagnoses in childhood and account for 65 % of adolescent emergency department visits. It is important for the pediatrician to understand the mechanisms of concussion, the expected time course of concussion resolution, and the circumstances involved in post-concussion syndrome recognized as symptoms beyond the typical remission period of several weeks. Pediatricians should also be cognizant of the special considerations in the pediatric population, especially among adolescent athletes. This chapter provides the necessary background for understanding the mechanisms and resolution pattern of concussion and also provides a comprehensive review of specific factors required in a history taken in an office visit for a child with a concussion. We will review aspects of the physical and neurologic exam specific to concussion, how to give feedback and make rational recommendations for the recovery period, how to manage persisting post-concussion syndrome, and when to make a referral to a specialist. Several case examples are provided to help the clinician understand the diversity of presentations and management of pediatric concussion.