A Parent’s Guide to Sports-Related Concussions in Kids

Concussions are common in children and teens. They can happen during sports, play, falls, car accidents, and bike rides. Understanding what happens during a concussion and what typical recovery looks like can help parents support their child during the healing process.

What is a concussion?

A concussion is a mild traumatic brain injury (mTBI) caused by a blow to the head or a force that makes the brain move rapidly inside the skull. This sudden movement can temporarily disrupt how brain cells function. Concussions usually do not show up on standard imaging, such as CT and MRI scans. When abnormalities are detected on imaging, the injury is referred to as a complicated mTBI. These injuries can have a different clinical course and recovery trajectory. For the purpose of this blog, we will focus on uncomplicated concussions, which represent the majority of pediatric mild head injuries.

Signs and Symptoms

Signs and symptoms of concussions are often classified into 5 categories: somatic, vestibular/oculomotor, cognitive, emotional, and sleep. Below are some common symptoms children may experience after a concussion (adapted from Halstead et al., 2018, Table 2).

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The Brain’s Neurometabolic Response After a Concussion

When a concussion occurs, the brain experiences a rapid series of chemical and metabolic changes called the neurometabolic cascade. A concussion may look invisible on a scan, but inside the brain, a rapid chain reaction begins. Within seconds of the injury, brain cells experience a surge of chemical activity that disrupts their normal balance and forces the brain to work overtime just to stabilize itself.

• Potassium, an electrolyte that helps cells send signals, leaks out of the brain cells, which throws off the cells’ normal electrical balance.

• Glutamate, a chemical messenger that excites brain cells, is released in excess and overstimulates nearby neurons.

• The excess glutamate activates NMDA receptors (N-methyl-D-aspartate), causing sodium and calcium to rush into the cell while more potassium flows out. This process further slows normal brain cell communication.

• To restore balance, brain cells turn on tiny pumps that move sodium and potassium back to their normal state. These pumps require a lot of energy, so the brain starts using more fuel (ATP and glucose) than usual. This temporarily drains the cells’ energy reserves.

• To deal with the extra calcium inside the cell, neurons move the calcium into structures called mitochondria, the parts of the cell that make energy. But too much calcium can interfere with how these structures work, reducing the cell’s ability to produce energy. As a result, brain cells may temporarily struggle to produce enough energy.

Supporting Your Child’s Recovery

Although these changes sound concerning, the brain is remarkably resilient. Fortunately, the chemical disruptions are short-lived, and most people recover within a few weeks as the brain returns to its normal balance.

If a concussion is suspected, your child should be removed from play right away to reduce the risk of further injury. Children are 8.8 times more likely to have a recovery longer than 21 days with continued play after a concussion. An additional head injury within 24 hours of the first injury can have even worse recovery implications (Halstead et al., 2018).

Early recovery usually involves reducing both physical and cognitive demands, such as intense exercise, or activities that worsen symptoms. However, complete or prolonged rest is not recommended because excessive inactivity may actually slow recovery. Instead, light physical activity, such as brisk walking or gentle cardiovascular exercise that do not provoke symptoms, can be helpful. Full sports participation should be avoided until recovery progresses and/or medical guidance is provided if needed. Most children benefit from gradual return to normal activities with temporary adjustments.

The Good News

The good news is the majority of children follow favorable recovery patterns, with 73% achieving rapid or typical recovery. Most children begin to feel significantly better within 1-2 weeks and the majority recover within about 4 weeks (Yeates et al., 2025). Check out these resources from the American Academy of Pediatrics on concussion-related and return to play information.