38 CLINICAL FOCUS
38 CLINICAL FOCUS
13 FEBRUARY 2026 ausdoc. com. au
Therapy Update
Concussion in children
Neurology
Bianca Charles( top left) is a physiotherapist at the Neurological Rehabilitation Group, and is involved in paediatric concussion research at the Murdoch Children’ s Research Institute and adult concussion research at Monash University, Melbourne, Victoria.
Taylor Mills( top right) is a neuropsychology registrar at the Royal Children’ s Hospital and a research psychologist at the Murdoch Children’ s Research Institute, with an interest in concussion, cognitive rehabilitation and neurodevelopment, in Melbourne, Victoria. Professor Gavin A Davis( centre left) is a neurosurgeon at Cabrini Health and Austin Health, an honorary professor at the Murdoch Children’ s Research Institute, an adjunct professor at the University of Notre Dame Australia, an adjunct clinical professor at Monash University and a member of the Concussion in Sport Group, in Melbourne, Victoria.
Katie Davies( centre right) is the principal physiotherapist at the Neurological Rehabilitation Group, and is involved in paediatric concussion research at the Murdoch Children’ s Research Institute and adult concussion research at Monash University, Melbourne, Victoria.
Vanessa C Rausa( bottom left) is a clinical neuropsychologist at the Murdoch Children’ s Research Institute and a PhD candidate in the department of paediatrics at the University of Melbourne, Victoria.
Professor Vicki Anderson( bottom right) is a paediatric neuropsychologist, director of clinical sciences research at the Murdoch Children’ s Research Institute, and professorial fellow in the school of psychological sciences and department of paediatrics at the University of Melbourne, Victoria.
Comprehensive, ongoing assessment and a stepwise progression to return to learning and sport are essential to ensure appropriate management of concussion in children and adolescents.
IN Australia, concussion is a frequent presentation among children and adolescents in both emergency and primary care settings. Diagnosis requires a plausible mechanism of injury and the presence of clinical symptoms and / or signs that cannot be explained by other confounding factors or other injuries. 1-3
In younger children, the majority of concussions occur at home, while sport-related concussion makes up a large proportion of emergency presentations in older children and adolescents. 4, 5 It is estimated that up to one in five adolescents will sustain a concussion before completing high school. 6 Increasing media attention on concussion has been associated with a rise in healthcare-seeking behaviour from parents following paediatric head injury, as well as hesitancy regarding children’ s participation in contact sports, and other physical activities such as bike riding or playing in the park. 5
Concussive symptoms can occur immediately post-injury or evolve over the following hours or days. Acute signs of concussion can include loss of consciousness, seizure activity, tonic posturing, ataxia, poor balance, confusion, behavioural changes, and amnesia. 1, 3 The concussion-induced cerebral pathophysiological processes are thought to include induction of a cascade of effects through neurotransmitter and metabolic pathways, with possible axonal injury, blood flow change and inflammation affecting the brain. 1, 3 While most patients demonstrate rapid clinical and physiological recovery post-concussion, approximately one-third demonstrate more generalised symptoms that can last days to months( persisting post-concussion symptoms [ pPCS ]). These symptoms typically fall into four categories, shown in table 1.
The impact of concussion on children can be wide-ranging and disruptive. Common consequences include difficulties returning to school, disrupted sleep, heightened irritability or anxiety, and reduced participation in physical and social activities. These disruptions are particularly problematic during critical stages of academic and psychosocial development. 7 The symptoms of pPCS often interfere with quality of life and longer-term daily functioning in
the 20-30 % of children with concussion who experience them. 8, 9 The constellation of symptoms involved in pPCS often requires a more targeted, multidisciplinary approach to care. 7 It is important for GPs to be familiar with the assessment and management options, both for acute concussion and pPCS.
Education
GPs play a key role in patient education and the diagnosis and management of concussion in the community. The most critical step is the initial recognition of injury, and in the context of sport, removal from play. The Concussion in Sport Group( CISG) published the sixth edition of the Concussion Recognition Tool( CRT6), which is for non-medical professionals to recognise possible concussion and to safely remove the athlete from the field of play. 10 Provision of CRT6( see online resources) to all teachers, parents, team trainers and other supervising adults is an important component of community education. Another valuable tool to assist with concussion recognition is HeadCheck: a community-facing digital health application that assists with sideline concussion checks, symptom monitoring, and commencement of management with psycho-education( see online resources). 11
Clinical assessment
Following a suspected concussion, standard acute post-head / neck injury assessment is required. In a patient with a Glasgow Coma Scale score of 15 and normal cervical spine assessment, clinical assessment includes a detailed history, including the mechanism of injury, the patient’ s
It is advisable to routinely allocate a longer appointment time for the assessment of patients after concussion.
Table 1. Categories of persisting post-concussion symptoms
Physical
Cognitive
Emotional
Sleep
Headache Nausea Visual disturbances Dizziness Sensitivity to light or noise
Poor concentration Memory difficulties Slowed thinking
Anxiety Irritability Low mood
Insomnia or hypersomnia Fatigue concussion history( including the management and recovery trajectory / time frame of each of these), concurrent or previous medical history( such as migraine / headache disorders, anxiety, depression or neurodiversity) and medication history. 2
Detailed symptom evaluation is vitally important and is best accomplished with the use of a symptom checklist, such as those published by the CISG in the Sport Concussion Assessment Tool 6( SCAT6, for ages 13 +) and Child SCAT6( for ages 8-12)( see online resources). 12, 13 These tools assist the medical practitioner in the diagnosis and management of concussion. These are multimodal tools that take 10-15 minutes to perform. They are best used in the acute period( first 72 hours) after a suspected concussion. During the sub-acute period(> 72 hours) it is recommended that the Sport Concussion Office Assessment Tool 6( SCOAT6, Child SCOAT6) is used( see online resources). 14, 15 The SCOAT6 / Child SCOAT6 have been developed to allow for easy transition from acute( SCAT6 / Child SCAT6) to sub-acute assessment and further multimodality evaluation. The SCOAT6 / Child SCOAT6 tools are designed for symptom-directed assessment, and include detailed symptom checklists, tests of memory and concentration, autonomic function, cervical spine evaluation, neurological examination, formal balance testing, simple and complex timed tandem gait, vestibuloocular assessment, mental health screen and sleep screen checklists. 14, 15 These tools were developed for use in the evaluation of concussion in a controlled office environment by healthcare professionals.
The Melbourne Paediatric Concussion Scale is a symptom questionnaire that can
NEED TO KNOW
Up to one in five adolescents will sustain a concussion before completing high school.
Post-concussion symptoms may persist for weeks to months in 20-30 % of children and adolescents. These may include physical, cognitive, emotional and social symptoms, which can interfere with quality of life and level of function.
Community education for adults and supervisors of child sports is important to ensure appropriate removal from play in the event of a concussive event.
Detailed clinical assessment using widely available tools is recommended as soon as practicable after a concussion. Routinely allocate longer appointments for post-concussion assessments as the use of tools or questionnaires is likely to take longer than the average standard consultation.
Evidence-based clinical guidelines do not support the use of intracranial imaging such as CT or MRI as standard following a concussion. Imaging may be indicated if a more serious injury is suspected, or if symptoms worsen over time.
Clear guidelines are readily available to inform clinicians when advising patients about a suitable stepwise progression back to learning and sport after concussion.
Referral to a multidisciplinary team for targeted and specific assessment and management may be indicated for patients with persisting postconcussion symptoms. This team may include a specialist paediatrician, sports physician, neurologist, physiotherapist, psychologist and neuropsychologist.
also assist with classifying symptoms into various domains. 16 This is a valuable questionnaire to be aware of, and it can also be used to screen for concussion symptoms, especially during the sub-acute period.
It is advisable to routinely allocate a longer appointment time for the assessment of patients after concussion, as a comprehensive clinical assessment and application of an appropriate tool or questionnaire will take longer than an average standard consultation.
Evidence-based clinical guidelines do not support the use of intracranial imaging such as CT or MRI as standard following a concussion. However, these should be performed when a more serious injury is suspected, or where symptoms increase in the days post-injury. Decision-making around imaging and management in a hospital setting are detailed in the PREDICT and PECARN ED Guidelines. 17, 18 Currently, advanced neuroimaging, fluid-based biomarkers and genetic testing are being investigated in the research setting for diagnosis, prognosis and recovery, but are not currently indicated for use in standard clinical practice. 19
Management
In the first 48 hours following concussion, relative rest is important. 20 Relative rest can be defined as a period of reduced activity as opposed to strict bed rest. Strict rest