What every parent should know about concussion in kids under 6, and why early intervention matters more than we used to think.
For a long time, many parents and more than a few clinicians have trusted a reassuring idea: young children’s brains are resilient and they bounce back quickly after a hit to the head. A toddler falls, cries, settles down, and the assumption is that they will be fine in a few days. Emergency visits often end with general guidance to watch them, and most research attention has focused on older kids and adults.
A new study in Pediatrics may make us rethink that.
What the Study Found
The study drew on the KOALA project (Kids’ Outcomes And Long-term Abilities after early childhood concussion), which followed 235 children between 6 months and 6 years old who came to emergency departments within 48 hours of a concussion. These children were compared with two other groups: 108 kids with orthopedic injuries and 75 healthy controls.
The numbers are striking:
- 28% of the children with a concussion still had symptoms one month after the injury.
- In the orthopedic injury group, that number was 10%, and in healthy children, just 2%.
- At three months, 24% of the concussion group remained symptomatic.
- At one year, 16% still had ongoing symptoms.
Those rates are very similar to those reported in older children and adults. In other words, the idea that very young kids “shake it off” quickly does not hold up when you look at the data.
As senior author Dr. Miriam Beauchamp, Canada Research Chair in Pediatric Traumatic Brain Injury at the University of Montreal, put it, this work challenges the view that young children just “bounce back” and shows that almost a third are still symptomatic at one month, sometimes much longer.
Why Young Children May Be More Vulnerable
Concussion in toddlers and preschoolers is not simply a smaller version of concussion in teenagers. There are real developmental and anatomical reasons that may make them more vulnerable to the same injury forces.
Young children have proportionally larger heads and weaker neck muscles, which makes their brains more exposed to rotational forces. Their skulls are thinner and more pliable, and the sutures have not fully fused, so the mechanical protection is different from that of an older child.
On top of that, the typical injury mechanism is different. In this age group, falls are far more common than sports-related injuries. They happen on playgrounds, down stairs, off couches, and on changing tables. These are everyday childhood events that parents often see as part of normal development.
In the United States, an estimated 350,000 children under age 6 present to emergency departments each year with concussion or mild head injury. Yet most concussion guidelines were developed for older children and adults, leaving a gap in how we approach evaluation and follow-up for the youngest patients.
The Diagnostic Challenge: When Kids Can’t Explain Their Symptoms
There is another layer to this: very young children cannot reliably tell you what they feel.
The symptoms we associate with concussion — headache, light sensitivity, feeling foggy, difficulty concentrating — are subjective and internal. They require not just language but also enough self-awareness to recognize that something is off and then describe it. A two-year-old simply does not have that capacity.
Because of this, many young children who present to emergency rooms are documented with broad labels like “unspecified head injury” rather than a diagnosis of concussion. The problem is not that they do not have symptoms. It is that they cannot report them as older patients can.
To work around this, the KOALA study used a parent-reported tool called the REACTIONS questionnaire (Report of Early Childhood Traumatic Injury Observations and Symptoms), developed by Dr. Beauchamp. Instead of asking children how they feel, it guides parents through 17 categories of observable changes, including things like:
- attention and memory
- headache and fatigue, as inferred from behavior
- sleep patterns
- mood and irritability
- anxiety or clinginess
- regression in skills
- sensitivity to light, noise, or touch
The questionnaire turned out to be very informative. Children who had higher symptom scores early on were significantly more likely to still have symptoms one month later. That means a carefully structured parent report can help identify, very early, which children are at higher risk for a prolonged recovery and need closer follow-up.
Which Children Are at Higher Risk for Persistent Symptoms?
The study also looked at factors that seemed to predict who would still be struggling down the line.
Several stood out:
- a higher burden of symptoms in the acute phase, as captured by the REACTIONS questionnaire
- a personal or family history of migraine, ADHD, learning difficulties, or psychiatric disorders
- socioeconomic factors, which we know influence outcomes after brain injury across all age groups
Why “Just Rest” Isn’t Enough
The expert commentary around this study was remarkably consistent on one point: passive rest alone is not an adequate plan.
My good friend and colleague, Dr. Teena Shetty, associate attending neurologist at the Hospital for Special Surgery and associate professor at Weill Cornell Medical College, emphasized the need to move beyond simple rest toward proactive, individualized care for early childhood concussion. Dr. Christina L. Master of the Children’s Hospital of Philadelphia noted that children with higher symptom burdens early on may benefit from earlier referral to specialized concussion care.
In practice, that means we should avoid a wait-and-see approach when a young child has clear symptoms, especially if they are pronounced or persistent.
Emerging Approaches to Treatment and Support
Research in children under 6 is still catching up to what we know in older age groups, but we are starting to see a trend toward a more active approach to care.
Nutritional Approaches
Nutritional support is often discussed in integrative and neurologic care. While evidence in this specific age group is limited and dosing must always be tailored by a pediatrician or pediatric neurologist, there are some nutrients that repeatedly come up in concussion research more broadly:
- magnesium has been studied for its potential role in reducing excitotoxicity and supporting neuroprotection after brain injury
- vitamin B12 is essential for normal neurologic function and may be appropriate in some cases, particularly in vegetarians
- omega-3 fatty acids have been investigated for their potential to reduce neuroinflammation after concussion
For very young children, it is especially important not to treat these like benign over-the-counter add-ons. Dosing, formulation, interactions, and safety are age-dependent, and any supplementation should be discussed with the child’s physician.
Vestibular and Vision-Based Rehabilitation
Many concussion symptoms in children involve balance and visual processing, such as dizziness, difficulty with coordination, unsteadiness on stairs or playground equipment, or sensitivity to visual motion and bright light. When these systems are affected, targeted vestibular rehabilitation and vision therapy, tailored to the child’s developmental level, can be very effective.
Gradual Return to Activity
The older advice to keep a child in a dark room until all symptoms are gone has largely fallen out of favor. Current evidence supports a gradual, structured return to both cognitive and physical activity, guided by a clinician.
The idea is to find a level of activity that does not significantly worsen symptoms and then progress step by step as the child is able to tolerate more. Too little activity can prolong recovery, and too much can derail it, so there is a sweet spot that needs careful supervision.
Emotional and Behavioral Support
Finally, there are significant emotional dimensions to these injuries. Young children recovering from a concussion can become more irritable, anxious, clingy, or withdrawn. Sleep can be disrupted. Parents may notice regression in toilet training or other skills. These changes are stressful for families and can feed into a cycle of worry and behavioral escalation.
Behavioral support for both parents and children can be helpful. That might include parent coaching, strategies to support sleep and routines, and, when age-appropriate, direct psychological support for the child.
What Parents Can Do After a Head Injury
If your child under 6 has a head injury — whether from a fall, a collision, or another mechanism — this study suggests several practical steps:
- Take the injury seriously, even if it looked like just a bump at the time. Young brains are still developing, and symptoms may be subtle or delayed.
- Watch closely for changes. Mood, sleep, irritability, appetite, play, balance, and behavior can be more reliable indicators in this age group than a verbal report of headache.
- Do not assume everything will normalize in a day or two. In this study, nearly one in three children with a concussion still had symptoms at one month.
- If symptoms persist beyond 7 to 10 days, or if they were intense from the beginning, ask about referral to a specialized concussion clinic or a pediatric neurologist with concussion expertise.
- Before starting supplements or non-standard therapies, talk with your child’s physician. Safety and dosing look very different in a small child than in an adult.
Where the Field Is Headed
Researchers are now looking for objective biomarkers — things we could measure in blood or saliva — that might help predict early on which children are at higher risk for persistent symptoms. Co-author Dr. Sean Rose of Nationwide Children’s Hospital has emphasized that a major next step will be to study treatment interventions directly in this youngest age group, rather than extrapolating from older kids and adults.
In the meantime, the most important thing we can do is take these injuries seriously from the start and avoid assuming that a young child will grow out of it on their own. For a meaningful minority of children, concussion is not a brief event but a prolonged recovery process, and thoughtful early intervention can make that trajectory much better.
Based on: Rose SC, et al. “Frequency and Predictors of Persisting Symptoms 1 Year After Early Childhood Concussion.” Pediatrics. 2026;157(2):e2025072885. As reported in Neurology Today.
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