Concussion Symptoms in Preschoolers: Signs Parents May Miss

Concussion Symptoms in Preschoolers: Signs Parents May Miss

A preschooler experiencing a concussion may not say, “My head hurts,” “I feel dizzy,” or “I cannot think clearly.” Instead, parents may notice that their child is unusually clingy, more irritable, less interested in playing, unsteady while walking, or unable to complete routines that were previously familiar.

Concussions can be especially difficult to recognize in preschool-aged children. Most concussion symptoms depend on self-reporting, and young children may not yet have the skills to do so. These skills include vocabulary, attention, body awareness, or memory skills needed to recognize and explain what they are feeling.

Identifying concussion symptoms in preschoolers often requires adults to carefully observe changes in the child’s behavior, communication, movement, sleep, eating, and participation.

What Is a Concussion?

A concussion is a type of mild traumatic brain injury that may occur after a bump, blow, or jolt to the head—or after a forceful impact to the body that causes the head and brain to move rapidly.

A child does not have to lose consciousness to sustain a concussion. In fact, most concussions occur without the child being “knocked out.”

Symptoms may appear immediately after the injury, but they can also become more noticeable several hours or days later.

Why Concussions Can Look Different in Preschoolers

Older children may be able to describe a headache, blurred vision, mental fog, nausea, or sensitivity to noise.

A preschooler may experience the same type of difficulty without knowing how to explain it.

For example:

• A child experiencing dizziness may ask to be carried or stop climbing.

• A child with light or noise sensitivity may cry in a busy room.

• A child experiencing cognitive fatigue may have a tantrum during a routine task.

• A child with a headache may hold their head, withdraw from play, or become difficult to comfort.

• A child experiencing confusion may respond slowly or struggle with familiar directions.

This is why it is important to compare the child with their own developmental and behavioral baseline.

Behavioral and Emotional Changes

Behavioral changes may be some of the earliest signs caregivers notice.

A preschooler with a possible concussion may:

• Become more irritable

• Cry more frequently

• Have unusually intense tantrums

• Seek more physical comfort

• Become harder to soothe

• Appear unusually quiet or withdrawn

• Show increased fearfulness

• Lose interest in favorite people or activities

• Demonstrate regression in previously established skills

Not every tantrum or emotional reaction after a fall indicates a concussion. The concern is a noticeable change from the child’s typical behavior, particularly when it begins after an injury or occurs with other symptoms.

Changes in Play and Participation

Play can provide important information about how a preschooler is functioning.

After a concussion, a child may:

• Stop participating in favorite games

• Avoid active or movement-based play

• Watch other children rather than joining them

• Become tired more quickly

• Abandon activities sooner than usual

• Struggle to follow the steps of a familiar game

• Become overwhelmed in noisy or visually busy environments

• Prefer quiet or less stimulating activities

These changes may reflect discomfort, dizziness, fatigue, sensory sensitivity, or difficulty processing information.

Balance and Movement Changes

Concussions can affect balance, coordination, and movement.

Watch for:

• Unsteady walking

• Increased stumbling

• More frequent falls

• Holding onto furniture or another person

• Moving more slowly or cautiously

• Avoiding stairs, climbing, running, or jumping

• Difficulty coordinating familiar movements

• Asking to be carried more often

Any significant or worsening difficulty walking after a head injury requires prompt medical attention.

Communication and Thinking Changes

Although cognitive symptoms may be difficult to identify in young children, caregivers may notice functional changes.

A preschooler may:

• Respond more slowly

• Seem confused

• Have difficulty following familiar directions

• Repeat questions

• Lose track of what they are doing

• Use fewer words than usual

• Have difficulty participating in conversation

• Forget familiar information

• Struggle with routines they previously understood

A speech-language pathologist may become involved when a concussion affects communication, attention, memory, executive functioning, feeding, or successful participation in school and daily activities.

Physical Symptoms

Young children may not clearly report pain or dizziness, but caregivers may observe:

• Holding or rubbing the head

• Nausea or vomiting

• Reduced appetite

• Dizziness or imbalance

• Unusual fatigue

• Sensitivity to bright lights

• Distress around loud sounds

• Vision-related difficulty

• Reduced tolerance for movement

• Appearing dazed or stunned

A single episode of vomiting can occur for multiple reasons, but repeated vomiting following a head injury is an emergency warning sign.

Sleep Changes

Concussion may affect how much or how well a child sleeps.

Changes may include:

• Sleeping more than usual

• Sleeping less than usual

• Difficulty falling asleep

• Waking more frequently

• Increased daytime sleepiness

• Changes in usual nap patterns

• Difficulty waking

Preschoolers naturally have different sleep patterns than older children, so compare the child’s sleep with their normal routine.

A child who is increasingly difficult to wake after a head injury requires immediate emergency evaluation.

When to Seek Emergency Care

Seek emergency medical care immediately when a child develops serious or worsening symptoms after a head injury, including:

• A headache or apparent head pain that becomes more severe

• Repeated vomiting

• Seizures or convulsions

• Increasing confusion or agitation

• Unusual behavior that continues to worsen

• Slurred speech

• Weakness or numbness

• Significant difficulty walking

• One pupil appearing larger than the other

• Loss of consciousness

• Inability to recognize familiar people or places

• Increasing drowsiness or difficulty waking

• Blood or clear fluid coming from the nose or ears

When you are uncertain about the seriousness of a child’s condition, contact a qualified healthcare professional or seek urgent medical evaluation.

What Parents and Caregivers Should Document

Clear observations can help a healthcare provider evaluate a child who cannot reliably explain their symptoms.

Write down:

• How and when the injury happened

• The part of the head or body that was struck

• Whether the child lost consciousness

• Any vomiting or seizure activity

• Changes in behavior or comfort-seeking

• Changes in communication

• Changes in walking or balance

• Changes in sleep or appetite

• Activities the child is avoiding

• Whether symptoms are improving or worsening

Whenever possible, describe the change using a specific functional example.

Instead of saying:

“My child seems different.”

You might say:

“My child normally runs to the playground and climbs independently. Since the fall, she asks to be carried, avoids the slide, and becomes upset when other children are loud.”

That comparison gives the healthcare provider more meaningful information.

Supporting Recovery After a Preschool Concussion

Follow the individualized recommendations provided by the child’s healthcare professional.

Current concussion guidance generally supports a brief period of reduced physical and cognitive demands followed by a gradual return to appropriate daily activities that do not significantly worsen symptoms. Children should not be isolated in a dark room for prolonged periods, and they should avoid activities that create a risk of another head injury while recovering.

Temporary adjustments may include:

• Shorter preschool or daycare days

• Additional rest breaks

• Reduced exposure to loud or visually busy environments

• Limiting climbing, running, wheeled toys, and rough play

• Providing quieter activities

• Allowing extra time to complete routines

• Monitoring fatigue and emotional regulation

• Maintaining communication among families, educators, and healthcare providers

Recovery plans should be individualized because concussion symptoms and developmental needs vary from child to child.

The Most Important Question: What Has Changed?

Parents and caregivers know the child’s routines, personality, communication style, and typical level of activity better than anyone else.

After a possible head injury, do not focus only on whether the child shows a stereotypical concussion symptom.

Ask:

• Is my child playing normally?

• Are they communicating normally?

• Are they walking and moving normally?

• Are they sleeping and eating normally?

• Are they tolerating their usual environment?

• Are they behaving like themselves?

A meaningful change from the child’s baseline may be the clearest indication that something is wrong.

Recognizing concussion symptoms early can help preschoolers receive appropriate evaluation, support, and protection from another injury while their brain recovers.

Educational Disclaimer

This article is provided for educational and informational purposes only and is not medical advice. It should not be used to diagnose or treat a concussion or other medical condition. Contact a qualified healthcare professional when a concussion is suspected. Call 911 or seek immediate emergency care for severe or worsening symptoms.