Persisting Symptoms After Concussion in Young Children: What Primary Care Clinicians Need to Know

In this video interview, Sean Rose, MD, a pediatric neurologist at Nationwide Children’s Hospital and The Ohio State University, discusses new research examining how frequently children younger than 6 years experience persistent symptoms after concussion, how those symptoms present differently than in older patients, and what primary care and emergency clinicians should consider when diagnosing, counseling families, and monitoring recovery.

Key Highlights

• Persistent symptoms are common after early childhood concussion, with roughly one-quarter of children younger than 6 years experiencing symptoms beyond 1 month, challenging assumptions that recovery is uniformly rapid at this age.

• Symptoms often present as parent-observed behavioral changes rather than self-reported complaints, making accurate diagnosis and monitoring dependent on caregiver input.

• Acute symptom burden at presentation predicts prolonged recovery, whereas loss of consciousness and head CT use do not, underscoring the value of early symptom assessment and follow-up.

Additional Resource: Rose SC, Dupont D, Tang K, et al. Frequency and Predictors of Persisting Symptoms 1 Year After Early Childhood Concussion. Pediatrics. 2026;157(2):e2025072885. doi:10.1542/peds.2025-072885

Transcript:

Consultant360: Can you please provide a brief overview of your study and the study results?

Sean Rose, MD: We studied concussion in young children, looking at kids under age six who come into the ER with a concussion, and we tracked them over the next year to follow symptoms and look at recovery. 

Consultant360: How common are persisting symptoms after concussion in children younger than 6 years, and how does this compare with other types of injuries?

Dr Rose: We found that in young kids, so under age 6 who come into the ER with concussion, 28% will still have symptoms 1 month later. That will continue as 24% at 3 months, and then 16% at 1 year after the injury. We also looked at kids who came into the ER with an orthopedic injury, so an arm or a leg injury, and found that at 1 month, 10 % were reporting symptoms, and that dropped a little bit over time. We finally looked at healthy kids, so without any injury, and tracked them over time. And they do report some symptoms because a lot of symptoms after concussion are nonspecific. But the healthy kids really reported a 2% to 4% rate of symptoms over time.

Consultant360: What early clinical features should primary care physicians pay the most attention to when assessing young children after a concussion?

Dr Rose: Well, young children after concussion do seem to have different symptoms than older kids and adults. First of all, it's harder for younger kids to report their symptoms. So it's harder for them to say things like, "I have a headache," "I feel dizzy," "I have foggy mentation," or other things that we expect older kids to be able to report. So we really rely on parents to observe changes in their child. And the things that we see most commonly are behavioral changes. That might be things like irritability or clinginess or change in sleep schedules. It can even affect parent-child interactions. And we do see some symptoms, more physical symptoms like headache and light sensitivity and nausea. But parents really have to recognize those symptoms a little bit differently in that age.

Consultant360: How should primary care clinicians counsel parents about expected recovery timelines and the possibility of ongoing symptoms after early childhood concussion?

Dr Rose: Well, the good news is that about three quarters of kids at this age will be fine after 1 month. So they'll be back to baseline level symptoms compared to regular uninjured kids. But about 25 to 30% of kids will still have symptoms after 1 month. And we want to identify what kids are injured, first of all. And that can be hard in and of itself because it's hard to diagnose a concussion at this age. We found through some other research that ER doctors are more likely to use a different diagnosis, just an unspecified injury diagnosis, rather than a concussion diagnosis at this age. So first, we need the right diagnosis. And then we have to track and manage these kids carefully over the next few weeks to try to improve symptoms and get them on a good recovery trajectory.

Consultant360: Which risk factors for prolonged recovery do not predict persisting symptoms in young children with concussion?

Dr Rose: Well, we did look at several factors to see what was predictive of prolonged symptoms. And a couple of things were not predictive. First was whether the child had loss of consciousness. So if they were knocked unconscious, that did not predict their recovery. Also, if they had a CAT scan of their head in the ER. So this is a clinician determining that their injury was concerning enough to do a CAT scan. That did not predict recovery. The main finding that we did show predicting recovery was the acute burden of symptoms in the ER. So parents are reporting the symptoms on a validated questionnaire for this age group. And if they reported higher symptoms right there in the ER, then that child was more likely to have longer recovery.

Consultant360: What role can primary care physicians play in early identification, monitoring, and following up of young children at higher risk for persistent symptoms after concussion?

Dr Rose: In our study, we looked at kids coming into the ER. That's a very concentric group of kids to study. They're coming in very quickly after their injury. Now, kids, of course, are coming into their primary care doctor's office after injury as well. And we would want both ER doctors and primary care doctors to evaluate for symptoms of a concussion. Many kids hit their heads and don't have a concussion. And so we don't want to overdiagnose. But we also want to recognize that these behavioral changes and some of these symptoms that are a little harder to recognize may be there in these young kids, whether they're coming into the ER. or primary care visit.

Consultant360: Were there any surprising findings or key takeaways from your study?

Dr Rose: Well, this is really the first study that has looked at the incidence of persisting symptoms in this young age group. We've already known that about a quarter to a third of older kids and adults do have persisting symptoms past one month. And now we know that that's true in young kids too. It's often commonly held that a young kid will hit their head. maybe be evaluated and assumed to be fine. And they'll recover well. They're young, their brain is modifiable over time. But we're seeing that concussion affects these young kids in a similar way as older kids and adults in that about a quarter do have longer symptoms and they need to be managed over time. One thing that I would recommend is... trying to manage these symptoms. Many of them are treatable, whether that's pain or neck strain or balance issues. There's different types of therapy or medications that can be helpful. Also, getting into early intervention services can be worthwhile, ensuring that the child is ready for entry into kindergarten when that time comes.

©2026 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Consultant360 or HMP Global, their employees, and affiliates.