A concussion is a mild traumatic brain injury (mTBI) that affects how the brain functions and can occur at any age, including infancy. It is typically caused by a jolt, blow, or bump to the head or body that causes the brain to move quickly inside the skull. The resulting effects are usually temporary, involving a disturbance at the cellular level rather than a visible structural abnormality on a scan. Symptoms can include problems with balance, sleep, mood, and concentration. Since infants cannot communicate how they feel, recognizing the signs requires careful observation.
Why Infant Brains Are Vulnerable to Injury
The unique physical characteristics of a baby make their brains particularly susceptible to head trauma. An infant’s head is disproportionately large and heavy compared to the rest of their body. This, combined with underdeveloped neck muscles, provides less support and control over head movement. Consequently, any sudden force results in greater acceleration and deceleration of the head, increasing the risk of the brain shifting violently inside the skull.
The skull bones in infants are thinner and softer than those of an older child or adult, offering less protection against impact. Even minor falls can create significant forces on the delicate brain tissue. The most common mechanisms of injury in this age group are accidental falls at home, such as falling from a changing table or bed, or during a car crash.
A severe cause of head trauma in infants is Abusive Head Trauma (AHT), formerly known as Shaken Baby Syndrome. This trauma results from violent shaking or blunt impact, causing the fragile brain to move back and forth uncontrollably. This extreme motion can tear delicate blood vessels and nerve fibers, leading to swelling, bleeding, and potentially permanent neurological damage or death. AHT is most common in children under the age of one and often occurs when a caregiver becomes frustrated by inconsolable crying.
Recognizing Symptoms in Non-Verbal Babies
Since infants cannot verbalize symptoms like a headache or dizziness, parents must look for physical and behavioral changes that signal a problem. Immediate signs requiring urgent attention include a loss of consciousness, even if brief, or repeated vomiting, which can indicate increased pressure. Excessive drowsiness, difficulty waking the baby from sleep, or a noticeable bulging of the soft spot (fontanelle) are also red flag symptoms. If the baby is inconsolable and cannot be calmed, this may be their only way of communicating severe distress or pain.
Parents should also watch for delayed or subtle changes that may emerge hours or days after an injury. A significant change in feeding habits, such as refusing to nurse or eat, or difficulty sucking or swallowing, can be a symptom of neurological disturbance. Behavioral shifts like increased irritability, crankiness, or a sudden lack of interest in favorite toys and surroundings are important indicators. Changes in movement, such as a loss of balance or coordination, or a general listlessness and tiring more easily than usual, warrant medical evaluation.
Emergency Response and Medical Diagnosis
If a baby sustains a significant blow to the head or exhibits any severe symptoms, emergency medical attention is necessary. Signs like seizures, one pupil being larger than the other, slurred speech, or increasing weakness in the limbs require an immediate call for emergency services. When speaking with medical professionals, providing a detailed account of the injury is important, including the time it occurred, the mechanism of the impact, and the baby’s immediate reaction.
The diagnostic process begins with a thorough neurological assessment and physical examination to check reflexes, coordination, and responsiveness. The doctor relies heavily on the caregiver’s observations of changes in behavior, feeding, and sleep patterns since the injury. While a concussion itself does not show up on imaging, a computerized tomography (CT) scan or magnetic resonance imaging (MRI) may be used to rule out more severe injuries. These imaging tests are used judiciously in infants to limit radiation exposure but are essential if a skull fracture or bleeding within the brain is suspected.
Post-Injury Care and Prevention
Recovery from a concussion in infants often requires a period of physical and cognitive rest in a quiet environment. Parents should try to maintain the baby’s normal sleep and nap schedule, though they may sleep more than usual in the initial days. It is important to monitor their sleep but avoid letting them sleep excessively without checking on their responsiveness. Activities that involve bouncing, rough play, or overstimulation should be avoided to allow the brain time to heal.
Since an infant’s brain is still developing, recovery can sometimes take longer than in older children, potentially lasting several weeks. Following the initial recovery, parents should continue to monitor for any subtle, lasting developmental or behavioral changes, and follow up with a pediatrician for continued assessment. Practical prevention strategies focus on minimizing the risk of falls and head impacts:
- Securing heavy furniture, such as dressers and televisions, to the wall to prevent tip-over accidents.
- Always using the correct car seat for the child’s size.
- Never leaving a baby unattended on high surfaces like changing tables or beds.