Learning Leader

Study Puts Spotlight on Post-Concussion Symptoms

“With 1 million to 2 million US children sustaining a concussion from just sport and recreation participation annually, it is essential to identify injury and noninjury factors that either promote or hinder recovery from mild traumatic brain injury” (Ewing-Cobbs, Cox, Clark, Holubkov, & Keenan, 2018). Findings are inconsistent regarding which factors contribute to a child being at high risk for prolonged symptoms. To shed much needed light on this important topic, Linda Ewing-Cobbs, PhD served as the lead author on a study titled “Persistent Postconcussion Systems After Injury.”

Dr. Ewing-Cobbs, a professor with the Children’s Learning Institute, holds the Harriet and Joe Foster Chair in Cognitive Neuroscience at McGovern Medical School at UTHealth. Her coauthor from UTHealth, Charles Cox, Jr., MD holds the George and Cynthia Mitchell Distinguished Chair in Neurosciences. Together they worked closely with three researchers from the University of Utah on the study supported by the Centers for Disease Control and Prevention (CDC). This October their efforts were published in Pediatrics, the official journal of the American Academy of Pediatrics. The published abstract and video introduction are available online for viewing.

Linda Ewing-Cobbs, PhD. 

Linda Ewing-Cobbs, PhD. PHOTO CREDIT: Maricruz Kwon, UTHealth

Children with mild traumatic brain injury often experience difficulty concentrating, headache, and irritability post injury. Additional post-concussion symptoms may be nonspecific and may include new physical, emotional, cognitive, and fatigue problems. Symptoms often resolve within one week to one month post injury for most children. Dr. Ewing-Cobbs said, “We were surprised at the number of children whose symptoms persisted throughout the first year following their injuries.” Even for children whose symptoms resolve, research documents persistent reductions in physical or academic areas for up to one year after injury.

In the study, Ewing-Cobb’s team analyzed the medical records of 347 children who were treated between 2013 and 2015 by the emergency department at one of two Level I pediatric trauma centers. Study participants ranged in age from 4 to 15 years, and were divided by age at injury, type of injury, and severity of injury. Follow-up surveys were conducted at 3, 6, and 12 month intervals after injury.

When analyzing injury characteristics and participant demographics, researchers identified factors that influenced a child’s likelihood of experiencing long-term symptoms. Children from stable families with greater social networks tended to be less likely to have lasting symptoms. Conversely, children from families with more stress and lower income were more likely to experience ongoing symptoms. Pre-existing mood or anxiety disorders were also identified as being related to persistent post-injury symptoms. Unexpectedly, study findings show that when compared to boys, girls have twice the odds of having chronic post-concussion symptoms.

Researchers found that at one year, chronic post-injury concussion symptoms persisted for 31 percent of children with complicated mild traumatic brain injury and 25 percent for those with mild traumatic brain injury. Interestingly, over 40% of parents reported one year after the injury that their child acted differently as compared to before the injury.

“The high rate of chronic concussion symptoms is of concern because of the strong relationship between persisting post-concussion symptoms and reduced health-related quality of life” (Ewing-Cobbs et al., 2018). Over time, emotional and cognitive symptoms may emerge in addition to the immediate physical symptoms. Because of this, it is suggested that children with persisting symptoms one month after injury be monitored by their primary care physician to screen for adjustment difficulties.

Concussions can have a more serious effect on the developing brain of children. Care should be taken to address the injury correctly and allow time for healing. Pediatrics often provide guidance regarding when and how children can return to play. Similar advisement should be considered for return to learning activities as well.

Sharing her knowledge, Dr. Ewing-Cobbs served on the CDC panel that generated new recommendations for management of concussion in children. These recommendations and other useful resources about concussions are available on the HEADS UP website. This information provides helpful insights to parents, health care providers, and school personnel to keep children healthy and safe.


Ewing-Cobbs, L., Cox, C. S., Clark, A. E., Holubkov, R., & Keenan, H. T. (2018). Persistent postconcussion symptoms after injury. Pediatrics, 142(5). https://doi.org/10.1542/peds.2018-0939


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