Children’s Concussion After a Car Accident

When Your Child Was in the Car: Concussion After a Crash

A parent guide from Dr. Verg at Dr. Verg Chiropractic, serving Vancouver, WA and Clackamas, OR

When a family is in a car accident, parents usually check on the children first, see no bruises, and breathe a sigh of relief. But a child’s brain can be injured without any visible mark and without a head strike. The same fast back-and-forth movement of the head that causes whiplash can shake the brain inside the skull. And unlike adults, children often cannot put what they feel into words.

That is why, at Dr. Verg Chiropractic, every child who was in the car gets a concussion screen, even if they say they feel fine.

Why children are more vulnerable in a crash

In children ages 1 to 12 injured in car crashes, about 60% of head injuries were injuries inside the skull with no skull fracture at all. Twisting and shearing forces on the brain, not just a hit to the head, were the main cause (Arbogast et al., 2005). A child’s body also makes them more vulnerable than an adult (Croft, Whiplash Injuries):

• Their head is large and heavy for the size of their neck.
• Their skull and spine bones are not fully hardened yet.
• The small joints of their neck are flatter, so they slide more easily.
• Their ligaments are naturally looser.

Children don’t say “I have a concussion”

In our experience, it is almost always the parent, not the child, who notices that something has changed. One 6-year-old in a booster seat told us she felt fine. Her parent told a different story: since the crash she had been irritable and hard to console, sleeping more than usual, and hard to wake up.

These are the changes parents in our office have noticed after a crash:

• Mood and behavior: irritability, crying easily, being hard to console
• Sleep: sleeping more, being hard to wake, or sleeping poorly
• Attention and hearing: repeatedly asking “what?”, seeming not to listen, losing focus
• Headaches: often only on long car rides or after a busy day
• Dizziness: feeling the room move when standing up quickly; one 9-year-old described it as “it just goes boom”
• Vision: blurry vision, rubbing the eyes, trouble reading for long
• Stomach: nausea, car sickness, or vomiting
• Ringing in the ears
• School: reading, spelling or schoolwork that gets harder

Teens can usually describe more. One teen passenger in a four-car chain-reaction crash had nausea when she got out of the car, pressure headaches every other day after activity, and irritability.

Dr. Verg’s advice to parents: watch school performance and developmental milestones in the weeks after a crash. A child who keeps saying “what?” may be having trouble processing what they hear, which can be connected to a concussion. That deserves a closer look.

Is this from the crash? Questions parents ask us

“My child says their head is spinning after a car accident”

Dizziness is one of the most common signs we see in children after a crash. One 9-year-old described it as “it just goes boom” when he stood up. An 8-year-old girl felt dizzy lying flat and when reading, and a positional test showed her inner-ear balance system was involved. A spinning head after a crash deserves an exam, even weeks later. See the recovery stories below.

“My child is way more sleepy since the accident”

Sleeping more and being hard to wake are changes parents often notice first. One 6-year-old in a booster seat said she felt fine, but her parent saw that she was sleeping more and hard to wake. If your child is severely hard to wake, that is an emergency: see “When to call us right away, or go to the ER” below. See the recovery stories below because for this 6-year-old pediatric chiropractic care was the perfect fix.

“My child can’t sleep or has nightmares after the crash”

Poor sleep, nightmares and fear of riding in the car can come from the brain injury, from the fright of the crash, or both. Research found that 74% of children had significant stress symptoms six weeks after a crash (Mather et al., 2003). See the recovery stories below.

“My child’s mood changed after the accident”

Irritability, crying easily, being hard to console and anger outbursts are some of the clearest signs of concussion in children. See “Mood changes are one of the biggest clues” below.

“My child isn’t eating like before”

A drop in appetite after a concussion is usually part of the nausea and motion sickness that can follow the injury. Sometimes it comes from the concussion’s effect on the eyes’ reflexes, and in that case it calls for visual occupational therapy that specializes in concussion. We check these reflexes at the exam work with very good visual rehabilitation specialists in our area to resolve the issue. See the recovery stories below.

“My child became clumsy after the car accident”

Bumping into things, tripping, or losing balance can mean the brain is not fully tracking where the body is. We test this with the eyes-closed balance test at every visit. In children with a mild brain injury, balance problems could still be measured 12 weeks later (Gagnon et al., 2004). See the recovery stories below.

“My child is doing worse in school since the crash”

Slipping grades, trouble reading or spelling, losing focus, and asking “what?” over and over can all be connected to a concussion. One 8-year-old girl had headaches after school months after her crash. See “Tell your child’s teacher” below. See the recovery stories below.

“My child gets headaches in the car or after a busy day”

In our office, children’s headaches often show up only on long car rides or after school. A neck or jaw strained in the crash often feeds these headaches. See the recovery stories below.

“My child gets car sick or dizzy in the car now”

The eyes’ focusing reflex is often the one thing that stays off after a concussion. As Dr. Verg explains, “the body kind of forgets certain reflexes,” so moving objects outside the car can bring on nausea or dizziness. See the recovery stories below.

“Noise bothers my child since the accident”

Sound sensitivity and ringing in the ears are common. One young child could not tolerate her brothers and sisters crying after a crash. See the recovery stories below.

Mood changes are one of the biggest clues

If your child’s mood or behavior has changed since the crash, take it seriously. In children, a change in mood is often the clearest sign of a concussion, and the research backs this up:

• Behavior problems are common. Two years after a brain injury, 73% of children with a mild injury had behavior problems such as irritability, aggression, not listening, and getting frustrated easily, significantly more than uninjured children (Hawley, 2004).
• Symptoms can outlast the first few weeks. Almost every child had symptoms in the first 24 hours after a minor head injury. At 4 to 6 weeks, nearly 1 in 4 (23.5%) still had headaches, tiredness, sleep problems or emotional ups and downs (Korinthenberg et al., 2004).
• Parents notice changes for months. In a study of 681 children, most with mild injuries, parents still reported headaches, attention and memory problems, low frustration tolerance, sleep problems, personality changes and slipping grades 10 months later (Hooper et al., 2004).
• Fear and trauma are part of the injury. Six weeks after a car crash, 74% of children had significant post-traumatic stress symptoms, and 86% of those with a mild brain injury did. At 13 weeks, 44% still had strong symptoms (Mather et al., 2003). Nightmares, fear of riding in the car, clinginess and anger outbursts can all come from this.

Tell your child’s teacher

School is where a concussion often shows up. In the same two-year study, 76% of children with behavior problems also struggled with schoolwork, and teachers often did not know about the injury once more than a year had passed (Hawley, 2004). Preschoolers with a mild head injury were more likely to need reading help years later (Wrightson et al., 1995). Let the teacher know about the crash, ask them to watch for changes, and plan a gradual return to full schoolwork if your child is struggling (Kamerling et al., 2003).

How we check a child for concussion

The exam is gentle and quick, and most children treat it like a game:

• Balance with feet together and eyes closed (Romberg test). A child who leans or sways is showing us the brain is not fully tracking where the body is.
• Eye tracking. Can the eyes follow a target smoothly and hold at the edges of vision? Trouble crossing the midline, extra blinking, or jumpy eye movements are signs we look for.
• Focusing visual reflex and pupils.
• A symptom check with the child and the parent together, because the parent often sees what the child cannot describe.
• The neck and jaw. Children’s necks and jaws are strained in crashes too, and jaw tension is a common driver of their headaches.

When the exam suggests a concussion, we refer to a pediatric concussion specialist for further testing, including detailed eye-tracking (saccade) checks and, when needed, visual occupational therapy and begin pediatric specific chiropractic care. We also screen brothers and sisters from the same crash; often one child has signs and another does not.

We recheck balance at every visit because it can take a while to recover. In children ages 7 to 16 with a mild brain injury, balance problems could still be measured 12 weeks later, compared with uninjured children (Gagnon et al., 2004).

Dr. Verg pays special attention to the focusing reflex: “Usually all of those are normal even in people who are quite concussed, except the accommodation.” And if a month or more has passed since the crash, it is not too late to have your child checked. A specialist can “first document and then track” the injury.

Most concussions never show anything on a CT or MRI, so a normal scan does not mean your child is fine. That is why these hands-on checks matter.

When to call us right away, or go to the ER

A concussion is not a brain bleed: “If there were bleeding in the brain, we would have already been in the hospital.” But after a crash, call our office immediately, or go to the emergency department if the doctor is unavailable, if your child has any of these:

• Vomiting
• Severe difficulty being awakened
• Loss of consciousness
• Slurred speech
• Failure to recognize people or places
• Increasing confusion

If your child can’t be evaluated fast enough, go to the ER. The ER will most likely do a CT scan, which shows dangerous bleeding in the brain. Dr. Verg suggests asking the physician whether an MRI could be done instead: “Hey doc, if the imaging can be done in the next 2 hours, could we have an MRI instead? I just heard that it can show subtle changes in the brain.”

How we treat children

Children need far less force than adults. Dr. Verg’s care for children after a crash is gentle and hands-on:

• Gentle cranial (skull bone) work with light pressure, “so that the head begins to restore itself.”
• Gentle jaw (TMJ) care when the jaw muscles are tight or one side moves less.
• Light neck care with low-force techniques, never twisting.
• Massage for tight neck and shoulder muscles.
• Home balance games. Dr. Verg gives children simple drills to “always practice imbalance”: standing on one foot, and “brushing your teeth with your feet together, eyes closed.” Belly bracing helps “train the brain.”
• Healthy food for healing. Cutting out sweets, refined carbohydrates and fruit for the first couple of weeks, while keeping whole grains, gives the healing brain steady fuel (see Part 2 of our adult series, “Feed the brain”).
• Activity limits for teens: no heavy lifting and avoiding any chance of another hit to the head while healing, with daily walks to keep the body and brain moving.
• A team. We work with pediatric concussion specialists and visual occupational therapists when vision or motion sickness symptoms persist.

Why rest and timing matter for young people

A young brain needs time to heal before it takes another hit. In a study of 207 patients aged 11 to 22 seen in the emergency room, those who had a concussion in the past year took nearly three times as long to recover from a new one (35 days versus 12). A single concussion more than a year earlier made no difference (Eisenberg et al., 2013). For a child in sports, a car-crash concussion counts too. It needs to heal fully before they return to contact play.

Recovery stories from our office

Details have been changed or left out to protect patient privacy. Results vary from child to child.

Dizziness and blurry vision: 9-year-old boy, rear-end crash

• What we saw: headaches on long car trips (never before the crash), sudden dizziness when standing up, blurry vision almost every day, one episode of vomiting, ringing in the ears, and neck pain. On exam he leaned to one side with eyes closed, his jaw was tight on one side, and his skull bones were restricted.
• Treatment: gentle cranial and jaw care, home balance drills, belly bracing, massage, weekly visits for about a month, and a concussion specialist referral to check whether he needed vision therapy.
• Improvement: by about 14 weeks after the crash, his dizziness, blurry vision, nausea and neck pain were all gone, and he was released from care.

“What?”: 6-year-old girl, same crash

• What we saw: irritability after the crash, and she kept asking “what?” Her balance was normal.
• Treatment: Dr. Verg treated the repeated “what?” as a possible attention or processing problem and arranged a pediatric reassessment that included eye-tracking checks, along with gentle care.
• Improvement: at her final visit she had “completely recovered” and was released.

Dizzy and sensitive to sound: 8-year-old girl, third-row seat, rear-ended while stopped

• What we saw: she was completely unprepared for the impact. She had headaches, neck, back and shoulder pain, and reduced neck turning, and she lost her balance on the eyes-closed test when gently nudged. In the following weeks her dizziness and nausea got worse, and a positional test showed her inner-ear balance system was involved.
• Treatment: gentle visits twice a week, massage, exercises and modified adjustments with no quick thrusts. When the dizziness grew, we referred her to a concussion specialist and a neurosurgeon, and the specialist added vision occupational therapy.
• Improvement: her headaches were gone within about a week of starting care. She was 50% better at about 7 weeks and 80% better at about 5 months, with normal balance, nearly full neck motion, and her shoulder pain resolved. Some dizziness when lying flat or reading, sound sensitivity and after-school headaches remained, and we reminded her parents to follow through with vision therapy.

Irritable and sleeping more: 6-year-old girl in a booster seat, rear-end crash

• What we saw: the child denied any symptoms. Her parent saw irritability, crying that was hard to console, sleeping more and being hard to wake, and one headache.
• Treatment: gentle care, with the parent watching her kindergarten progress and milestones.
• Improvement at about 1 month: her irritability and sleep were better, she was playing outside again, and she had no headaches. Her balance had improved.

Headaches, nausea and vision: teen passenger, four-car chain-reaction crash

• What we saw: nausea after the crash, pressure headaches on the top and sides of the head every other day, irritability, mild balance trouble, and trouble holding her gaze in one direction with extra blinking when her eyes crossed the midline.
• Treatment: a concussion specialist referral, daily walks, no sweet foods, no lifting over 30 pounds, and avoiding any chance of a head impact. Visual occupational therapy was planned if her eye reflexes were still off at one month.
• Improvement at about 6 weeks: about 50% better overall. Irritability, vision changes and light and sound sensitivity were gone. Headaches were down to one or two a week, lasting about 30 minutes. Nausea was gone in daily life but still came on winding roads, so we discussed visual occupational therapy.

Watching school: 9-year-old boy, front passenger

• What we saw: a mild headache and slight irritability, with no light or sound sensitivity or nausea. He stuttered when reading for a long time, though that had started before the crash.
• Plan: gentle care, with his parent watching his reading and school performance in case anything changed.

Many published cases confirm children’s concussion improvement with chiropractic care

A 6-year-old with attention problems after a fall whose spelling scores went from 20% to 80% in three weeks with gentle cranial and neck corrections. A 16-year-old football player who still had daily headaches, neck pain, fogginess, poor sleep and trouble concentrating five weeks after a concussion, despite a normal MRI. After five visits of neck and upper back adjustments over two weeks, he had significant relief after the second visit and virtually complete resolution by the fifth. He began a graded return to activity at about two months and was back to full game play, symptom-free, at three months (Pfefer et al., 2011).

What parents can take from these cases

• Children often look fine and say they feel fine. Trust what you notice in their mood, sleep, attention and schoolwork.
• In these recordings, children’s symptoms mostly cleared within one to three and a half months with gentle care.
• Car sickness, eye-tracking problems and processing changes can linger. Those children do best with a specialist and vision therapy on the team.
• Get every child who was in the car checked, even the one who “wasn’t hurt.”

Want the research behind this guide? Read our companion page,Pediatric Concussion After Car Crashes: What the Research Shows.

Gentle care for the whole family in Vancouver, WA & Clackamas, OR

If your child was in a car accident and something seems off (their mood, sleep, attention, headaches or balance), have them checked, even if they say they feel fine. At Dr. Verg Chiropractic we screen every family member who was in the car.

• Complimentary new-patient consultation for each family member.
• Direct insurance claim handling: we work directly with auto insurance Personal Injury Protection (PIP) claims, so you can focus on your family.
• Multilingual care team: English, Ukrainian (Українська), and Russian (Русский).
• Vancouver, WA clinic: 109 SE 101st Ave, Vancouver, WA 98664. Phone: (360) 203-6000
• Portland / Clackamas, OR clinic: 10001 SE Sunnyside Rd #120, Clackamas, OR 97015. Phone: (503) 386-9819

Read our adult series for more on how concussion happens, how we treat it, and adult recovery stories.

Medical disclaimer

This article is provided for educational and informational purposes only and does not constitute formal medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider regarding your child’s condition or post-accident symptoms.

When to call us right away, or go to the ER: if your child has vomiting, severe difficulty being awakened, loss of consciousness, slurred speech, failure to recognize people or places, or increasing confusion, call our office immediately, or go to the emergency department if the doctor is unavailable. If your child can’t be evaluated fast enough, go to the ER.

References

• Eisenberg MA, Andrea J, Meehan W, Mannix R. Time interval between concussions and symptom duration. Pediatrics. 2013;132(1):8-17.
• Erdman J, Oria M, Pillsbury L, eds. Institute of Medicine, 2011 (“feed the brain, starve the concussion”).
• Pfefer MT, Cooper SR, Boyazis AM. Chiropractic management of post-concussion headache and neck pain in a young athlete and implications for return-to-play. Topics in Integrative Health Care. 2011;2(3).chiro.org

Added references

Full citations are in the companion research page, Pediatric Concussion After Car Crashes: What the Research Shows.

• Arbogast KB, Jermakian JS, Ghati Y, et al. Proceedings of the International IRCOBI Conference. 2005.
• Croft AC. Whiplash Injuries. 3rd ed.
• Gagnon I, Swaine B, Friedman D, Forget R. Archives of Physical Medicine and Rehabilitation. 2004.
• Hawley CA. Brain Injury. 2004.
• Hooper SR, et al. NeuroRehabilitation. 2004.
• Kamerling SN, Lutz N, Posner JC, Vanore M. Pediatric Emergency Care. 2003.
• Korinthenberg R, Schreck J, Weser J, Lehmkuhl G. Brain & Development. 2004.
• Mather FJ, Tate RL, Hannan TJ. Brain Injury. 2003.
• Wrightson P, McGinn V, Gronwall D. Journal of Neurology, Neurosurgery & Psychiatry. 1995.