Pediatric Concussion After Car Crashes: What the Research Shows

A companion to our parent guide, “When Your Child Was in the Car: Concussion After a Crash.” From Dr. Verg Chiropractic, serving Vancouver, WA and Clackamas, OR.

Our parent guide covers the signs to watch for and how we care for children after a crash. This page is for parents, teachers and health professionals who want the research behind it. It gathers the studies Dr. Verg relies on, from crash engineering to school performance to hormones.

1. Crash forces and why children are vulnerable

• Brain injury without a skull fracture. Using pediatric trauma registry data and crash surveillance databases, Arbogast, Jermakian, Ghati, Smith, Maltese and Menon (2005, Proceedings of the International IRCOBI Conference) found that about 60% of head injuries in children ages 1 to 12 in motor vehicle crashes were intracranial injuries with no skull fracture. Rotational acceleration and inertial shear forces, not direct head contact alone, were the main drivers. Independent predictors of head injury included lap-belt-only restraint (1.2%), sitting in the front passenger seat (1.4%), rollovers (4.6%) and being on the struck side (1.6%).
• When an SUV or truck hits a car. Kallan, Arbogast and Durbin (2005, 49th AAAM Proceedings) showed that children in passenger cars struck in side impacts by light trucks and SUVs had a significantly higher risk of serious intracranial injury, because the taller bumpers and door sills of these vehicles do not line up with a car’s structure.
• Injury without a head strike, even in a car seat. Arbogast, Cornejo, Kallan, Winston and Durbin (2002, 46th AAAM Proceedings) studied children in forward-facing child restraints in the Partners for Child Passenger Safety system. Among those with serious injuries (AIS 2+), 96% were to the head, neck, spine or limbs. Inertial forces alone, with no contact, produced subdural hematomas and focal brain contusions, especially when the harness was loose or poorly anchored.
• A child’s anatomy. In Whiplash Injuries (3rd ed.), Dr. Arthur Croft attributes children’s vulnerability to five features: (1) a head that is large and heavy relative to the neck, (2) skull and spinal bones that are not fully ossified, (3) underdeveloped side portions of the vertebrae, (4) facet joints that are oriented more horizontally and resist shear poorly, and (5) naturally lax spinal ligaments.

2. Balance problems that linger

• Balance at 12 weeks. Gagnon, Swaine, Friedman and Forget (2004, Archives of Physical Medicine and Rehabilitation) followed 38 children ages 7 to 16 with mild TBI (mean Glasgow Coma Scale 14.8) at 1, 4 and 12 weeks, compared with matched uninjured children. On three balance tests (the Bruininks-Oseretsky balance subtest, the Postural Stress Test and the Pediatric Clinical Test of Sensory Interaction for Balance), injured children still showed significant dynamic balance deficits at 12 weeks (P < 0.001, P = 0.031, and P = 0.05 for eyes-closed tandem stance).
• Early symptoms versus lasting ones. Korinthenberg, Schreck, Weser and Lehmkuhl (2004, Brain & Development) followed 98 children ages 3 to 13 with minor head injury. Almost all had symptoms and EEG changes in the first 24 hours, and 23.5% still had headaches, fatigue, sleep problems or emotional instability at 4 to 6 weeks.

3. Thinking, school and behavior

• Behavior. In a two-year follow-up of 67 school-age children with TBI (35 mild), Hawley (2004, Brain Injury) found that 73% of children with mild TBI had behavior problems, including irritability, aggression, disobedience and low frustration tolerance, significantly more than uninjured children (P = 0.02). Of the children with behavior problems, 76% had marked difficulty with schoolwork. Teachers were often unaware of the injury once more than a year had passed.
• What parents report months later. Hooper and colleagues (2004, NeuroRehabilitation) surveyed the caregivers of 681 children with TBI (83% mild) at 1, 4 and 10 months. At 10 months caregivers still often reported recurrent headaches, attention and memory problems, low frustration tolerance, sleep problems, personality changes and falling grades.
• Slower learning over the years. Ewing-Cobbs, Barnes, Fletcher, Levin, Swank and Song (2004, Developmental Neuropsychology) tracked reading, spelling and math in children ages 5 to 15 for up to five years after TBI. Early brain injury can slow the growth of basic reading and math skills over time, especially when the child is injured young.
• Preschoolers. Wrightson, McGinn and Gronwall (1995, Journal of Neurology, Neurosurgery & Psychiatry) compared 78 preschoolers with a mild head injury (seen in the ER but not admitted) with 86 uninjured children. At 6 months, 1 year and 6.5 years, the injured children scored lower on visual-cognitive tests and were more likely to need reading help at school.
• Attention problems after injury. Max and colleagues (2004, Developmental Neuropsychology) studied 118 children after TBI or orthopedic injury and documented secondary ADHD, attention problems that began after the injury. It was linked to injury severity, slower processing speed and weaker day-to-day functioning.
• Memory. Levin and colleagues (2004, Neuropsychology) followed working memory in 144 children (79 with mild TBI) for up to 24 months and linked deficits to left frontal injury and severity. McCauley and Levin (2004, Developmental Neuropsychology) found that children with mild TBI had slower reaction times and lasting problems with prospective memory (remembering to do something later) compared with children who had orthopedic injuries.

4. Emotional trauma after a crash

• Mather, Tate and Hannan (2003, Brain Injury) studied children ages 6 to 15 after road crashes: 14 with mild TBI and 29 with other injuries. At 6 weeks, 74% had clinically significant post-traumatic stress symptoms (86% of the mild TBI group and 69% of the others). At 13 weeks, 44% were still highly symptomatic. Having a mild brain injury did not protect a child from PTSD, so both need attention.

5. Medical follow-up

• Hospital pathways. Kamerling, Lutz, Posner and Vanore (2003, Pediatric Emergency Care) described the Children’s Hospital of Philadelphia trauma pathway: structured ER triage, written home instructions for tracking symptoms, cognitive rest, a gradual return to school, and formal sports restrictions.
• Better MRI. Tong and colleagues (2004, Annals of Neurology) studied 40 children with TBI and found susceptibility-weighted imaging (SWI) MRI much more sensitive than conventional gradient-echo MRI for detecting tiny bleeds from diffuse axonal injury, and better at predicting long-term outcome.
• Hormones. Popovic, Aimaretti, Casanueva and Ghigo (2005, Journal of Endocrinological Investigation) and Kelly and colleagues (2006, Journal of Neurotrauma) note that acceleration-deceleration forces can injure the pituitary stalk or hypothalamus. If a child develops unusual long-lasting fatigue, depression or slowed growth months after a crash, screening for post-traumatic hypopituitarism or growth hormone deficiency is recommended, because hormone replacement can correct it.

6. The neck-brain connection and pediatric specific chiropractic care

• A toddler case. Araghi (1992, Proceedings of the National Conference on Chiropractic and Pediatrics) reported a 2-year-old boy with persistent vomiting, lethargy and low energy after a head impact. Exam and CT confirmed a concussion without structural damage, and his symptoms resolved after adjustments at the base of the skull.
• Vision loss. Gorman (1995, Journal of Manipulative and Physiological Therapeutics) reviewed closed head trauma in children and adults and reported narrowing of the visual field or vision loss in one eye in up to 35% of closed head injuries, attributed to small-vessel spasm and neck dysfunction affecting blood supply to the head.
• Brain blood flow after whiplash. Otte and colleagues (1995, Lancet; 1997, Journal of Neurology, Neurosurgery & Psychiatry) used SPECT and PET imaging in whiplash patients with post-concussion symptoms such as memory loss, visual changes and emotional disturbance. They found reduced blood flow and glucose use in the parieto-occipital region of the brain and attributed it to abnormal pain signals from the injured upper neck.
• “Hibernating” brain regions. Terrett (1993, Chiropractic Technique) proposed that neck dysfunction and altered brain blood flow can leave areas of the brain alive but underactive, causing tiredness, dizziness, depression, irritability and poor concentration.
• Eye function after chiropractic care. A 2024 randomized controlled trial in the Journal of Manipulative and Physiological Therapeutics found that chiropractic care improved gaze stability in young adults with long-lasting post-concussion symptoms, supporting the idea that lingering visual problems can come from the upper neck (Cade & Turnbull, 2024). See Part 2 of our adult series for details.

7. Why it matters long term (adult studies)

• Bohnen and colleagues (1994, Brain Injury) followed mild head injury patients for 1 to 5 years. Headaches, mental fatigue and distress were significantly worse than in controls and may not fully reverse.
• Research in the Journal of Neuropsychiatry and Clinical Neurosciences (1994) found that post-traumatic headache is, surprisingly, most severe after mild head injuries, often lasting years even after legal settlement.
• Di Stefano and Radanov (1995, Acta Neurologica Scandinavica) followed 117 whiplash patients for two years. 18% were still symptomatic, with ongoing problems in divided attention and complex tracking.

Our takeaway: a child’s concussion is not just a headache that goes away. It can affect balance, mood, learning and hormones for months, which is why we screen every child in the car, recheck them over time, and work with pediatric specialists when needed.

Gentle care for the whole family

If your child was in a car accident, we screen every family member who was in the car. We offer complimentary new-patient consultations, handle PIP auto insurance claims directly, and our team speaks English, Ukrainian and Russian.

• 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

For signs to watch for and how we treat children, read our parent guide,Children’s Concussion After a Car Accident.

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. 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.

References

• Arbogast KB, Jermakian JS, Ghati Y, Smith RA, Maltese MR, Menon RA. Proceedings of the International IRCOBI Conference. 2005.
• Kallan MJ, Arbogast KB, Durbin DR. 49th Annual Proceedings, Association for the Advancement of Automotive Medicine. 2005.
• Arbogast KB, Cornejo RA, Kallan MJ, Winston FK, Durbin DR. 46th Annual Proceedings, Association for the Advancement of Automotive Medicine. 2002.
• Croft AC. Whiplash Injuries: The Cervical Acceleration/Deceleration Syndrome. 3rd ed.
• Gagnon I, Swaine B, Friedman D, Forget R. Archives of Physical Medicine and Rehabilitation. 2004.
• Korinthenberg R, Schreck J, Weser J, Lehmkuhl G. Brain & Development. 2004.
• Hawley CA. Brain Injury. 2004.
• Hooper SR, et al. NeuroRehabilitation. 2004.
• Ewing-Cobbs L, Barnes M, Fletcher JM, Levin HS, Swank PR, Song J. Developmental Neuropsychology. 2004.
• Max JE, et al. Developmental Neuropsychology. 2004.
• Levin HS, et al. Neuropsychology. 2004.
• McCauley SR, Levin HS. Developmental Neuropsychology. 2004.
• Mather FJ, Tate RL, Hannan TJ. Brain Injury. 2003.
• Kamerling SN, Lutz N, Posner JC, Vanore M. Pediatric Emergency Care. 2003.
• Tong KA, et al. Annals of Neurology. 2004.
• Popovic V, Aimaretti G, Casanueva FF, Ghigo E. Journal of Endocrinological Investigation. 2005.
• Kelly DF, et al. Journal of Neurotrauma. 2006.
• Wrightson P, McGinn V, Gronwall D. Journal of Neurology, Neurosurgery & Psychiatry. 1995.
• Araghi HJ. Proceedings of the National Conference on Chiropractic and Pediatrics. 1992.
• Gorman RF. Journal of Manipulative and Physiological Therapeutics. 1995.
• Otte A, et al. Lancet. 1995; Journal of Neurology, Neurosurgery & Psychiatry. 1997.
• Terrett AGJ. Chiropractic Technique. 1993.
• Cade AE, Turnbull PRK. Journal of Manipulative and Physiological Therapeutics. 2024;47(1-4):1-11.
• Bohnen N, et al. Brain Injury. 1994.
• Journal of Neuropsychiatry and Clinical Neurosciences. 1994 (post-traumatic headache).
• Di Stefano G, Radanov BP. Acta Neurologica Scandinavica. 1995.