How to explain persistent concussion symptoms to your family

Children notice changes in a parent even when nobody explains them [6]. A review of nine studies looked at children whose parent had a stroke or another brain injury, such as a severe TBI [9]. Many children wanted information about the injury, and talking helped them cope [9]. Many also took on new jobs at home, and some effects lasted for years [9]. Headway, a UK brain injury charity, says research suggests children manage better when adults are honest with them at a level they can follow [5].

None of these sources focus on concussion alone. A U.S. military guide used below covers moderate or severe TBI, and the review and other guides cover brain injuries of all kinds [10, 9]. Much of their advice may still fit, because children react to what they see, such as a parent who spends the afternoon in a dark room.

A few points apply at every age:

• Say more than once that nothing they did caused the injury, since young children often blame themselves [11, 6].
• Tell them you love them just as much as before [6].
• Keep meals, bedtime and the school run as steady as you can [5, 10].
• It is fine to say you do not know [6].
• Invite questions again and again. As one guide puts it, “No question is too silly.” [6]

Fatigue needs special care. A guide from Ireland’s National Rehabilitation Hospital warns that children may think a tired parent will be fine after a short rest [11]. It advises explaining how deep the fatigue runs, so children do not push you into plans you cannot manage [11].

Sources: Defense and Veterans Brain Injury Center, revised 2019, for moderate or severe TBI [10]; McGill University Health Centre, 2014 [12]; National Rehabilitation Hospital [11]; Headway [5].

Young children, up to about age 5

Children of 2 or 3 can tell anger, sadness and joy apart on a parent’s face [10]. Keep explanations short, and use picture books or play. Guides suggest giving preschoolers a toy doctor kit or dolls to act out what is happening [12, 10]. At 4 and 5, magical thinking is common, and young children often blame themselves for a relative’s injury [10, 11].

Script: My head got hurt in the car crash. It is healing slowly. Sometimes it makes me sleepy or grumpy. That is the hurt talking, and you did not cause it.

School age, about 6 to 11

By about age 8, children understand cause and effect better and can feel for others [10]. Give real explanations instead of magical ones, and walk through what will happen step by step [12]. Some become angry or resentful, or tired from extra chores [12]. Many children of 6 or 7 enjoy having a job of their own [10]. Keep the jobs small, since extra caring duties can cut into a child’s time with friends [5].

Script: The crash shook my brain, a bit like a bruise on the inside. You cannot see it, but it gives me headaches, and loud noise makes them worse. That is why I sometimes leave the room when it gets noisy. It is getting better, and my care team is helping.

Teenagers

Teens can understand how complex a brain injury is [11]. If they sense you are holding back, they may fill the gaps with their own guesses [5]. Give them the facts about your symptoms, treatment and what to expect [12]. Help them rehearse what to say when friends ask [10]. Encourage them to stay busy with school and friends, and try not to lean too hard on older children at home [10, 5].

Script: I want you to have the real picture. I still have concussion symptoms: headaches, trouble concentrating and running out of energy fast. Most people improve, and mine is taking longer. Ask me anything, and you never have to cover for me.

Watch how they are doing

Kids often keep their worries to themselves [5]. Look for sudden, extreme changes in behavior, pulling away, or risky behavior, and ask your child’s doctor or a counselor for help if you see them [12, 10]. Let the school know what is going on so teachers can watch for changes [5, 11]. Some rehabilitation teams will meet with a child to explain brain injury and answer questions, so ask yours [11].