Retrospective, Observational Study of Recovery in Pediatric Recurrent Concussions
Viviane Ugalde1, Bill Rosen2, Sophia Andrews3
1Physiatry & Brain Injury Medicine, St Charles Center for Orthopedic & Neurosurgery, Division of Physiatry, Bend, OR, USA.
Journal of Child Neurology
|December 4, 2025
Summary
Recurrent concussions in children can lead to longer recovery times, particularly for headache recovery and return to play. Early symptoms and history of anxiety or headaches may indicate prolonged recovery in pediatric concussion patients.
Area of Science:
- Pediatric Neurology
- Sports Medicine
- Neuroscience
Background:
- Limited research exists on recurrent concussions (RC) in young children, with conflicting findings.
- Understanding recovery patterns in pediatric concussion is crucial for effective management.
- Previous studies have not fully elucidated factors influencing recovery in children with multiple concussions.
Purpose of the Study:
- To investigate the recovery timelines (return to play, return to learn, headache recovery) in children with recurrent concussions compared to first-time concussions.
- To identify factors associated with prolonged recovery in pediatric concussion patients.
- To explore differences in symptom presentation and history between children with first concussions (FC) and recurrent concussions (RC).
Main Methods:
- A cohort of 505 children (ages 5-18) with concussions presenting to an outpatient clinic over two years were studied.
- Data included demographics, concussion history, symptom presentation, and recovery metrics (RTP, RTL, HR).
- Statistical analyses were performed to identify associations between concussion history, symptoms, and recovery outcomes.
Main Results:
- Recurrent concussions (RC) were associated with a higher number of initial symptoms, including affective symptoms, fatigue, and headache.
- A history of premorbid headaches and anxiety was more common in children with RC.
- Prolonged headache recovery (HR) was linked to the number of concussions and prior concussion recovery duration. Prolonged return to play (RTP) and HR were associated with longer prior concussion recovery times. Prolonged return to learn (RTL) was linked to a shorter interval between concussions.
Conclusions:
- Recurrent concussions in children exhibit distinct recovery patterns compared to first concussions, necessitating increased clinical awareness.
- Factors such as symptom burden, premorbid anxiety, and headache history influence recovery duration in pediatric concussion.
- Further research is essential to refine definitions of full concussion recovery, particularly for children experiencing recurrent injuries.
