Age-appropriate assessment of concussion in children and adolescents

Sport-related concussion (SRC) in children and adolescents presents unique diagnostic challenges due to heterogeneous clinical presentations and rapid neurodevelopmental trajectories. This focused review emphasizes that diagnosis fundamentally relies on symptomatic reporting and objective physiological assessments spanning multiple domains, integrating age-specific tools such as the revised Sport Concussion Assessment Tool 6 (SCAT6) and the Sport Concussion Office Assessment Tool 6 (SCOAT6). While the SCAT6 (ages >13) and Child SCAT6 (ages 8-12) are optimized for acute evaluation within the initial 72 hours, the SCOAT6 framework facilitates comprehensive multidomain assessment during the subacute phase (3-30 days). Clinicians must prioritize visio-vestibular and oculomotor screenings, as dysfunction in these areas is highly prevalent and associated with protracted recovery. For younger children (ages 5-9), the specialized VOMS-Child (VOMS-C) uses developmentally appropriate binary symptom reporting to accurately identify injury. Management paradigms have shifted toward active rehabilitation; the cornerstone of modern care is Sub-Symptom Threshold Aerobic Exercise (STTAE), which, when initiated within 2-10 days post-injury, significantly accelerates recovery. While computerized neurocognitive testing and emerging biomarkers offer insights, clinical decision-making must remain anchored in validated functional assessments while accounting for suboptimal effort in youth populations.