JAMA Clinical Reviews Evaluating for Pediatric Concussion
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Apr 6, 2026 Sonal N. Shah, MD, MPH, an emergency pediatrician and Harvard/Boston Children’s faculty, walks through pediatric concussion care. She covers pathophysiology, on-field red flags, and which early symptoms matter. Short practical assessments are highlighted: ocular motor tests, near-point convergence, balance and gait checks, plus timelines and return-to-play considerations.
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Concussion Is a Metabolic Network Injury
- Concussion causes ionic flux, widespread depolarization, altered cerebral blood flow, and energy mismatch leading to inflammation and axonal dysfunction.
- These pathophysiologic changes disrupt networks for balance, vision, cognition, and mood.
Remove Players With Red Flags Immediately
- Immediately remove any player with red flags like neck pain, seizure, loss of consciousness, repeated vomiting, worsening headache, or GCS <15 from play.
- These red flags come from the SCAT-6 observable signs and require urgent medical evaluation.
Watch For Observable On-Field Signs
- On-field observable signs (lying motionless, impact seizure, disorientation, balance problems, blank stare) should prompt immediate removal and medical assessment.
- High-risk mechanisms or striking surface without protective gear also demand removal.