HMN 2026: How A child’s headache, dizziness and mental fog now stand out as the clearest concussion red flags

Knowing whether a child has sustained a concussion is an important matter to clinicians, parents and bystanders alike. However, the signs and symptoms that are most meaningful to look for are not as well defined. A study published last week in JAMA provides important new information that pinpoints the signs and symptoms that strongly indicate that a child has a concussion.

“When it comes to concussion recognition and diagnosis, there are a lot of clinical variables to consider. This diversity primarily stems from the different ways in which concussion presents across patients,” says Haley Chizuk, Ph.D., a research assistant professor in the Department of Orthopedics in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, and a co-author on the study, which was led by Sonal Shah, MD, of the Division of Emergency Medicine at Boston Children’s Hospital.

“It is unknown, however, which signs or symptoms of concussion are most effective at ruling in or out concussion as a diagnosis in children. This study provides strong evidence as to which signs and symptoms strongly indicate that a child has a concussion,” adds Chizuk, who is also a research scientist and certified athletic trainer (ATC) with UBMD Orthopedics and Sports Medicine.

Common symptoms like headache and dizziness increase the likelihood that a child or adolescent has suffered a concussion, while the absence of headache reduces the likelihood. The meta-analysis—which aimed to evaluate the diagnostic accuracy of symptoms and signs observed in the initial evaluation of a child or adolescent who may have had a concussion—also identifies several other key clinical features, such as mental fog, nausea, sensitivity to light and noise, dizziness, drowsiness, fatigue and difficulty remembering.

“Presence of any of these symptoms should prompt removal from play and evaluation by a trained medical professional,” the researchers write.

“This systematic review and meta-analysis is, to our knowledge, the first to identify which commonly studied aspects of pediatric concussion most strongly indicate the presence or absence of injury,” Chizuk says. “All of the symptoms and signs we discuss are common in concussion care. However, this review takes a breadth of studies to identify what our body of evidence indicates as the most informative variables for recognition and diagnosis.”

Chizuk adds that the study provides context for clinicians and even bystanders as to the signs and symptoms to look for when a child is suspected of sustaining a concussion, whether through participation in sports or playing.

“Accurate and timely recognition of pediatric concussion is undoubtedly critical for improving patient outcomes,” she says.

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