Personal Injury Blog

Concussions in Children - Your Questions Answered

As parents and caregivers, we all strive to protect our children from harm. Despite our precautions however, too many of our kids will suffer concussions from sports and activities, or as passengers in a car accident.

Concussions (also called mild traumatic brain injuries or mTBIs), usually happen after a direct head trauma – for example, when the child’s head strikes the ice while playing hockey or from a fall off a bicycle. Although a helmet can absorb some of the force, the child might nonetheless suffer a concussion. This happens because secondary or indirect impact can also cause TBIs. In these cases, the initial blow causes the brain to strike the opposite side of the skull with enough force to cause the brain injury. Similarly, in car accidents, the injury can occur because of direct trauma (e.g.: striking the window or headrest), or even where there is no obvious impact. In whiplash-type injuries, for example, the neck snaps back and forward or from side to side when the cars collide. This violent movement can cause secondary trauma within the skull, resulting in an mTBI.

Unfortunately, because they can happen in low-speed car accidents and/or without a direct head injury, many childhood concussions are never diagnosed or are not diagnosed in a timely manner. And despite their classification as “mild” brain injuries, this term only refers to the severity of the initial injury and has nothing to do with the impact it can have on your child’s development and functional loss. In the worst case, your child can suffer permanent and life-changing impairments.

Screening for Concussion – Sport/Activity Injury

Recently, government and healthcare agencies have begun to focus greater attention on the prevalence and impact of childhood concussions. For instance, the Sport Concussion Assessment Tool (SCAT5), was developed by Dr. Shelina Babul of the BC Injury Research and Prevention Unit at the BC Children’s Hospital in Vancouver. It is a standardized tool for evaluating suspected concussions in individuals aged 13 years and older (the Child SCAT5 is used for children aged 5 through 12). Both tools provide comprehensive guidance for appropriate responses to suspected concussions. If your child participates in organized activities including sports, you should insist that the organization implements SCAT5 protocols. For more information, visit https://cattonline.com/scat/.

Diagnosing Concussion – What to Look For

Whether in response to SCAT5 screening or after a car accident, diagnosing a concussion can be difficult, since mTBIs cannot be detected on CT imaging, which is the standard hospital screening protocol for brain trauma. Unless there are other outward signs of brain injury at that time, the child’s TBI will generally go undiagnosed.

The symptoms of concussion/mTBI include some or all of the following:

  • headaches
  • nausea and vomiting
  • fatigue
  • confusion
  • poor concentration
  • impaired memory
  • ringing in the ears
  • sensitivity to light and sound
  • poor balance
  • light-headedness
  • slow information processing
  • mood and behavioural changes

These symptoms often only manifest days or weeks after the collision. Depending on the age of your child, it can be difficult to identify these symptoms objectively. Pre-verbal children present even greater challenges – they cannot tell you how they are feeling and are so young developmentally that you might not even know their “normal”.

In addition to those listed above, the following symptoms might indicate concussion in an infant or toddler:

  • crying more than usual
  • changes in the way they act or play
  • changes in nursing, eating or sleeping
  • becoming easily upset, exhibiting more tantrums
  • loss of new skills, such as toilet training
  • lack of interest in favourite toys

If your child has suffered a head injury, no matter how mild, and you suspect they might have suffered a concussion, you should monitor for ongoing symptoms that do not resolve within expected timelines. If symptoms persist for more than two weeks, we recommend that you seek more sophisticated imaging or neurological testing.

Diagnosing Concussion – Imaging and Assessments

Two specialized imaging techniques can be used to screen for concussion: functional magnetic resonance imaging (FMRI) and single photon emission computed tomography (SPECT). FMRI measures changes in blood flow that occur with brain activity and is sophisticated enough to identify the functional deficits associated with a mild TBI. SPECT uses a contrast agent injected in the vein to create detailed images of the brain that can highlight hemosiderin deposits caused by bruising or other damage to the tissue following a concussion-type injury.

Remember, even a “mild” brain injury can cause lasting or permanent damage to your child’s nervous system, impairing their vision, balance and coordination, muscle strength and tone. Neurological testing by your family physician or a specialist can identify the nature and extent of any nerve damage your child has suffered.

Apart from screening for the ongoing physical impairments your child might experience, you should also monitor for persistent age-inappropriate behaviour or functional deficits. Seek input from educators and caregivers and compare the child’s overall demeanor and function with your knowledge of them pre-injury. If you continue to have concerns, you can request a referral for neuropsychological testing. The neuropsychologist will perform a battery of assessments designed to determine your child’s level of function against expected norms. They can provide a concussion or post-concussion syndrome diagnosis and can recommend treatment and therapy options.

Legal Matters – “No-Fault” Accident Benefits

“Accidents happen,” they say. And it will often be true that nothing could have been done to prevent your child’s concussion and ongoing post-concussion impairments. However, if your child was involved in a car accident, they are entitled to assessments, treatment and other benefits through your auto insurer regardless of who, if anyone, was to blame for the accident. Navigating the red tape and complexity of the Statutory Accident Benefits System (SABS) after an accident can be overwhelming, especially if you have also been injured. We recommend that you speak with a reputable personal injury law firm after the accident. Your legal team can submit the paperwork and coordinate your child’s treatment. At Campisi LLP, we are pleased to offer a free, no-obligation consultation to set your mind at ease and discuss your options.

Because concussion is an “invisible” injury that can remain undetected, the auto insurer will often dismiss your child’s injuries as “minor” and only provide limited funding under the Minor Injury Guideline (MIG). When our client is a child with possible brain trauma, we fight on their behalf to compel the insurer to fund diagnostic imaging or neuropsychological testing to demonstrate their injury (note: neurological testing is typically covered under OHIP).

A brain injury diagnosis is important for your child’s recovery because it takes them out of the MIG, which in turn entitles them to standard medical/rehabilitation and attendant care coverage (currently up to $65,000). The diagnosis is also crucial because these limits can quickly be exhausted if the child’s ongoing impairments are severe enough. In these most serious claims, an application for determination of catastrophic impairment (or CAT for short) must be submitted.

The CAT application seeks to demonstrate that your child has suffered severe injuries and functional impairments that will require enhanced funding for complex and longer-term treatment and ongoing care. Your child should be deemed CAT after a brain injury diagnosis supported by evidence of intracranial pathology, confirmed on diagnostic imaging (including SPECT and FMRI) that results in in-patient admission to a public hospital, or upon in-patient admission to a program of neurological rehabilitation. If neither of these is applicable, their brain injury can also be demonstrated through neuropsychological testing nine months or more after the accident.

A successful CAT determination greatly increases your insurer’s exposure on the claim, which means they will strenuously resist in all but the most obvious cases. Post-concussion claims, because of the seemingly minor initial injuries that can cause them, are almost always denied, leading to a legal dispute in front of the Licence Appeal Tribunal (LAT). At Campisi LLP, we have extensive experience and an outstanding record of success in fighting CAT determination disputes, and always put our client’s interest first.

Legal Matters – Negligence Lawsuits

If you know or suspect that your child has suffered a concussion, you will need to consider whether someone else’s negligence might have caused or contributed to their injuries. Depending on the specific facts, several parties might share responsibility. For example, in a car accident, the other driver, improper signage or poor road conditions/maintenance might be to blame. In a sport or activity, faulty equipment, unsafe conditions or negligent supervision by teachers, coaches or other organizers might lead to the concussion. Public property (e.g.: schools, municipal or provincial parks, sidewalks) or privately owned property (residential or commercial) might not be reasonably safe for your child’s use.

Each type of negligence claim has its own complexities and will require expert assistance. Again, we recommend that you discuss your potential lawsuit with a reputable personal injury firm and invite you to contact our experts to discuss these matters at your convenience.

Concussion – The Good News

Proving that a brain injury occurred, dealing with your insurance company regarding treatment, and/or starting a lawsuit to seek fair compensation for your child’s concussion-related impairments is stressful, confusing and time-consuming, and can place enormous strain on your family’s well-being and resources. Thankfully, most concussions will heal normally within several weeks, without ongoing symptoms or complications. For those that do not, you can trust Campisi LLP to be with you every step of the way.

Put the experts to work for you. Campisi LLP – Champions with heart!

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