Study: 1 in 6 Children with Concussion Experience a Second Concussion Within 2 Years


Researchers with Children's Hospital of Philadelphia and the CDC found higher number of concussion symptoms and long recoveries predict risk of another concussion.

A new study from Children’s Hospital of Philadelphia’s (CHOP) Center for Injury Research and Prevention (CIRP) and the CDC fount that 1 in 6 children who has a concussion will experience a repeat concussion within 2 years.1

Researchers identified 536 children ages 5-15 years who had an initial visit for a concussion at a CHOP location between July 1, 2012 and June 30, 2013, and reviewed their electronic health records (EHRs) for a 2-year follow-up period. They found that 8% of these patients were diagnosed with a second concussion within the first year, and 16% had a second concussion within 2 years, including 3% who were diagnosed with 2 additional concussions.1

Several characteristics of the initial concussion predict an elevated risk of subsequent concussions, including an increased number of symptoms and longer recovery time, according to the study, published inThe Journal of Pediatrics. In addition, the risk of repeat concussion among children ages 12-15 years was almost twice as high as those ages 9-11 years. The increased risk for older children may attributed to an increased exposure to sports and recreational activities.1

"Knowing a child's increased risk for repeat concussions can help families make better decisions about their child's health," said study author Christina Master, MD, co-lead for CIRP's concussion research program and a sports medicine pediatrician at CHOP.1"We know that having a lot of symptoms or a long recovery time from your initial concussion are associated with a subsequent concussion within a couple of years. By looking at the number of symptoms and length of recovery, clinicians can give families data on which to make informed decisions about future risk.”

According to the CDC, immediate medical attention should be sought for head trauma in a child if any of these symptoms are present:2

  • Headache that gets worse and does not go away.
  • Weakness, numbness, or decreased coordination.
  • Repeated vomiting or nausea.
  • Slurred speech.
  • Look very drowsy or cannot wake up.
  • Have one pupil (the black part in the middle of the eye) larger than the other.
  • Have convulsions or seizures.
  • Cannot recognize people or places.
  • Are getting more and more confused, restless, or agitated.
  • Have unusual behavior.
  • Lose consciousness.
  • Will not stop crying and are inconsolable.
  • Will not nurse or eat.

In an interview withContemporary Clinic, Elizabeth K Rende DNP, RN, CPNP-PC, PMHS-BC, FAANP of Duke Pediatric Neurology, said seemingly minor head trauma, such as a bump on the head, will also cause headache and discomfort in a child. However, “[it] should resolve within days, if not a week or so,” she added.

According to Carolyn Pizoli, MD, PhD, Duke University School of Medicine, Department of Pediatrics, a major difference between adult and pediatric concussion is that anxiety from parents can affect recovery in a child.3

“The treatment of the child upon reentry to school (by teachers, staff) is also a variable that can really make or break a kid's trajectory,” Pizoli added.3

In the CHOP study, a recovery course of more than 28 days correlated to a 65% increased risk of repeat concussion compared to patients with a recovery of less than 7 days. Patients who experienced more than 10 symptoms had twice the risk of repeated injury compared to patients with less than 2 symptoms. The risk of concussion did not vary by how patients got their initial concussion, suggesting that all concussions, regardless of cause, contribute to an individual's overall burden of concussion and risk of subsequent injury.1

"This is one of the first studies to quantify the risk of a subsequent injury given a first concussion," said Dr. Matt Breidingof the CDC, in a prepared statement.1"We hope that clinicians will pay particular attention to these findings since repeat concussions can have real consequences for a young person's health and development. The results of this study can aid a clinician in discussing the risk of further injury with patients and their parents."

Rende said a headache has multiple potential causes, including head trauma, and it’s important that children seek and receive treatment right away, regardless of whether they are in school, with family or in other scenarios. Adults should also take seriously a headache complaint, she said.

“This is a barrier that can be very discouraging for a child because on the outside they look like they feel fine, but on the inside they're really having a bad headache, and if a teacher or school staff person doesn't believe that headache exists, they're not likely to get treatment. Over time, a child just stops reporting that headache because they're either embarrassed or nobody wants to believe them,” said Rende.

CHOP provides free resources for learning more about signs of concussion, recovery and prevention strategies on itswebsite. Additional resources for healthcare providers and others involved in the care of children are available from CDC throughHEADS UP to Youth Sports.


  1. One in Six Children with Concussion Experiences a Second Concussion Within Two Years [news release]. Philadelphia, PA; May 14, 2019: CHOP. Accessed May 15, 2019.
  2. Centers for Disease Control and Prevention. Symptoms of Traumatic Brain Injury (TBI). CDC website. Reviewed March 11, 2019. Accessed May 15, 2019.
  3. Duke University School of Medicine, Department of Pediatrics. Faculty Spotlight: Carolyn Pizoli, MD, PhD. Duke Pediatrics website. Published March 6, 2019. Accessed May 15, 2019.
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