When a child hits their head, some parents assume it’s a concussion—but according to Dr. James Cahalin, SSM Health Cardinal Glennon Children’s Hospital ER physician and concussion specialist, that’s not always the case. Some children only experience a closed head injury, which is a blow to the head without the neurological changes required for a concussion. Identifying the difference is an important part of making sure kids receive the right care.
A key challenge in concussion care is the wide range of symptoms children might experience. As Dr. Cahalin explained, “If you’ve seen one concussion, you’ve seen one concussion,” meaning every case is unique. One child may only have a headache, while another may experience dizziness, vision problems, mood changes, or cognitive difficulties. Where the head was hit and how much force was involved both play major roles in how symptoms develop.
Early care is simple and strategic. For the first 24–48 hours, Dr. Cahalin recommends both physical and cognitive rest: no sports or running, limited screen time, and sometimes a short pause from schoolwork. “The initial treatment of a concussion is one to two days of physical and cognitive rest,” he said. “I don’t want you to play any sports … and we give them a couple days to see how they do.” If symptoms ease, kids begin a structured, stepwise progression back to activity.
That next phase is the Return to Sport (RTS) protocol, a daily, symptom limited ramp up of exercise that was originally built for high school and collegiate football schedules. “The Return to Sport protocol was designed for American football,” Dr. Cahalin explained. “You get a concussion on Friday and you’re ready to play next Friday”—provided symptoms have resolved and the athlete passes a focused exam.
Not all concussions look the same, which is why symptoms are organized into five distinct subtypes: migraine headache dominant, cognitive-thinking, emotional, balance, or vision related. This approach allows for better understanding of what each child is experiencing to tailor treatment, recovery expectations, and referrals. Dr. Cahalin often collaborates with pediatric physical therapists who work with families weekly, while he continues to monitor their progress. Together, this coordinated approach ensures that each child receives individualized care based on the pattern of symptoms they’re facing.
Dr. Cahalin’s passion for helping children heal is unmistakable—and it’s why families trust him to guide them through some of their most challenging moments.
