In news that will give many parents chills, new research has found that a third of kids and adolescents who suffer a concussion will develop a mental health problem.
Researchers undertook a literature review of more than 90,000 children across nine countries and found that 36.7 per cent of those who'd had a concussion showed 'significantly' high levels of depression, post-traumatic stress and other internalising problems.
Of these 20 per cent also showed 'externalising' problems, such as aggression, attention issues and hyperactivity.
The review looked at 69 articles published over a 40 year period (1980-2020), which referenced kids aged between 0-18 years.
Of the concussions, 42 per cent were caused by falls, sporting injuries accounted for 29 per cent and car accidents made up a further 15 per cent.
While pre-existing mental health problems were a 'strong predictor' for developing issues post-concussion, up to 26 per cent of kids with no history of problems developed these post-injury.
And of those with pre-existing issues, 29 per cent developed new mental health problems.
While the majority of issues improved within six months of sustaining the concussion, in some kids these persisted for several years.
The findings led researchers to recommended mental health evaluations be included in both concussion assessments and management.
Researcher Alice Gornall from the MCRI said the findings provided a better understanding of the relationship between delayed recovery and mental health.
Ms Gornall said up to a third of kids could suffer a concussion by the age of 13 and more needed to be known about the ramifications.
"Despite the high incidence of concussion among children and adolescents, identifying those at risk of ongoing difficulties after concussion remains a prominent challenge for clinicians," she said.
"On top of this, children take twice as long to recover from concussion than adults, with one in four children experiencing symptoms beyond one-month post-injury."
Bruce Henry is one dad who witnessed this in his daughter Emma, 17, after she had two concussions within a year of one another.
Both happened while playing netball - the first when she knocked her head on a goal post, the second when she was struck in the back of the hear by a ball.
After the second, she developed headaches, anxiety and had difficulty concentrating, making even simple tasks suddenly draining.
Her dad is now pushing for more focus on the mental health impacts that can arise following the injury.
"When a child has a concussion they might look fine but you can't see the underlying impact," Henry said.
"It's so important for mental health to form part of concussion management, which has been essential to Emma's recovery process."
An eight session intervention program - Concussion Essentials, is currently being trialled at the MCRI, in the hope of preventing long term symptoms.
It involves a mix of physiotherapy and psychology and informs participants about post-injury symptoms such as fatigue and headaches, which researchers say is showing promising early results.
The seriousness of concussions has been a focus of sporting codes recently, leading the AFL to implement a rule this year that players who suffer a serious concussion must be sidelined for 12 days and receive a medical clearance before returning to play.
This has been taken up by some community level football clubs, including by the West Australian Football Commission, meaning young players will be better protected.
Even this however, has not been deemed enough, with Monash University researchers calling for this to be extended to 30 days, saying the current period does not allow sufficient time for adults to recover.