How did a 5 year old get 2 concussions playing sports?

Most of the diagnostic criteria used to diagnose a concussion in the doctor's office/ER are subjective and are dependent on an accurate response from the patient. Doctors tend to be very conservative and diagnose a concussion based on very limited evidence. In fact, there used to be a billable/chartable diagnostic code for future reference if symptoms develop that would confirm a concussion.

"I see in your medical record that you suffered a trauma that might have been a concussion."

If the doctor does not know the patient's history, How well can he balance? Does he have any pre-existing nystagmus? What is his normal gait? the exam room tests are inaccurate. A dehydrated patient or tired patient could manifest symptoms that mimic concussion symptoms.

This is especially true when a concerned mother is present. If they diagnose a concussion, the mother will usually remove him from further risk for a time. There is no harm in this cautious approach except if the patient or parent starts keeping score.

Some will try to use other's observations. "I saw his head hit the skateboard ramp hard."

"He fell back and slammed his head on the ice"

A fall from upright to a head hit on ice or concrete would be a concern......

Unless there was Loss of Consciousness or other serious symptoms, it is very difficult to diagnose a concussion in the exam room. There are a few blood test that can point to a likely concussion but they are not widely used.

A 5 year old would not be a good candidate for the ImPact test or similar tests of neurocognitive function. Besides, they work best when they have a preseason baseline. The 'normal' range of neurocognitive development in a 5 year old can be quick large. The normal range starts to narrow when they reach about 8 years old.

A very good fitting helmet would be a necessity on ice or concrete activities. Most bike helmets are just a bit better than useless. They are rarely fitted and worn properly.

Regarding the football athletes, they have two risks. High velocity hits and tackles that are not frequent and lower velocity subconcussive impacts that happen hundreds of times in a single season.

Hockey can have similar risks. A limited body checking league would reduce the risk.

From a lifetime of experience, I reduced my risk after a serious injury at 10 years old then reduced it even further after an injury at 15 years old. Even so, I suffered 12+ more concussions in the following 30 years. None from sports as I quit contact sports at 15.

So, what can you do? Be smart. reduce risks when practical but still live life.