NCHS Data Brief ■ No. 302 ■ February 2018

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Parental Report of Significant Head Injuries in

Children Aged 3–17 Years: United States, 2016

Lindsey I. Black, M.P.H., Emily P. Zammitti, M.P.H., Howard J. Hoffman, M.A.,

and Chuan-Ming Li, M.D., Ph.D.

Key findings

Data from the National 

Health Interview Survey

● In 2016, based on parental 

report, 8.3% of boys and 5.6% 

of girls aged 3–17 years have 

ever had a significant head 

injury in their lifetime. 

● As age increased, the 

percentage of children who 

have ever had a significant head 

injury also increased, peaking 

at 11.7% among children aged 

15–17 years.

● Non-Hispanic white children 

were more likely to have ever 

had a significant head injury 

compared with non-Hispanic 

black, Hispanic, and other 

non-Hispanic children.

● The percentage of children 

who have ever had a significant 

head injury was higher among 

those whose parents had more 

than a high school education 

compared with those whose 

parents had a high school 

education or less.

● Among children who have 

ever had a significant head 

injury, the majority have only 

had one such injury (81.3%). 

In recent years, there has been increased awareness and prevention efforts 

toward reducing concussion incidence. Previous research has most often 

estimated the prevalence of concussions among youth using medical claims 

data (1–4). In the 2016 National Health Interview Survey (NHIS), parents or 

guardians answered questions about whether their children have ever had a 

significant head injury or concussion. This report presents estimates of 

parent-reported lifetime significant head injuries among children aged 3–17 

years, providing information about head injuries beyond those that were 

medically attended.

Keywords: youth • injury • concussion • National Health Interview Survey

In 2016, 7.0% of children aged 3–17 years have ever had a 

significant head injury in their lifetime.

Figure 1. Percentage of children aged 3–17 years who have ever had a significant head injury, 

by age and sex: United States, 2016

 

1

Significantly different from girls (p < 0.05). 2

Significant linear trend by age group (p < 0.05).

NOTE: Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db302_table.pdf#1.

SOURCE: NCHS, National Health Interview Survey, 2016.
NCHS Data Brief ■ No. 302 ■ February 2018

■  2  ■

● The percentage of children who have ever had a significant head injury increased with age 

and was nearly three times higher among children aged 15–17 years (11.7%) compared with 

children aged 3–5 years (4.0%) (Figure 1).

● For both boys and girls, as age increased, the percentage of children who have ever had a 

significant head injury also increased. 

● Overall, boys (8.3%) were more likely than girls (5.6%) to have ever had a significant head 

injury. 

● Among those aged 15–17 years, boys (14.1%) were more likely than girls (9.2%) to have 

ever had a significant head injury. For every other age group, the percentage of boys who 

have ever had a significant head injury was also observed to be higher than the percentage of 

girls, though none of these differences were statistically significant. 

Non-Hispanic white children were almost twice as likely to have ever had a 

significant head injury compared with non-Hispanic black and other 

non-Hispanic children.

● For both boys and girls, non-Hispanic white children had a higher percentage of lifetime 

significant head injuries compared with non-Hispanic black and other non-Hispanic 

children. Overall and among girls, non-Hispanic white children were more likely than 

Hispanic children to have ever had a significant head injury (Figure 2).

Figure 2. Percentage of children aged 3–17 years who have ever had a significant head injury, by race and Hispanic 

ethnicity and sex: United States, 2016 

 

1

Significantly different from non-Hispanic white children (p < 0.05). 2

Significantly different from girls (p < 0.05).

NOTE: Access data table for Figure 2 at: https://www.cdc.gov/nchs/data/databriefs/db302_table.pdf#2.

SOURCE: NCHS, National Health Interview Survey, 2016.
NCHS Data Brief ■ No. 302 ■ February 2018

■ 3 ■

● Non-Hispanic black (6.6%) and Hispanic (7.7%) boys were more likely than girls of

the same race and Hispanic ethnicity (3.1% and 3.6%, respectively) to have ever had a

significant head injury.

● The percentage of non-Hispanic white and other non-Hispanic boys who had a lifetime

significant head injury was observed to be higher than that among girls; however, these

differences were not statistically significant.

Overall, children with parents who had more than a high school education 

were more likely than children with parents who had a high school diploma 

or GED or less to have ever had a significant head injury.

● Among girls, those with parents who had more than a high school education (6.4%) were

more likely than those with parents who had a high school diploma or General Educational

Development (GED) high school equivalency diploma or less (4.0%) to have ever had a

significant head injury (Figure 3).

● Among boys, there was no significant difference between those with parents who had more

than a high school education (8.5%) and those with parents who had a high school diploma

or GED or less (7.7%) to have ever had a significant head injury.

● Regardless of parental educational attainment, boys were more likely than girls to have ever

had a significant head injury.

Figure 3. Percentage of children aged 3–17 years who have ever had a significant head injury, by parental educational 

attainment and sex: United States, 2016

 

1

Significantly different from children with parents who have more than a high school education (p < 0.05). 2

Significantly different from girls (p < 0.05).

NOTES: Parental educational attainment is based on the highest educated parent living in the household. GED is General Educational Development high 

school equivalency diploma. Access data table for Figure 3 at: https://www.cdc.gov/nchs/data/databriefs/db302_table.pdf#3. 

SOURCE: NCHS, National Health Interview Survey, 2016.
NCHS Data Brief ■ No. 302 ■ February 2018

■  4  ■

Most children who have ever had a significant head injury have only had 

one in their lifetime.

● Overall, 81.3% of children who have ever had a significant head injury have had one, and 

18.7% have had two or more significant head injuries in their lifetime (Figure 4).

● There were no statistically significant differences between boys and girls in the distribution 

of the number of lifetime significant head injuries.

● Among children who have ever had a significant head injury, 78.8% of boys and 85.1% of 

girls have only had one in their lifetime. 

Figure 4. Percent distribution of number of lifetime significant head injuries among children aged 3–17 years who have 

ever had a significant head injury, by sex: United States, 2016 

NOTE: Access data table for Figure 4 at: https://www.cdc.gov/nchs/data/databriefs/db302_table.pdf#4.

SOURCE: NCHS, National Health Interview Survey, 2016.
NCHS Data Brief ■ No. 302 ■ February 2018

■ 5 ■

Summary

In 2016, 7.0% of children aged 3–17 years have ever had a significant head injury based on 

parent- or guardian-reported data from NHIS. Boys were more likely than girls to have ever had a 

significant head injury. Non-Hispanic white children were nearly twice as likely to have ever had 

a significant head injury as non-Hispanic black and other non-Hispanic children. There were also 

differences based on parental educational attainment. The percentage of children who have ever 

had a significant head injury increased as age increased, with about 1 in 10 children aged 15–17 

years having ever had a significant head injury. Among children who have ever had a significant 

head injury, the majority have only had one such injury (81.3%), while 18.7% have had two or 

more. 

This report provides insight into the demographic differences in the prevalence of a lifetime 

significant head injury among children aged 3–17 years. The findings in this report are consistent 

with previous research and present new data, including the prevalence of multiple significant 

head injuries (5,6). Further, NHIS estimates are not based on the receipt of medical care and 

therefore provide a broader picture of the prevalence of serious head injuries in youth. This 

report’s estimates are based on parent or guardian report and may be influenced by parental recall, 

parental awareness, social desirability to report such injuries, and interpretation of the terms 

“significant head injury” and “concussion.” “Significant head injury” likely represents a range 

of severity, from superficial contusion to severe traumatic brain injury. Consequently, the results 

of this report should not be interpreted as describing the prevalence of physician-diagnosed 

traumatic brain injury or concussion.

Definitions

Significant head injury: Based on the survey question, “In (his/her) lifetime, has (sample child) 

ever had a significant head injury or concussion?” 

Number of significant head injuries: Among those who have ever had a significant head injury 

or concussion, a follow-up question was asked: “In (his/her) lifetime, how many significant head 

injuries or concussions has (sample child) had?” 

Parental educational attainment: Based on the education level of the parent with the highest level 

of education, regardless of that parent’s age, and is based only on parents living in the child’s 

household. 

Race and ethnicity: Based on two separate questions that determine Hispanic or Latino origin and 

race. Persons of Hispanic or Latino origin may be of any race. 
NCHS Data Brief ■ No. 302 ■ February 2018

■  6  ■

Data source and methods:

Data from the 2016 NHIS were used for this analysis. NHIS is a nationally representative survey 

of the civilian noninstitutionalized U.S. population. It is conducted continuously throughout 

the year by the National Center for Health Statistics (NCHS). NHIS is an in-person interview 

conducted in the respondent’s home. In some instances, follow-up to complete the interview is 

conducted via telephone. The survey consists of (a) the Family Core component, with questions 

asked about all members of the family; (b) the Sample Adult component, which collects 

additional information from one randomly selected adult per family; and (c) the Sample Child 

component, which collects additional information about one randomly selected child per family. 

The Sample Child component is completed by a family respondent, usually a parent (91% of 

respondents for children aged 3–17 years were a parent in 2016). Data for this analysis come from 

the Sample Child and Family Core components of NHIS. For more information about NHIS, visit 

https://www.cdc.gov/nchs/nhis.htm. 

Questions on significant head injuries were asked as part of a series of supplemental questions 

to the Sample Child component, which were sponsored and funded by the National Institute on 

Deafness and Other Communication Disorders. The text for these questions specified “significant 

head injury or concussion” but was simplified to “significant head injury” in this report. The 

child’s respondent was not provided any additional definitions or context for these questions. 

Previous work has found that the prevalence of self-reported concussions among adult athletes 

increased after a definition of the condition was presented (7), though it is not known how this 

may affect how a parent or guardian reports about a child’s injury. Parental report of a diagnosed 

concussion has been found to be reliable in cognitive testing, but other details were not recalled 

as definitively (8).

NHIS is designed to yield a nationally representative sample, and these analyses used weights to 

produce national estimates. The sample design is described in more detail elsewhere (9). Point 

estimates and the corresponding variances for this analysis were calculated using SUDAAN 

software (10) to account for the complex sample design of NHIS. Linear trends by age group and 

differences between percentages were evaluated using two-sided significance tests at the 0.05 

level. 

About the authors

Lindsey Black and Emily Zammitti are with the National Center for Health Statistics, Division of 

Health Interview Statistics. Howard Hoffman and Chuan-Ming Li are with the National Institute 

on Deafness and Other Communication Disorders, Epidemiology and Statistics Program.
NCHS Data Brief ■ No. 302 ■ February 2018

■ 7 ■

References

1. Zonfrillo MR, Kim KH, Arbogast KB. Emergency department visits and head computed

tomography utilization for concussion patients from 2006 to 2011. Acad Emerg Med 22(7):872–7.

2015.

2. Taylor AM, Nigrovic LE, Saillant ML, Trudell EK, Proctor MR, Modest JR, Vernacchio

L. Trends in ambulatory care for children with concussion and minor head injury from eastern

Massachusetts between 2007 and 2013. J Pediatr 167(3):738–44. 2015.

3. Zhang AL, Sing DC, Rugg CM, Feeley BT, Senter C. The rise of concussions in the

adolescent population. Orthop J Sports Med 4(8):1–7. 2016.

4. Bakhos LL, Lockhart GR, Myers R, Linakis JG. Emergency department visits for concussion

in young child athletes. Pediatrics 126(3):e550–6. 2010.

5. Veliz P, McCabe SE, Eckner JR, Schulenberg JE. Prevalence of concussion among US

adolescents and correlated factors. JAMA 318(12):1180–2. 2017.

6. Arbogast KB, Curry AE, Pfeiffer MR, Zonfrillo MR, Haarbauer-Krupa J, Breiding MJ, et al.

Point of health care entry for youth with concussion within a large pediatric care network. JAMA

Pediatr 170(7):e16094. 2016.

7. Alosco ML, Jarnagin J, Tripodis Y, Martin B, Chaisson C, Baugh CM, et al. Utility of

providing a concussion definition in the assessment of concussion history in former NFL players.

Brain Inj 31(8):1116–23. 2017.

8. Massey M, Dunston S, Creamer L. Results of cognitive testing of questions on traumatic

brain injury. Hyattsville, MD: National Center for Health Statistics. 2017. Available from:

https://wwwn.cdc.gov/qbank/report/Massey_2017_NCHS_TBI.pdf.

9. National Center for Health Statistics. Survey description, National Health Interview Survey,

2016. Hyattsville, Maryland. 2017.

10. RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.
NCHS Data Brief ■ No. 302 ■ February 2018

Suggested citation

Black LI, Zammitti EP, Hoffman HJ, Li CM. 

Parental report of significant head injuries 

in children aged 3–17 years: United States, 

2016. NCHS Data Brief, no 302. Hyattsville, 

MD: National Center for Health Statistics. 

2018.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Interview Statistics

Stephen J. Blumberg, Ph.D., Acting Director 

Stephen J. Blumberg, Ph.D., Associate 

Director for Science

For e-mail updates on NCHS publication 

releases, subscribe online at: 

https://www.cdc.gov/nchs/govdelivery.htm.

For questions or general information

about NCHS:

Tel: 1–800–CDC–INFO (1–800–232–4636)

TTY: 1–888–232–6348

Internet: https://www.cdc.gov/nchs

Online request form: https://www.cdc.gov/info

ISSN 1941–4927 Print ed. 

ISSN 1941–4935 Online ed. 

DHHS Publication No. 2018–1209

CS289136

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road, Room 4551, MS P08

Hyattsville, MD 20782–2064

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

For more NCHS Data Briefs, visit:

https://www.cdc.gov/nchs/products/databriefs.htm.

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS

PERMIT NO. G-284