New Concussion Protocol for Kids: Get Them Back to School Earlier

New Concussion Protocol for Kids: Get Them Back to School Earlier


For years, the treatment protocol for children with concussions was to keep them out of school to rest in a quiet, darkened room with reduced access to screens until they felt better. Over the past decade, however, doctors have encouraged children to return to school and do light activities after only a few days off, even if symptoms persist.

A recently published study of more than 1,500 children supports the new approach. It found that an early return to school – which the researchers defined as missing less than three days – benefited children aged 8 to 18, who had less severe symptoms two weeks after their concussion compared to children aged 8 to 18. children who stayed at home longer. In fact, staying home longer seemed to delay healing.

The idea is to allow children to “maintain as much normalcy and routine as possible, obviously with academic supports and modifications as needed,” said Christopher Vaughan, a neuropsychologist at Children’s National Hospital in Washington who led the study. .

Many doctors and institutions have already adopted this treatment plan. “We have certainly changed our protocols to recognize that too much rest is not good, that individuals should return to activities as soon as they are able to tolerate it, with modifications, and that they should heal in their life. environment, which for children is school,” said pediatrician Paul Berkner, medical director at the University of New England and chair of the Maine Concussion Management Initiative.

The new study “confirms our recommendation and lends credence to the fact that they might actually get better faster if we do,” he added.

Vaughan said that “about a quarter of the population or more have suffered a concussion, many of which occurred in childhood. The vast majority of people will go on to lead healthy, productive lives, but because brain injuries like concussions can be harmful if not treated properly, we take every injury seriously.

He teamed up with colleagues from hospitals and universities across Canada to determine whether the number of days a child missed school after a concussion affected their symptoms. Researchers analyzed records from an earlier study of 1,630 children ages 5 to 18 who had been treated for concussion in nine Canadian pediatric emergency departments. There were equal numbers of boys and girls, and concussions weren’t limited to those caused by sports. Children missed an average of three to five days of school, with the youngest returning to school on average earlier than the oldest.

The study showed “significant” associations between returning to school earlier and improving symptoms for children aged 8 and over, and particularly for those who initially felt worse. (There wasn’t enough data for a finding involving children ages 5 to 7.) This led researchers to suggest that returning to school sooner may reduce stress related to missed classes and allowing a child to follow a normal sleep schedule and resume light-moderate physical activity sooner, which they believe will lead to faster recovery. On the other hand, prolonged activity restriction and isolation, they suggested, could increase the risk of anxiety and depression, and being home could increase screen time.

Berkner said most relatives of patients he treated did not push back against the new recommendations. And schools are ready to help.

“Most schools have concussion protocols, both for physical activity and also for school accommodations,” said Sigrid Wolf, pediatric sports medicine physician at Lurie Children’s Hospital in Chicago. In Illinois, every school must have a concussion surveillance team to help provide accommodations such as taking breaks, having extra time for tests or homework, or reading printed materials rather than text on screens. .

Although they won’t be going to the gym or recess, they will be encouraged to do light activities, like walking or riding a stationary bike. “Light to moderate physical activity also helps children recover more quickly from concussions,” Wolf said.

A concussion damages the connections between nerve cells in the brain, impairing brain function until these pathways are repaired. It is important to give the brain enough time to rewire itself after a concussion. If a child resumes sports activities before their brain has healed and suffers another concussion, that second injury could lead to more severe symptoms — and, in rare cases, could lead to brain swelling, Wolf said.

But a concussion only slightly increases the risk of subsequent concussions, Wolf said. Additionally, “every concussion is different. So just because you had a bad concussion the first time doesn’t mean the next time you’ll have a bad concussion.

Signs of a concussion fall into five categories, Wolf said: physical symptoms, such as headache, sensitivity to light and sound, neck pain and nausea; vestibular symptoms, such as dizziness and balance problems; cognitive symptoms, such as memory, concentration, or processing speed; emotional symptoms, such as irritability and depressed or anxious mood; and sleep and energy symptoms, such as fatigue, increased sleepiness, and difficulty falling or staying asleep.

If a possible concussion has occurred during an activity, it is important to immediately remove your child from the field or court. “We know kids recover faster when they’re taken out of play immediately,” she said. “Continuing to play even for 15 minutes after sustaining a head injury is a risk factor for having prolonged concussion symptoms.” The mantra: “When in doubt, remove them.”

The next step is to see a medical professional, who can help you determine if your child has a concussion and when your child should return to school. for example, children with a history of headaches or migraines may need extra support as they return to school, Berkner said.

“We’ve really learned a lot more about concussions and how to treat concussions than we knew just 10 years ago,” Vaughan said. “A lot of people still believe that exercising is bad when you have a concussion, but there have been numerous research studies in animals and humans showing that light non-contact aerobic exercise, usually started just days after a concussion, is associated with faster recovery.”

Vaughan and Wolf also said concussion experts are moving away from basic preseason cognitive tests that are often done by schools and sports teams, due to doubts about the accuracy of the tests.

When deciding whether a patient should return to sport, Vaughan focuses on the relationship between the child and his or her parents. Signs that a child is fully recovered include: “He has no symptoms at home, he has no symptoms when exercising, his school performance and cognitive functioning seem normal. Their parents consider them to be back to normal.

While doctors want parents to understand the potential seriousness of concussions, they also want them to be happy that most children recover within a month.

“We take all brain injuries seriously, regardless of their name or the number of symptoms that appear afterward,” Vaughan said. “Fortunately, many [children] improves fairly quickly. And certainly, if someone does nothing to continue to injure their brain during the recovery process, we expect full recovery and a return to normal life activities.

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