New concussion protocol for kids: get them back to school faster


For years, the treatment protocol for children with concussions was to keep them out of school to rest in a quiet, dark room with limited access to screens until they felt better. In the past decade, however, doctors have taken steps to encourage children to return to school and light activity after just a few days of rest, even if symptoms persist.

A recently released study involving more than 1,500 children supports the new approach. It found that an early return to school — which researchers defined as missing less than three days — was beneficial for kids ages 8 to 18, who had less severe symptoms two weeks after their concussion compared to kids who stayed home longer. In fact, staying home longer seemed to slow recovery.

The idea is to enable children “to remain normal and routine as much as possible, of course with academic support and adjustments when necessary,” said Christopher Vaughan, a neuropsychologist at Children’s National Hospital in Washington who led the study.

Many doctors and institutions have already adopted that treatment plan. “We have certainly changed our protocols to recognize that too much rest is not good, that individuals should return to activity as soon as they can tolerate it, with adjustments, and that they should do their healing at their own pace. environment, which is school for kids,” said pediatrician Paul Berkner, medical director at the University of New England and president of the Maine Concussion Management Initiative.

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

Vaughan said that “about a quarter of the population or more has suffered a concussion, many of which occurred during childhood. The vast majority of people will live healthy and productive lives, but because brain injuries such as 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. The researchers analyzed data from a previous study of 1,630 children ages 5 to 18 who had been treated for concussions in nine Canadian pediatric emergency departments. There were an equal number of boys and girls, and concussions were not limited to those caused by sports. Children missed an average of three to five days of school, with younger children returning to school earlier than older children on average.

The study showed “significant” associations between an earlier return to school and improved symptoms for children ages 8 and older, and especially those who initially felt worse. (There weren’t enough data for a finding involving children ages 5 to 7.) This led researchers to suggest that a faster return to school may reduce stress about missed classes and allow a child to resume normal activity. sleep schedule and resume light to light. – rather moderate exercise, all of which they believe will lead to a faster recovery. On the other hand, long-term activity restriction and isolation, they suggested, could increase risks for anxiety and depression, and being at home could increase screen time.

Berkner said most of the parents of patients he has treated have not opposed the new recommendations. And schools are ready to help.

“Most schools have concussion protocols, both for physical activity and academic adjustments,” says Sigrid Wolf, a sports medicine pediatrician at Lurie Children’s Hospital in Chicago. In Illinois, every school is required to have a concussion monitoring team to help provide accommodations, such as taking breaks, having extra time for tests or assignments, or reading printed materials instead of text on screens.

While they won’t go to the gym or go to recess, they will be encouraged to participate in light activities such as walking or cycling on a stationary bike. “Light to moderate physical activity also helps kids recover faster from concussions,” Wolf said.

A concussion damages the connections between nerve cells in the brain, which alters how the brain works until those pathways are repaired. It’s important to give the brain enough time to rewire itself after a concussion. If a child returns to athletic activities before his brain has healed and suffers another concussion, that second injury could cause more serious 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. Further: “every concussion is different. So just because you had a bad concussion the first time doesn’t mean you’ll have a bad concussion the next time.

Signs of a concussion fall into five categories, Wolf said: physical symptoms, such as headaches, 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 sleep, and difficulty falling or staying asleep.

If a possible concussion occurred during an activity, it is important to get your child off the field or track right away. “We know that children recover faster if they are taken out of play immediately,” she said. “Continuing to play for even 15 minutes after you sustain a head injury is a risk factor for long-term concussion symptoms.” The mantra: “When in doubt, pull ’em out.”

The next step is to see a health professional, who can help you determine if your child has a concussion and when your child should go back to school; for example, children with a pre-existing history of headaches or migraines may need additional support for their return to school, Berkner said.

“We’ve really learned a lot more about concussion and how to treat concussion than we knew even 10 years ago,” Vaughan said. “Many people still believe that exercise is bad when you have a concussion, but there are multiple animal and human studies that show that light non-contact aerobic exercise, which usually begins several days after a concussion, is associated with faster recovery. .”

Vaughan and Wolf also said concussion experts are moving away from preseason cognitive tests, often conducted by schools and athletic teams, because of doubts about the accuracy of the tests.

When deciding whether a patient should return to sports, Vaughan focuses on the reports of the child and his parents. Signs that a child has made a full recovery include: “They have no symptoms at home, they have no symptoms when they play sports, their school performance and cognitive functioning appear normal. Their parents see them as normal again.”

While doctors want parents to understand the potential seriousness of concussions, they also want them to take heart from the fact that most kids recover within a month.

“We take all brain injuries seriously, no matter what they’re called or how many symptoms occur afterwards,” Vaughan said. “Fortunately many [children] get better relatively quickly. And certainly, if someone does nothing to keep their brain injured during the recovery process, we expect a full recovery and return to normal life activities.”

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