New concussion protocol for kids: Get them back to school sooner


For years, the treatment protocol for children with concussions involved keeping them out of school to rest in a quiet, dark room with reduced access to screens until they felt better. However, in the past decade, doctors have come forward to encourage children to return to school and light activities after a few days of rest, even if the symptoms persist.

A recently released study involving more than 1,500 children supports the new approach. It found that returning to school early – which the researchers defined as missing less than three days – benefited children aged 8 to 18, who had less severe symptoms two weeks after a concussion compared to children who stayed at home longer. . In fact, staying at home longer seems to delay recovery.

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

Many doctors and institutions have implemented these treatment plans. “We have definitely changed the protocol to understand that a lot of rest is not good, that people should return to activity as soon as they can tolerate it, with modifications, and that they should do the healing. environment, which is for school children,” 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 recommendations, and gives us confidence that we can actually do it faster if we do it,” he said.

Vaughan says that “about a quarter of the population or more will experience a concussion, many of which occur in childhood. Most people will live healthy and productive lives, but because brain injuries like concussions are potentially dangerous if not treated properly, we take all injuries seriously.

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They collaborated with colleagues from hospitals and universities across Canada to determine whether the number of days children miss school after a concussion affects their symptoms. The researchers analyzed records 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 are equal numbers of men and women, and concussions are not the only ones caused by sports. Children miss three to five days of school on average, with younger children returning to school earlier than older children on average.

The study showed a “significant” association between returning to school earlier and better symptoms for children 8 and older, and especially for those who initially felt worse. (There aren’t enough data for findings involving 5- to 7-year-olds.) This has led researchers to suggest that returning to school sooner may reduce stress about missed classes and allow children to stay on a normal sleep schedule and continue. light. Moderate physical activity earlier, all of which they believe will lead to faster recovery. On the other hand, the restriction and long separation of activities, it is suggested, can increase the risk of anxiety and depression, and being at home can increase screen time.

Berkner said most parents of patients he treats have not rejected the new recommendations. And the school is ready to help.

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

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Even if they don’t want to go to the gym or take a break, they will be encouraged to do some light activity, such as walking or riding a stationary bike. “Light to moderate physical activity also helps children recover faster from concussions,” Wolf said.

A concussion damages the connections between nerve cells in the brain, which alters the way the brain functions until the pathways are repaired. It is important to give your brain enough time to rewire itself after a concussion. If a child returns to athletic activity before the brain has healed and suffers another concussion, that second injury can cause more severe symptoms — and, in rare cases, can cause brain swelling, Wolf said.

But concussions only increase the risk of concussions, Wolf said. Furthermore, “every concussion is different. So just because you had the first concussion, it doesn’t mean the next time you’re going to have a serious concussion.

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 depression or anxious mood; and sleep and energy symptoms, such as fatigue, increased sleepiness and difficulty falling or staying asleep.

If a concussion can occur during an activity, it is important to remove the child from the field or court immediately. “We know that kids recover faster when they’re removed from play, he said. “Continuing to play for 15 minutes after you’ve had a head injury is a risk factor for long-term concussion symptoms.” Mantra: “When in doubt, pull it out.”

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The next step is to consult a health professional, who can help determine if your child has a concussion and when your child should return to school; for example, children with a history of preexisting headaches or migraines need additional support to return to school, said Berkner.

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

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

When deciding whether a patient should return to sports, Vaughan focuses on reports from children and their parents. Signs that a child has fully recovered include: “He has no symptoms at home, no symptoms during exercise, school performance and cognitive function appear normal. His parents see him as normal again.

While doctors want parents to understand the potential severity of concussions, they also want to be cautious because most children recover within a month.

“We take all brain injuries seriously, regardless of what they’re called or how many symptoms they present,” Vaughan said. “Thank you, a lot [children] it gets better relatively quickly. And of course, if someone does nothing to further damage the brain during the recovery process, we expect a full recovery and return to normal life activities.


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