Caring for a Child's Concussion

Bumps and bruises are a part of every childhood, but with the large number of children participating in organized sports, traumatic brain injuries, including concussions, are on the rise. Emergency room visits for sports- and recreation-related traumatic brain injuries among young people increased by 62 percent in the last decade, causing such concern that the first-ever White House Healthy Kids & Safe Sports Concussion Summit was held in May. It was there that President Obama announced that various organizations, including the NFL and NCAA, were pledging $86 million to concussion research.

Quick to follow was the release of the first comprehensive pediatric concussion guidelines in June. Developed by an expert panel of pediatric health professionals from the U.S. and Canada, these guidelines provide evidence-based recommendations for the diagnosis and treatment of concussions in children (from ages 5 to 18) to parents, caregivers, coaches, schools and health care providers.

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"This is so important because children get more concussions than adults do, with increased risk because their brains are still developing," says Roger Zemek, assistant professor of pediatrics and emergency medicine at the University of Ottawa and chair of the "Guidelines for Diagnosing and Managing Pediatric Concussion."

"Concussions are caused by a blow to the head, face, neck or elsewhere on the body that results in the shaking of the brain, leading to a disruption of the normal function of the brain rather than an injury to the structure of the brain," Zemek says. "Children do not need to [lose] consciousness to have a concussion."

And while two-thirds of pediatric concussions are related to sports injuries, Zemek notes, the remaining third occur from falls or collisions at home, school, the playground and other non-sports causes, like car crashes, making it especially vital for parents, teachers and coaches to learn the symptoms of concussions.

Zemek offers a list of symptoms to look out for, as they can vary:

-- Physical: headache, nausea, dizziness, changes in vision or hearing, coordination and/or balance problems

-- Cognitive: confusion, slower than normal reaction times, problems concentrating, feeling dazed or in a fog

-- Behavioral: irritability, sadness or emotional swings

-- Sleep: falling asleep or sleeping more or less than usual

So what should one do if he or she suspects a child has suffered a concussion? "When in doubt, sit them out," Zemek says. Remove a child from the activity immediately, the guidelines advise, and do not let them return to play or practice. This would prevent another hit that could complicate the injury and possibly put the child's life at risk. Assess the child for symptoms and do not leave him or her alone. Symptoms may not appear until several hours after the blow. Watch for possible symptoms to evolve, and take a child who does show symptoms to a health care professional as soon as possible.

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If a child has been diagnosed with a concussion, the guidelines counsel parents to follow the written and verbal information given by the health care professional and to develop a return-to-learn program after acute symptoms have improved. This includes both physical and cognitive rest, an important change from previous recommendations.

"Years ago, children were told to rest after concussion, which means something entirely different today with the onset of technology. Now rest must include a break from screen time and handheld devices," Zemek says. "We know more about the importance of ensuring thinking rest in addition to the physical rest required for recovery."

A study in the February issue of Pediatrics confirmed that increased cognitive activity is associated with a longer recovery from concussion. "Cognitive activity is defined as anything that taxes the brain," says study author Naomi J. Brown, a pediatric and adolescent sports medicine specialist in the department of orthopedic surgery at The Children's Hospital of Philadelphia. "This would include reading, doing homework, watching TV or going to a movie. It also includes texting, being on the phone or being on the computer."

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At each visit to a sports concussion clinic, researchers asked 335 patients, ranging in age from 8 to 23 years, how much cognitive activity they had participated in since their previous visit. Those who engaged in the highest levels of cognitive activity took the longest to recover from their symptoms, averaging 100 days versus 20 to 50 days for those who engaged in less cognitive activity or complete cognitive rest. "This is the first study showing the independent, beneficial effect of limiting cognitive activity on the recovery from concussion," Brown says.

To further aid in recovery, the pediatric guidelines also recommend that parents work with the child's primary care professional, school and/or employer in making accommodations to tasks or schedules.

"We know that most children will improve within a matter of weeks to a month," Zemek says. "However, up to a third of children may have symptoms that last a month or more. It's important to set realistic expectations for recovery and to take the steps recommended in the guidelines to promote recovery and prevent re-injury."