A recently published study involving more than 1,500 children supports the new approach. It found that an early return to school, which the researchers defined as missing fewer than three days, benefited children ages 8 to 18, who had less severe symptoms two weeks after their concussion compared with children who stayed at home longer. In fact, a longer stay at home seemed to delay recovery.
The idea is to allow children to “maintain as much normality and routine as possible, obviously with academic support and modifications where necessary,” said Christopher Vaughan, a neuropsychologist at Children’s National Hospital in Washington who led the study.
Many doctors and institutions have already adopted such a treatment plan. “Certainly, we have changed our protocols to recognize that too much rest is not good, that people should return to activity as soon as they can tolerate it, with modifications, and that they need to heal in their own body. environment, which for children is school,” said pediatrician Paul Berkner, medical director of the University of New England and president of the Maine Concussion Management Initiative.
The new study “confirms our recommendation and lends credence to the fact that they may in fact improve faster if we do that,” he added.
Vaughan said that “about a quarter of the population or more have suffered a concussion, many of which occurred during childhood. The vast majority of people will live healthy and productive lives, but because brain injuries like concussions have the potential to be harmful if not properly treated, we take every injury seriously.”
It partnered 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 records from a previous study of 1,630 children ages 5 to 18 who had been treated for concussion at nine pediatric emergency departments across Canada. There were equal numbers of boys and girls, and the concussions were not limited to those caused by sports. Children missed an average of three to five days of school, with younger children on average returning to school earlier than older children.
The study showed “significant” associations between an early return to school and improvement in symptoms in children aged 8 and older, and especially in those who initially felt worse. (There were insufficient data for a finding involving children 5 to 7 years of age.) This led the researchers to suggest that a quicker return to school may reduce the stress of missed classes and allow a child to stay on a normal sleep schedule and resume light-to-moderate physical activity sooner, all of which they believe which will lead to a faster recovery. On the other hand, prolonged activity restriction and isolation, they suggested, could increase the risks of anxiety and depression, and being at home could increase screen time.
Berkner said that most of the parents of the 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 accommodations,” said Sigrid Wolf, a pediatric sports medicine physician at Lurie Children’s Hospital in Chicago. In Illinois, every school is required to have a concussion supervision team to help provide accommodations such as taking breaks, having extra time on tests or homework, or reading printed material instead of text on screens.
Although they will not be going to the gym or recess, they will be encouraged to participate in light activities such as walking or riding 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, disrupting how the brain works until those pathways are repaired. It is important to give the brain adequate time to rewire itself after a concussion. If a child returns to 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 swelling of the brain, Wolf said.
But one concussion only slightly increases the risk of subsequent concussions, Wolf said. Furthermore, “every concussion is different. So just because you had a severe concussion the first time doesn’t mean you’ll have a severe concussion the next time.”
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 tiredness, increased sleepiness, and trouble falling or staying asleep.
If a possible concussion has occurred during an activity, it is important to remove your child from the field or court immediately. “We know that children recover faster when they are removed from the game immediately,” she said. “Continuing to play for even 15 minutes after sustaining a head injury is a risk factor for prolonged concussion symptoms.” The mantra: “When in doubt, get them out.”
The next step is to see a health professional, who can help you determine if your child has a concussion and when to return to school; For example, children with a prior history of headaches or migraines may need extra support getting back to school, Berkner said.
“We really have learned a lot more about concussions and how to treat them than we did even 10 years ago,” Vaughan said. “Many people still believe that exercising is bad when you have a concussion, but there have been multiple animal and human research studies showing that light non-contact aerobic exercise, typically started only several days after a concussion , is associated with faster concussion. Recovery.”
Vaughan and Wolf also said concussion experts are moving away from preseason baseline cognitive tests often administered by schools and sports teams, due to concerns about the accuracy of the tests.
When deciding whether a patient should return to sports, Vaughan focuses on reports from the child and his parents. Signs that a child is fully recovered include: “They have no symptoms at home, they have no symptoms when they exercise, their school performance and cognitive functioning seem normal. Their parents see them as normal again.”
While doctors want parents to understand the potential seriousness of concussions, they also want to take heart from the fact that most children recover within a month.
“We take all brain injuries seriously, no matter what they’re called or how many symptoms follow,” Vaughan said. “Fortunately, many [children] improve relatively quickly. And certainly if someone does nothing to continue to injure their brain during the recovery process, we expect a full recovery and a return to normal activities of life.”
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