Concussion care for children and teens: What parents need to know

Concussions are very common — in fact, they are the most common kind of traumatic brain injury (TBI). While most people recover completely, concussions sometimes lead to lifelong problems, as we've learned from the experiences of former National Football League players.

That's why it's important that we do everything we can to not just prevent concussions in children and teens, but to give them the right treatment when a concussion happens.

The problem for doctors, parents, and coaches has been that while we want to do the right thing when a child gets a concussion, it's not always easy to know what the right thing is. To help, the Centers for Disease Control and Prevention (CDC) reviews all the research and makes recommendations to help guide us as we care for children with concussions.

Every child is different, and concussion care should reflect that

The recommendations reflect the fact that every child who has a concussion is different. Every injury is different, obviously, but it's more than that. Some children are more likely to have trouble, such as those who have had prior concussions or have learning problems, mental health problems, or neurological problems.

Interestingly, children whose families are stressed for reasons such as poverty can take a longer time to recover from concussions. And there is a bit of a wild-card factor too: sometimes children unexpectedly take a long time to recover — or, conversely, recover very quickly.

What are the concussion care recommendations?

Practice guidelines developed by the CDC for health providers include these points:

• Most children with concussions don't need CT or MRI scans. If there was a severe injury or the child is having severe or unusual symptoms, then it's worth doing to be sure there isn't internal bleeding, a fracture, or some other injury. Most of the time with concussions, there is nothing to see — and it's not worth the risk or expense involved in these imaging studies.
• Use the right tool to make the diagnosis. There are some symptoms we associate with concussion, like bad headache, dizziness, loss of memory of the accident. But because it isn't always clear, it's helpful to use a checklist or questionnaire that is validated, meaning that it's been shown to accurately pick out those with a concussion from those who simply have a bad clunk to the head and not a concussion.
• When a child has a concussion, assess for risk factors for a prolonged recovery. As I said above, some children take longer to get better — and while we can never predict for sure, it's important to think about that at the time of the injury.

What should parents know about concussions?

• Most children and teens with concussions get completely better within one to three months. But it's important that children, families, and coaches know what all the symptoms are after a concussion, and understand what's normal and what is a sign of a problem. For example, trouble sleeping, dizziness, and moodiness can be normal, but if any of those symptoms are getting worse, it's important to call the doctor.
• Parents can help children return to normal activities after a concussion. Rest — of not just the body, but the mind too — is important for the first two to three days after a concussion, but after that it's important to start getting back to normal. When people rest completely for longer than that, it actually takes them longer to get better.

Getting back to normal after a concussion

We used to think that total rest of the brain and body after a concussion was the best treatment. Increasingly, research shows that resuming normal activities is the better treatment. For example, recent research analyzing many studies showed that exercise can help speed recovery from concussion. The tricky part is figuring out how best to resume normal activities, because it is different for each child.

The basic idea is to start slow and see how the child does. If they do okay, they can do a bit more schoolwork or exercise. If they don't do okay — meaning they have more symptoms — they should do less and go more slowly.

The process of getting back to normal life can take a few days, or a few months. It has to be tailored to each child and each situation, which is why collaboration with your pediatrician is so important. It's also really important not to rush the process, especially when it comes to returning to a sport where concussions are common, such as football, hockey, or soccer. If a child gets another concussion while they are still recovering, it will take them much longer to get better, and put them at risk of permanent disabilities.

To learn more, visit the CDC's Heads Up page.

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