New concussion guidelines are better for kids

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Between 1.1 million and 1.9 million children and teens have a concussion every year. It's a common injury and one that needs to be taken seriously.

There have been strict rules on what kids can and can't do after they have a concussion. But new guidelines, the first update in eight years, are relaxing the rules a bit, making it a little easier for kids to recover both physically and mentally.

Angelo Neumann had four concussions by the time he was 9.

"At home, we just have to be extra cautious that he doesn't hit his head," said Mark Neumann, Angelo's dad.

Softball star Hali Jester had a concussion too. She didn't sit out to recover, then had a devastating second one.

"I don't like to sit out," she said. "I don't like to miss anything, and I didn't take care of myself. I didn't realize how serious this could be."

Dr. Mark Halstead, who works in pediatric medicine at Washington University in St. Louis, says it's crucial to take concussions seriously.

"When athletes continue to play after their concussion and they don't come out immediately, those kids have much worse symptoms, and it actually oftentimes doubles their recovery time," he said.

Previous guidelines said to completely rest the brain after a concussion.

"We had some people who said, 'That doesn't sound exactly right,' because we've tried that with things in medicine before, [and] that doesn't usually get people better," Halstead said.

New guidelines have flipped that old thinking on its head. While kids don't go back to normal activity right away, light exercise like a 20-minute brisk walk as early as a day after an injury is beneficial.

"The research out there shows that when we start doing some light physical activity earlier on in the process, people recover quicker," Halstead said.

Previous guidelines suggested limiting electronics. But cutting off a kid's social network can lead to isolation, anxiety and depression.

The new rule? Electronics are OK.

"We don't want someone to be, you know, on restricted use of them, but also that there's no harm necessarily in using them," Halstead said.

Another change to the guidelines is that kids shouldn't be kept out of school for a prolonged time, but limiting academic workload may be necessary.

"Being totally inactive is not good for our bodies either," Halstead said.

According to a report by the American Academy of Pediatrics, concussions ranked highest in boys tackle football, followed by lacrosse, ice hockey and wrestling. In girls' sports, soccer reported the most incidents, followed by lacrosse, field hockey and basketball.

RESEARCH SUMMARY
NEW CONCUSSION GUIDELINES BETTER FOR KIDS
REPORT #2689

BACKGROUND: Each year, an estimated 1.1 million to 1.9 million U.S. children and teens are treated for a recreational or sport-related concussion. Research shows that sport-related concussion remains common in nearly all sports at all levels, with boys' tackle football and girls' soccer reporting the most incidents, followed by other high-contact sports. Guidance on treatment and recovery of injured players has progressed over the past few years. The American Academy of Pediatrics latest research recommends reducing, but not eliminating, a return to some physical and cognitive activity in the days following a concussion. "Athletes absolutely need to take an immediate break from play after a concussion, but we find that, during the recovery process, it is best to encourage a reasonable amount of activity, such as brisk walking," said Dr. Halstead, an associate professor of pediatrics and of orthopedics at Washington University School of Medicine in St. Louis. (Source: https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Offers-Updated-Guidance-on-Sport-Related-Concussions.aspx)

IMPORTANCE OF EARLY INTERVENTION: The evaluation and treatment of a concussion is the key to a safe outcome. The symptoms of a concussion can cause problems when the child returns to school, home or community activities. The evaluation of a concussion will assess possible cognitive, behavioral or physical symptoms to assist in planning during recovery. During an evaluation, a child will be given tests of attention, memory and speed. Test results are used to determine any needed interventions, as well as plan for return to school, sports, and other physical activities. Often children with concussions experience prolonged symptoms, which interfere with their daily activities and sports. Clinicians will evaluate the child and help put a plan together that provides the necessary support for school, work, and return to play decisions. Premature physical and/or mental exertion, before the brain has fully recovered, can both prolong recovery and worsen outcome of a concussion. (Source: https://childrensnational.org/visit/conditions-and-treatments/brain--nervous-system/concussion)

NEW RESEARCH: The mission of the National Institute on Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge about the brain and nervous system and use that knowledge to reduce the burden of neurological disease. NINDS-funded researchers are coordinating a large international study to evaluate treatments for children with moderate to severe traumatic brain injury (TBI). Most of the treatments for TBI are based on studies involving adults. Children are rarely included in research studies so the best course of treatment in pediatric TBI cases is often not clear. The five-year study, called the Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial, aims to develop evidence-based guidelines that can immediately improve recovery and disability rates among children with TBI. The study will include 1,000 children from more than 36 locations in the United States and abroad. Researchers are looking at the effectiveness of immediate interventions, such as lowering intracranial pressure, as well as strategies to prevent secondary injuries and deliver nutrients to the brain. (Source: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Traumatic-Brain-Injury-Hope-Through)