Grant Baldwin, PhD, Director, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
Disclaimer: The findings and conclusions in this manuscript are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
It’s a long pass to the end zone. Two young players collide on the field. The crowd is silent, as one player is slow to get up. Does he have a concussion? Does he need to be removed from the game? What happens next?
Whether on the screen, in the stands, or on the sidelines, you may have watched this moment play out. Yet, for many of us, there are questions that remain. For example, you may wonder, “How can we ensure all children are protected from a concussion?”
Concussions, also referred to as mild traumatic brain injuries (mTBI) in clinical and research settings, are a commonly-reported injury among children. Whether from a collision on the sports field, a fall, or a car crash, a concussion can lead to short- or long-term problems that affect how a child thinks, acts, feels, and learns. Research suggests that children have a greater chance of getting a concussion, and may have a longer recovery than adults.
The good news is that there are actions you can take to improve the care of children with a concussion. Earlier this month, the Centers for Disease Control Prevention (CDC) published the first-ever evidence-based guideline in the U.S. on mTBI (including concussion) among children—for all causes of this injury. The CDC Pediatric mTBI Guideline was developed by leading experts in the field,(1) and is based on a review of scientific research published over a 25-year period. The CDC Pediatric mTBI Guideline has 19 sets of clinical recommendations that cover diagnosis, prognosis, and management and treatment.
There are three key things we want all health care providers, parents, schools, and sports programs to know about concussion.
- Most children with a concussion have a good recovery. About two-thirds of children will feel better within a couple of weeks, and will no longer have symptoms due to their concussion. Providing encouragement and support during their recovery can help. In fact, research shows that providing education to patients and families on concussion can help improve their recovery and lead to better overall health outcomes. Unfortunately, some children will have symptoms that last for months or longer. CDC recommends that children who have symptoms that do not improve or go away within four to six weeks be referred to a brain injury specialist or for additional assessments and interventions. Download CDC’s diagnosis and management checklist for more information. You can also share handouts for patients and families on concussion safety.
- Children should slowly get back to non-sports activities within two-three days after a concussion. Research shows that strictly limiting a child’s activities after a concussion (also known as “strict rest”) can actually make them feel worse. Keeping children from social activities too long may also make children feel isolated or “down.” We now know “strict rest” is not the right approach. CDC recommends that right after the injury, while symptoms are most severe, children should be encouraged to relax at home and to get extra sleep. Most of all, children should avoid activities that make symptoms worse. Within two to three days, children should start light activities, such as returning to school and taking short walks. As children start to feel better, they should slowly add in non-sports activities until they are back to their regular routine. The return to sports process should start once the child is back to their regular activities. Throughout the recovery process, it is important to find ways to help children feel connected to friends and loved ones and to keep their health care provider up-to-date about how they are feeling. For more tips, check out CDC’s return to activity plan, as well as the process for returning to school and sports.
- A child’s recovery plan should be customized to their symptoms. No two concussions are alike, and there is no one-size-fits-all approach to concussion management. CDC recommends that children receive a recovery plan customized to their individual For example, for children who are experiencing headaches, CDC recommends offering non-opioid analgesics, as well as counseling on their potential overuse. However, no matter the symptoms a child experiences, active management from a health care provider is critical. This includes getting written instructions from a health care provider on safely returning to school and sports. Research suggests that when health care providers supply information to a child’s school (such as a letter to schools), children are four times more likely to get extra support in school to help with their recovery. Download and share CDC’s letter for schools to help a child with their recovery.
We are excited about the potential of the CDC Pediatric mTBI Guideline to improve the care of children with concussion. We need your help to spread the word. Please share information on the Guideline with health care providers, parents, schools, and sports programs in your community. You can get more tips on how to get involved with concussion safety at www.cdc.gov/HEADSUP.
Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #PedsNeurosurgery.
- Neurosurgeons participating in this guideline effort included: Shelly D. Timmons, MD, PhD, FAANS; Michael S. Turner, MD, FAANS(L); Edward C. Benzel, MD, FAANS; Ann-Christine Duhaime, MD, FAANS; Patricia B. Raksin, MD, FAANS; John Ragheb, MD, FAANS; Richard G. Ellenbogen, MD, FAANS.