Guidelines unveiled for concussed kids
What to look for, what to do and how to treat it
Sam Barton was doing what children do every day — playing in gym class — when “somebody fell on somebody,” in his father’s words, and the 10-year-old banged his head on the floor.
There were no visible bumps or bruises, no signs of nausea, but Sam complained of a headache and feeling off, so his parents took him to the doctor. There he was diagnosed with a probable concussion. Tests he did later, as part of research at the Children’s Hospital of Eastern Ontario (CHEO), confirmed that not only did he have a concussion but that the knock had affected his ability to concentrate and his muscle strength, among other things.
Concussions are more common in children and youths than in adults — one in 70 children brought to the emergency room is there because of a concussion, and an estimated 10 to 20 per cent of hockey players between nine and 17 have at least one head injury a year. But pediatric concussions have always been less well understood.
That should change with the release Wednesday of the first-ever comprehensive guidelines for pediatric concussions, developed by a team led by Dr. Roger Zemek, a scientist at CHEO, along with the Ontario Neurotrauma Foundation.
The guidelines are meant to help doctors, nurses, parents, teachers, coaches and community workers recognize the signs of concussion
“We are all aware that there is no such thing as a minor concussion. A head injury is a head injury.” MICHAEL BARTON
in children and youth, as well as what to do when they identify one, how it should be treated and when a child is ready to return to school and sports.
One of the key pieces of advice is to remove children from play as soon as a concussion is suspected, with the underlying message: “If in doubt, sit them out.”
That is crucial, said Zemek, because a second concussion before the brain has recovered can have “devas- tating consequences.”
The guidelines released Wednesday include pocketsized assessment tools that list signs and symptoms of concussion.
“We are all aware that there is no such thing as a minor concussion. A head injury is a head injury,” said Sam’s father, Michael Barton.
But, he added, parents need some reasonable guidelines for what to look for and “the path for return to play.”
Although many sports organizations have developed their own guidelines over the years, Zemek said it was important to have comprehensive guidelines with the most up-to-date science because concussions don’t just happen in hockey rinks or playing fields, but also in their backyards, the playground, recreation centres and at school. And, although many doctors are getting better at recognizing signs of concussion in children, only a minority base their recommendations about return to school and sports on the latest and best evidence, said Zemek.
One of the keys to managing concussions is understanding that a wide range of symptoms, including irritability, sadness and fatigue can be signs that the brain has not yet healed.
Once symptoms have resolved, the child or adolescent should gradually return to school, sports and other activities — and if symptoms return they should return to physical and mental rest.