In early September, which is also Brain Injury Awareness Month, the Centers for Disease Control and Prevention (CDC) released significant new guidelines regarding diagnosing and managing head injuries (concussion) in youth. Such guidelines are geared towards doctors, parents, school personnel, and coaches of children who have suffered or may suffer from a mild traumatic brain injury.
There is an estimated 1.1 – 1.9 million sports and recreation-related concussions in children 18 and under. A concussion can be caused by a direct blow to the head, face, or neck (e.g., head striking the ground after a tackle) or an impact to another part of the body that results in a force transmitted to the head (e.g., a tackle resulting in an abrupt stop). Following that, there is a short-lived impairment of neurological function that resolves spontaneously. Of note, symptoms and signs may evolve over minutes to hours. Most common symptoms include headache, fatigue, dizziness, poor balance, deficits in attention, processing speed, and working memory, and anxiety/mood concerns. On average, children and adolescents generally take four weeks to recover following sports-related concussion.
Some of the new recommendations provide diagnostic clarification. Specifically, the guidelines inform medical providers that imaging studies, such as CT scans and X-rays, are not necessary for diagnosing mild traumatic brain injuries. Avoiding such tests subsequently helps minimize children’s exposure to radiation. Furthermore, it is important to use validated, age-appropriate symptom scales which can help track recovery. Medical providers should also assess risk factors that are known to impact a child’s recovery. Such factors include pre-existing psychiatric concerns, learning disabilities, as well as lower cognitive ability. Of note, other studies have documented the importance of family distress variables in prolonging recovery. Another key recommendation by Dr. Christopher C. Giza, professor of pediatric neurology and neurosurgery at the University of California, is to “counsel patients to return gradually to non-sports activities after no more than two to three days of rest”. This is a change from previous recommendations of keeping children in a dark, quiet room for a long recovery period after mild traumatic brain injury which has been found to contribute to anxiety and depression in children due to the isolation and worry about missing schoolwork and being away from friends. Research suggests that overall, concussion management should involve a biopsychosocial framework, incorporating both injury and psychosocial factors.
Please read the following article, For Kids with Concussions, Less Time Alone in a Dark Room, to learn more about the new guideline as well as find links for age appropriate concussion symptom scales, informational materials for parents and coaches, and a school letter for children returning to school after a concussion.
A few helpful links about Mild Traumatic Brain Injury:
The Brain Injury Association of New Hampshire is a non-profit that offers information, services, and resources to “make a hard topic like brain injury a little easier to understand”.
The Krempels Center of New Hampshire is a non-profit organization for people living with brain injury that offers “programs that engage our members in meaningful and productive experiences and provide ongoing support and resources to survivors and their families”.
Biking event fundraiser in October for Krempels Center
A very helpful guide on Concussion in Kids that answers questions such as: Does my child have a concussion? Should I get a formal evaluation? How can I support my child’s recovery?