Thanks to a great deal of research, educational efforts, and media attention, the word is finally getting out about the risks and treatment of concussion in children. Since most concussions occur during sports, most of the attention has been focused on when and how a child should safely return to sports participation. However, concussion causes brain dysfunction, which can affect concentration, memory, and learning. Activities such as reading, listening to a lecture, watching slides, or working on a computer can cause headaches, confusion, fatigue, and other neurological symptoms. Current recommendations have included return to school guidelines, but these have not been emphasized as heavily as returning to sports.
The American Academy of Pediatrics, during its annual meeting, has issued new, more detailed guidelines for returning to school after a concussion. The guidelines acknowledge that there is little research in this area; however, they reflect the best we know at this time.
Teachers and school officials need to be aware that children with a concussion may miss school, or may require shorter school days or fewer or modified assignments until the brain is healed and symptoms have resolved. Children do not have to be symptom-free to return to school, but they do need to be able to participate in learning activities. Usually, when the child can be symptom-free for 30-45 continuous minutes, he can return to school.
The guidelines also call for a high degree of communication between pediatricians, parents, students, teachers, school administrators, and any medical specialists. They also suggest that the school have two teams, a physical team consisting of athletic trainers, PE teachers, coaches, and school nurses, and an academic team consisting of counselors, teachers, school nurses, and administrators. Both of these recommendations are likely to be difficult to implement.
The guidelines also state that children should not return to sports and physical activities until she can participate in academic and social activities at school. This is likely to be unpopular with children (and parents) who are eager to return to sports. I think that this is a change from current guidelines which do not link the two together.
I believe that the concern with returning to school is not further injury, as it is with sports, but with worsening symptoms, discomfort, poor grades, the emotional upset that can come from struggling with schoolwork, and perhaps a delay in recovery but again this has not been clearly demonstrated. While returning to sports too early can cause physical harm and delay healing, return to academic activities too early can cause poor performance and mental and emotional health problems.
I think these goals are worthy and necessary ones. However, we are still struggling to get everyone to follow the right guidelines for returning to sports and physical activities. I still see other doctors telling children that they can “return to play in two weeks.” This completely contradicts everything we know about concussion and all current guidelines. I agree that we need to work on the academic aspect as well, but we still have much work to do on following the return to sports guidelines as well.
Summary of the new guidelines
- Everyone involved needs to realize that children with concussion may need a delay in returning to school and/or an adjustment in schoolwork to avoid continuing or worsening symptoms and possible harm in learning and school performance.
- Most concussions resolve in 1-3 weeks, and a formal learning plan, such as a 504 plan, is not usually necessary.
- Students with prolonged symptoms would likely benefit from more specialized medical care and may require a more formal learning plan.
- Ideally, there will be a team approach with coordination between the medical team, the family team, and the school team.
- Students should be back to academic baseline before returning to sports, PE, and other physical and extracurricular activities.
Links
Clinical Report: Returning to Learning Following a Concussion
