For some time, the best advice for treating kids with sports-related concussions has called for rest, both mental and physical.
But the latest update from the American Academy of Pediatricscalls for reducing — not eliminating — physical and mental exercise in the days following such brain injuries.
“Kids really seem to do better if they take relative rest for a few days, then get back to school and start increasing physical activity, without contact,” said Dr. Kody Moffatt, director of the pediatric sports medicine program at Children’s Hospital & Medical Center in Omaha. He is one of three lead authors of the update, published Monday. It’s the first update from the academy in eight years.
Previously, Moffatt said, some doctors and parents were recommending cocooning: keeping the injured child or teen in a dark room with no sound, no stimulation, no cellphone.
Young people who already are feeling lousy can quickly become anxious or depressed in such circumstances. Being able to reach out to friends can help with recovery.
“There’s a big difference between sending a text and doing algebra,” he said.
Students who’ve suffered a concussion benefit from adjustments to their academic workload — but prolonged school absence is discouraged.
A return to physical activity might involve brisk walking, the authors wrote.
But electronics do need to be kept in check.
Kids shouldn’t be thinking about video games until they’re completely back in school.
“If you can’t go to school, you shouldn’t be playing ‘Fortnite,’ ” Moffatt said, referring to the popular video game.
Moffatt said the update comes amid a rapid expansion of what researchers know about concussions. “What this does is try to summarize the current knowledge, fully expecting it’s going to be in a different place in five years,” he said.
An estimated 1.1 million to 1.9 million American children and teens are treated for a recreational or sports-related concussion every year, according to the report.
But the authors indicate that such injuries remain underreported, even as awareness has grown among doctors, parents, coaches and youths themselves.
All 50 states, as well as the District of Columbia, now have laws requiring that kids who are suspected of having a concussion be removed from play and cleared by a medical provider before returning.
Many, like Nebraska, also require schools to adopt “return-to-learn’’ plans to accommodate children with brain injuries as they return to schoolwork.
Many sports governing bodies and athletic associations also have required more training for coaches, players and parents, as well as rule changes in games and limits on contact in practice, all aimed at mitigating risks and making sports safer.
What else we learned in the report
- Recent research indicates that middle school tackle football has the highest concussion rate — occurring in between 2.6 and 2.9 of every 1,000 games or practices. But most research has focused on treatment of high school athletes.
Moffatt said a number of factors are probably involved in the higher concussion rate for middle school football players, most involving age and maturity. As young people go through adolescence, physical changes occur in the brain that help protect if from injuries. Middle schoolers are still learning tackling technique. They also lack the same neck strength as older athletes.
- Most adults with a concussion will get better within a week or two, Moffatt said. With kids and teens, recovery time usually is closer to four weeks. “We think the reason for that is the physical maturation of the brain during adolescence,” he said.
- Football, lacrosse, ice hockey and wrestling carry the biggest concussion risk for boys. For girls, the list starts with soccer, which is second to tackle football overall, followed by lacrosse, field hockey and basketball.
What we still don’t know
- While there’s still no way to prevent all concussions in sports, Moffatt said, rule changes have helped. Studies are now underway nationally to determine which changes are going to be most effective.
- A blood test or scan that would pinpoint when a person is concussed, and when that person has recovered, would be helpful but has proved elusive. A concussed brain looks normal in imaging. A CT scan is needed if a doctor suspects bleeding in or around the brain, Moffatt said, but most have gotten away from routine CT scans for concussions when bleeding isn’t suspected.
- The authors also note that the long-term effects of a single concussion — or multiple injuries — have not been determined.
But in other research, repeated concussions have been linked with a debilitating brain disease found in the autopsies of some retired football players.