Concussions are scary. We often hear about them in relation to collegiate and professional sports, but mild traumatic brain injuries impact all age groups. The Centers for Disease Control and Prevention (CDC) has a new set of guidelines to help protect kids. The concussion protocols for youth cover diagnosis, prognosis and treatment of the injury. Shawn Spooner, MD, a sports medicine expert for UnityPoint Health, explains the guidelines and helps identify what parents need to know to find the most personalized care for their families.
Concussion Information for Parents
According to the CDC, concussions can result from a bump, blow or jolt to the head. This impact can cause the head and brain to move quickly back and forth and can cause the brain to bounce or twist in the skull resulting in chemical changes in the brain and sometimes damage to the brain cells.
How long does a concussion last? Most kids with a concussion feel better within a couple of weeks. Some symptoms may appear right away, while others may be a bit delayed. Your child might not realize they have concussion symptoms until they try their normal, everyday activities. They might experience:
- Physical symptoms. This includes irritation to light, dizziness or balance issues, headaches, nausea or vomiting and vision problems.
- Cognitive symptoms. The child might have problems concentrating, feel foggy or notice difficulty with short- or long-term memory.
- Social/emotional symptoms. These symptoms may include anxiety, irritability, feeling more emotional and/or sadness.
- Changing sleep patterns. The child might sleep less, sleep more or have trouble falling asleep.
While these signs of a concussion are all normal bodily responses, if you see something that concerns you or something gets worse, contact your doctor immediately.
“Parents may choose to inquire about the experience of their child’s provider in terms of concussion care, especially in cases where symptoms are persistent or complex. Also, parents have an important role in many of the recommendations. Everything from avoiding unnecessary advanced imaging (CT, MRI) to ensuring the proper multidisciplinary approach to treatment should be a focus for a parent of a child recovering from a concussion,” Dr. Spooner says.
New Concussion Protocol for Youth
Dr. Spooner says the CDC’s move to publish specific pediatric concussion guidelines is a step in the right direction. It gives the public and medical providers the tools to correctly identify and manage concussions in youth 18 and under, which is a population that isn’t often the focus.
“There has been a large emphasis on sports concussions in the past, which has essentially addressed the adolescent population and young adult athletic populations,” Dr. Spooner says. “However, there has been much less attention to the pediatric, as well as the older adult population. The CDC’s move to publish specific pediatric guidelines indicates a movement forward in the proactive education of the public and medical providers.”
Deciphering the Concussion Guidelines
The CDC guidelines refer to mTBI, which stands for mild traumatic brain injury. Dr. Spooner says mild traumatic brain injury is a phrase that’s more technically accurate than concussion. However, in general, mTBI and concussion can be used interchangeably.
The CDC recommends 19 specific guidelines. We know, that’s a lot! So, Dr. Spooner identifies the points he finds most important for how to treat a concussion.
- Use validated tools for diagnosis and screening. The CDC guidelines suggest health care providers should not routinely use a head CT (CAT scan) for diagnostic purposes. Instead, it’s best to use validated tools for concussion diagnosis and screening. Examples of validated scales include: Post-Concussion Symptom Scale, Health and Behavior Inventory, Post-Concussion Symptom Inventory and Acute Concussion Evaluation. Most of these scales consider age and severity of symptoms such as dizziness, fatigue, headache and vomiting. Dr. Spooner says there’s been a lot of recent hype regarding serum markers and saliva testing, but he says these types of tests are still in the research stage, and the CDC guidelines say they shouldn’t be widely used.
- Understand comorbidities. Comorbidities is a fancy word for being able to identify if a child has another condition or disease that might impact how he/she heals from a concussion. Additional comorbidities could mean a longer recovery or result in more complicated cases. Examples include prior concussion, mental health conditions, learning disorders, prior headache syndromes and unique demographic or social stressors.
- Practice “relative rest.” The CDC guidelines support the return to appropriate levels of activity after just a few days of rest (2-3 days), which leads to earlier recovery and better outcomes. This includes beginning light activity and gradually re-introducing regular activities (not including sports). Once the child is back to regular non-sports activities, the patient can gradually return to sports.
- Importance of education. The guidelines address the importance of education for the patient and his/her family. The CDC also stresses the importance of coordination of care between the patient, family, care team, school staff and anyone else involved in the care process.
- Best practices for concussion symptom treatment. The guidelines pinpoint the best treatment for symptoms such as headaches, blurriness and dizziness. The guidelines also point out techniques for sleep management, cognitive rehabilitation and emotional support management. Generally, rest and careful use of acetaminophen and ibuprofen or similar over-the-counter pain medications are helpful to treat headaches. Also helpful is avoiding headache triggers such as vigorous exercise or cognitive activity, bright lights, electronics, etc. Sometimes when headaches are persistent doctors can prescribe prescription headache medication.
Putting the Guidelines into Practice
Dr. Spooner says it’s up to each medical provider to review the new CDC concussion guidelines and recommendations and to put them into practice.
“Unfortunately, I believe it will take some time to implement these new standards. There is always so much new material being developed and released by multiple medical groups, specialty boards, journals and special interest groups that it can be hard to keep up with the constant flow of new information. I fear these guidelines will be easily overlooked and take some additional time to gain traction. Hopefully, with some additional public exposure, those who care for the pediatric population will take time to review the guidelines and learn from them,” Dr. Spooner says.
Overall, Dr. Spooner says these guidelines are an important step in encouraging a more standard approach to care of concussions. And that approach to care should lead to better outcomes.
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