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Kids health

Concussion Protocols for Kids are Changing: Here's What You Need to Know

Gone are the days when parents were advised to keep kids with concussions in dark rooms for days on end with zero stimulation.

Concussion Protocols for Kids are Changing: Here's What You Need to Know

When Erin Smith’s 12-year-old son Beckett emerged from a play structure at an indoor gym last January, she knew something was wrong. “He was dazed, had a pounding headache, and was very tired,” recalls the Toronto mom. Smith’s fears about his condition were confirmed the next day when he was assessed by a physician: Beckett had suffered a severe concussion.

After Beckett’s head injury, Smith and her family were advised to let him rest as much as possible for the first few days. But after about a week, Smith was strongly encouraged to have him return to school for a few hours a day. She was concerned that Beckett still had persistent light- and sound-sensitivity and headaches but she says, “The doctor wanted us to ensure Beckett kept up social connections. “He advised us to follow Beckett’s lead in terms of what he could tolerate.”

This approach aligns with current pediatric concussion protocols, says Dr. Kristian Goulet, an assistant professor at the University of Ottawa’s Brain and Mind Institute. “You want to get your child back to their life as soon as possible, albeit in a very safe and gradual way,” says Dr. Goulet, who is also medical director of the Eastern Ontario Concussion Clinic.

Gone are the days when parents were advised to keep kids with concussions in dark rooms for days on end with zero stimulation. Here is what Dr. Goulet advises parents about concussions in children.

Rest after a concussion, followed by safe, gradual re-entry to daily life

"We recommend a short period of rest—about 24 to 48 hours—with a gradual return to playing and physical activity under the supervision of a medical professional." For example, Dr. Goulet often suggests parents take their child for a walk within 24 hours of the injury or maybe do some stretching or another gentle exercise that doesn’t put their child at risk of getting another blow to the head.

You also want to make sure that their return to sports is gradual, again with no risk of another head injury. Kids can graduate from gentle exercise to more aerobic exercise after about 72 hours. They can increase the intensity every 24 hours, but make sure they're not pushing themselves too hard. Contact sports are not recommended until cleared by a doctor.

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Screen time after a mild traumatic brain injury is something parents often wonder about. Dr. Goulet says, "The less screen time, the better overall. The minimal amount to stay socially connected. The more screen time they have, the harder on the brain." If your kid is bored, try playing podcasts or reading to them.

It’s also important parents understand how detrimental stress is to recovery. Concussions are stressful—psychologically and physically. When a child suffers a concussion, a fight-or-flight response is turned on. If that stress response is maintained it can prevent symptoms from diminishing. Parents and kids should work together to minimize stress.

Concussion Protocols for Kids are Changing: Here's What You Need to Know

To help minimize stress:

  • Make sure your child keeps a consistent sleep routine.
  • If your child needs a nap during the day, they should do so. But it’s better to try and stick to a regulated sleep cycle at night.
  • Ensure your child is eating well and staying hydrated.
  • You want your child to stick to a healthy diet, as we know highly processed and high sugar foods negatively impact the brain.
  • Try to limit the use of acetaminophen or ibuprofen to 12 days a month or less.
  • If your child exceeds that amount, they risk developing overmedication headaches.

No longer recommended:

  • Waking your child every two hours
  • Kids need brain rest. If you wake them every two hours, that's not giving their brain the rest it needs.
  • Keeping your child in a dark room for days
  • If the pandemic has taught us anything, it’s that kids don’t fare well when they’re socially isolated. So-called ‘cocoon therapy’ doesn’t work.
  • Prolonged absence from school

"We like to see kids back in school by day two or three, although with heavy academic accommodations such as shortened days, no tests, no notetaking, and lots of breaks, says Dr. Goulet. “Managing Beckett’s re-entry to school and keeping things low-key really helped,” Smith says, adding that her son has fully recovered from his concussion. “As he stayed longer at school, the more quickly he began to recover. The socialization totally helped.”

Red flag concussion symptoms

Dr. Goulet says symptoms typically appear right after head trauma, but in some cases, can take up to two or three days after the initial incident to emerge. If the following symptoms occur, take your child immediately to the emergency department:

  • Inability to wake the child
  • Severe or worsening headaches
  • Severe drowsiness or confusion
  • Seizures or convulsions
  • Neck pain
  • Double or blurred vision
  • Vomiting more than once
  • Shooting pain or tingling down the arms or legs
  • Loss of consciousness

Even if your child doesn’t experience any of the above red flags, if they have sustained head trauma, you should seek medical attention so they can be seen by a health-care provider within days of the incident.

This article was originally published on Jun 20, 2024

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Sarah is a content and communications professional with deep experience in producing and creating content for print, digital and social. As a freelance columnist at the Toronto Star, she is the author of “Healthy Kids,” a biweekly column that offers practical and evidence-based advice on raising healthy kids to parents and caregivers. An extensive background in journalism led to managing editor roles at two national magazines,
including Today’s Parent.

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