The New Concussion Rules

Expert tips on what you should know about concussions
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With the growing popularity of youth sports, along with traditional kid pursuits like bike riding and climbing trees, the risk of a concussion is ever-present and shouldn't be taken lightly. Fortunately, more awareness and a better understanding of the signs and symptoms are helping young concussion sufferers. Here's the latest research and advice, so you can keep your child safe both on and off the field.

1. Take all head bumps seriously.

The American Academy of Pediatrics (AAP) recommends calling your pediatrician if your child sustains anything beyond a light bump on the head. That advice seems to be getting out: More children are being seen in emergency rooms with head injuries that they sustained while playing sports, according to a recent report from the Cincinnati Children's Hospital Medical Center published in Pediatrics. This likely means that parents and coaches are doing a better job of recognizing the signs and complications of concussions, but there's still work to be done. Another recent study, published in the journal JAMA Pediatrics, found that nearly 60 percent of middle school girls continued to play soccer even though they'd displayed concussion symptoms.

2. When in doubt, sit out.

"A player should never return to the field or court if there is any evidence of a concussion. Repeat this mantra: 'When in doubt, sit them out,'" urges Elizabeth Pieroth, Psy.D., a neuropsychologist at NorthShore University HealthSystem in Chicago and the concussion consultant for the Chicago Bears, Blackhawks, Fire, and White Sox, and Northwestern University.

The National Football League, the National Federation of State High School Associations, and the Centers for Disease Control and Prevention have all been working together to make sure this happens. Currently, all 50 states have youth concussion laws on the books. Each state law is different, but the main points are the same: Train coaches and officials to recognize concussions and get kids off the playing field, court, or rink when a head injury occurs. Georgia's law also requires schools to put in place policies for addressing student head injuries. The law in Tennessee covers recreational youth leagues as well as private and public schools and requires coaches, parents, and athletes to sign documents that state their awareness of this danger before a child participates. And Wisconsin recently updated its existing law to ensure that schools hand out concussion-related information to students each year.

3. Brain rest is as important as physical rest.

Growing evidence suggesting a need to rest the brain to promote healing prompted the AAP to release a new policy statement saying that kids who suffer a concussion may need a significant break from school, followed by a gradual return. This report recommends a team approach -- including parents, teachers, and the child's pediatrician -- to manage the student's recovery and guide her return to the classroom.

"The brain is the most complex organ in the body -- the master computer behind our movements, thinking, behavior and personality -- so an injury to it can interfere with learning, reading, and computer work," explains Gerard Gioia, Ph.D., a pediatric neuropsychologist at Children's National Medical Center in Washington, D.C., and the director of Safe Concussion Outcome, Recovery, and Education (SCORE). For some students, simply being in the school building, with its noisy kids, flashing computer screens, and bright lights, can affect symptoms. Concussions are also an "invisible" injury -- kids tend to look fine on the outside, and this often makes it difficult to understand the need for more time at home to heal.

Typically, a child with a concussion will recover within about three weeks, but it may take longer for someone whose symptoms are more severe. On the other hand, most students with mild to moderate symptoms can head back to school with a gradual return-to-school plan, including classroom accommodations and adjustments in his schedule (no gym class, reduced reading, periodic rest breaks).

While at home recovering from a concussion, children should avoid brain-taxing activities that can worsen symptoms. Every concussion is different: Some children may not be able to tolerate video games, computer use, and a lot of reading. On the other hand, playing simple board games and cards, listening to audiobooks, and helping out in the kitchen may be better activities while the brain is recovering. Some TV is also okay, but don't let it consume your child's day. Symptoms should be used as a guide for which activities to engage in, Dr. Gioia says. In general, moderation is the rule and if symptoms worsen, that is the sign to stop an activity.

In a study in the February 2014 issue of Pediatrics, researchers found that adolescents with diagnosed concussions who spent the most time away from books, homework, computers, and video games recovered more quickly. Those kids who took a complete vacation from homework, books, and computers, as well as kids who spent minimal (no reading, no homework, less than 20 minutes a day of video games or online activity) to moderate (reading less than 10 pages per day and doing less than one hour of homework, video games, or online activity) amounts of time with these activities recovered in about 20 to 50 days. But for those who didn't take any kind of "brain break" at all and students who engaged in significant schoolwork (reading a little less than usual but still doing most of their assignments), the recovery time was up to 100 days.

All concussions are unique and symptoms vary, so each child's return to the classroom will require an individualized approach, says Mark Halstead, M.D., the AAP study lead author on a gradual return to school and an assistant professor of pediatrics and orthopedics at Washington University in Saint Louis.

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Copyright © 2014 Meredith Corporation.

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