Along with teachers and other school personnel such as coaches, parents are "critical participants"1in a child's treatment and recovery from a suspected concussion,including decisions about return to school, return to sports/recreationand return to everyday social and home activity:
- Active involvement of the parent is standard practice in pediatrics;
- The student athlete's everyday environments at home and at school serve as important venues for observing post-concussion symptoms; and
- Parents and teachers are in the best position to observe the child's behavior and ability to function, which are important factors in the treatment of and recovery from concussion.
Ten-point checklist for parents
- Regularly monitor athlete closely for first 24 to 48 hours.2 Most sport-related concussions are mild, but the potential always exists for a more serious, life-threatening head injury, such as an epidural hematoma (bleeding between the skull and the brain) or second-impact syndrome. Because delayed onset of symptoms during the first 24 to 48 hours is possible (and more likely in children), parents - or another responsible adult - should closely monitor the athlete during this time. The traditional rule has been to wake up a concussed athlete every 3 to 4 hours during the night to evaluate changes in symptoms and rule out the possibility of an intracranial bleed, such as a subdural hematoma. A good rule of thumb is to wake up your child during the night to check for signs of deteriorating mental status (see #2), but only if he experienced a loss of consciousness or prolonged amnesia after the injury, or was still experiencing other significant post-concussion signs or symptoms when he or she went to bed. There is no need to check his eyes with a flashlight or test his reflexes.
- Immediate hospitalization if condition deteriorates.2 If your child experiences any of the following signs of deteriorating mental status, take her to the hospital immediately:
- Has a headache that gets worse
- Is very drowsy or can't be awakened (woken up)
- Can't recognize people or places
- Is vomiting repeatedly
- Behaves unusually, seems confused or very irritable
- Experiences seizures (arms and legs jerk uncontrollably)
- Has weak or numb arms or legs
- Is unsteady on his feet or has slurred speech.
- Use acetaminophen (e.g. Tylenol®) or codeine for headache. Do not give aspirin or anti-inflammatory medicine (e.g. NSAIDs such Ibuprofen/Advil®). An ice pack on the head and neck is okay as needed for comfort.
- No drugs, alcohol: Warn your child about the dangers of ingesting alcohol, illicit drugs, or other substances that might interfere with cognitive function and neurologic recovery. Do not give sleeping tablets.
- Physical and "cognitive" rest: The "cornerstone" of concussion management is physical and cognitive rest until symptoms clear and then a graded program of exertion prior to medical clearance and return to play.1 This means your child should rest and avoid strenuous activity for at least the first 24 hours. Because activities that require concentration and attention may make post-concussion symptoms worse and delay recovery, youth athletes who have sustained concussions should also limit their day-to-day and school-related activities until they are symptom free. This means no homework, videogames, text messaging and staying home from school while still experiencing concussion symptoms. Apart from limiting physical and cognitive activities (and other risk-taking opportunities for re-injury) while concussion symptoms are still present, no further treatment is required during the recovery period and the athlete typically resumes sport without futher problem.
- No same day return to play; graduated return-to-play. The Zurich Consensus Statement on Concussion in Sport1 recommends that athletes should NOT be allowed to return to play on the day of injury and that, when returning athletes to play, they should follow a step-wise, symptom limited program with each stage taking 24 hours or longer to complete, and the athlete returning to the previous step if symptoms recur with exercise or at rest.
- No driving until medical cleared.
- Normal diet: Limited information is available regarding the recommended diet for the management of concussion. A normal well-balanced diet that is nutritious in both quality and quantity should be maintained to provide the needed nutrients to aid in the recovery process. Avoid spicy foods.
- Further testing/management. The Zurich consensus statement abandons the simple versus complex classification in favor of a list of "modifying factors," the presence of which may suggest the need for more sophisticated concussion management strategies, such as examination by a specialist and more testing. These factors include:
- His post-concussion signs or symptoms last more than 10 days or recur with exercise;
- He experienced concussive convulsions or prolonged loss of consciousness (LOC) (one minute or more) at the time of injury;
- He has suffered one or more concussive events in the past, especially where they appear to be recurring with progressively less impact force (e.g. a minor blow) or takes longer to recover after each successive concussion; or
- He has learning disorders and/or attention deficit hyperactivity (ADHD).
- Trust your instincts. Be as involved in the management of your child's concussion as your instincts tell you to be. Don't be afraid to ask your child how he is feeling, or take him to his pediatrician or a specialist if you suspect something is wrong.
- Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Br. J. Sports Med. 20090: 43:i76-i84.
- Sport Concussion Assessment Tool 2, Br. J. Sports Med. 2009; 43; i85-i88
Revised and updated: December 28, 2011
