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Health & Fitness New concussion guidelines for physicians, parents, advise less rest, more activity when recuperating

Parents and even doctors can find it difficult to keep up with rapidly changing research on how to treat a child with a concussion. A new guideline written by Canadian and international pediatric-concussion experts aims to change that.

The Ontario Neurotrauma Foundation, based in Toronto, has published the Living Guideline for Diagnosing and Managing Pediatric Concussion (found on braininjuryguidelines.org), an online document that its authors say will be updated regularly with the latest research on brain injury in children. While it’s intended primarily for physicians, the guide also has sections for parents and youth sports coaches. It replaces the Foundation’s previous guide, published in 2014.

Dr. Nick Reed, associate professor in the department of occupational science and occupational therapy at the University of Toronto who, along with Dr. Roger Zemek, senior scientist at CHEO Research Institute in Ottawa led the panel that created the guide, says his team will work to ensure the guideline is never out of date by adding new research at least once every other month.

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“We want to make sure that if we’re directing health-care professionals and families to use and rely on this guideline that we make sure the information in it is the latest and greatest research available,” Dr. Reed said.

Children make up more than 40 per cent of all concussion patients in Ontario, with children under five having the highest incidence of injury. More than 60,000 doctor visits a year in the province are for pediatric concussions, but Dr. Reed says these numbers don’t reflect the ubiquity of the condition, as many concussion sufferers do not seek medical care.

The guide took three years and more than 40 experts from across North America to complete. The panel synthesized 383 scientific articles into 22 suggested courses of action, which they call tools, for concussion management and a range of recommendations for clinicians.

Dr. Reed says the most significant change made to the 2014 guideline is what he calls the “no more bedroom jail” concept. Previously, children with concussions were advised to rest – and not to engage with screens, social life, sports or school – until their symptoms dissipated. For some, this could take months or even years. Dr. Reed says in prolonged cases more rest is likely doing more harm to the child.

"We need to consider that locking people away from their lives and all the things that make them smile may be causing some secondary harm,” he said, adding that these extensive rest periods can potentially lead to mental-health issues and muscle atrophy.

The new guideline recommends only 24 to 48 hours of rest. After that, children are encouraged to gradually reintroduce activity to their lives (with physician guidance).

The new guidelines drew praise from others in the field.

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Dr. Kevin Chan, chair of the Canadian Pediatric Society’s acute-care committee, praised the new guide, calling it a step forward for concussion management.

Dr. Adrienne Davis, a pediatrician working in emergency medicine at SickKids, said she would recommend the site to her patients and colleagues. “One criticism of guidelines is that as soon as they’re published they’re outdated. The fact that they’ve committed to updating it is great.”

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