Children who suffer a concussion need more rest time than adults, perhaps as much as 30 days of no physical activity, no television viewing or electronic gaming, according to a new report.
Ontario medical officials saw 2,000 patients and reviewed 4,000 academic papers to produce new guidelines to recognize and treat concussions in children aged 5 to 18 that are sure to surprise some parents, players, teachers and coaches:
- Symptoms in children and youth can be far more persistent – of the patients examined, 30 per cent had symptoms, such as headaches, that persisted for more than a month.
- Children who suffer a concussion need more time to recover than adults, who are usually instructed to rest for seven to 10 days.
- Along with physical symptoms such as loss of consciousness, lack of balance, headache and neck pain, the guidelines warn of emotional symptoms including irritability, sadness, anxiety and nervousness.
- A young person’s memory should also be tested (with questions about the game or previous games played).
The guidelines were released Wednesday to help parents better recognize concussion symptoms, and to provide health-care workers with "evidence-based recommendations" to recognize and treat them.
The guidelines state that if a player has even one concussion-related condition – whether an obvious physical symptom such as vomiting, an emotional indicator or a failed memory test – he or she has to be immediately removed from play.
Researchers discovered that wasn't always the case, and that there were still "a large number of providers who were not providing the latest advice regarding cognitive rest."
Dr. Roger Zemek, a scientist at the Children's Hospital of Eastern Ontario in Ottawa and lead author of the report, said, "only about one in four providers were using concussion tools to measure concussion symptoms severity and to track recovery. My hope is that this resource will lead to standardization of care of pediatric concussion across the medical community.
"The doctors are getting better at recognizing concussions, but we're still behind in how to manage return to work," said Dr. Zemek. "The tools exist but some [doctors, parents, coaches] don't know how to use them or they couldn't find them."
Dr. Zemek collaborated with the Ontario Neurotrauma Foundation and chaired a 30-member panel of medical experts – including many from across Canada and some from the U.S., including Dr. Rebekah Mannix, professor of pediatrics at the Boston Children's Hospital.
He says these are the "first comprehensive pediatric guidelines that we're aware of."
Dr. Zemek strongly believes young brains need more post-concussion rest because it is such a pivotal time in terms of growth.
"Just as children go through stages of early development – learning to walk, to speak, to read, etc. – there is a great deal of growth that occurs in the later childhood and adolescent years – social development, critical thinking skills," he said.
To better spread the word, the panel of experts prepared a pocket Concussion Recognition Tool to share the guidelines with schools, coaches, parents and others.
The document outlines how to recognize a concussion (loss of consciousness, convulsions, balance problems, headaches and so on) and what to do next (remove the player from the field of play, ask the player simple questions to check his or her memory, call for an ambulance if needed). The pediatric guidelines are available online.
Toronto lawyer David McCarthy coached minor hockey in Toronto for a decade, starting in 2002, and noticed a dramatic shift in the way people dealt with concussions.
"There wasn't a set program," Mr. McCarthy said about concussion protocol. "We didn't know how different players reacted and how they should be treated. By the end of my time coaching, it was clearly on the radar screen."
Mr. McCarthy, who played hockey at Princeton and the University of Toronto, has a son who is recovering from a concussion he suffered while playing for the Greater Toronto Hockey League's Leaside Flames.
"I applaud the efforts being done [by concussion researchers]," said Mr. McCarthy. "It's an important issue. We still don't know what the long-term effects will be."
Editor's note: A previous version of this article said incorrectly that David McCarthy's son suffered a concussion while playing for the St. Michael's Buzzers of the Ontario Junior Hockey League in Toronto. In fact, he suffered the concussion while playing for the Greater Toronto Hockey League's Leaside Flames.