An expert warns against pushing kids to return, after research links faster recovery to a shorter break from school.
An Australian expert has urged doctors and parents not to rush children back to school after a concussion, and instead let symptoms drive the recovery timeline.
The warning comes after new research links an early return to school with faster recovery.
The analysis of 1600 children visiting Canadian EDs for acute concussion found that sending children back to school within two days after a concussion was associated with a quicker recovery and lower symptom burden two weeks later.
Children aged eight to 12 had 35% lower symptom levels when they returned to school within the first two days, while 13- to 18-year-olds had 20% lower symptom levels.
“Surprisingly, earlier return to school was associated with lower symptom levels at day 14 among those with higher initial symptom,” the authors wrote in JAMA Network Open.
“The results of this study support the possibility that an earlier return to school is associated with a lower symptom burden at 14 days postinjury and may directly or indirectly promote faster recovery.”
But Melbourne paediatric neuropsychologist Professor Vicki Anderson said symptoms, rather than time, were the best measure of whether a child should go back to school.
“Over the years it’s become more and more clear that you can’t have blanket guidelines to determine when someone goes back to school or play,” said Professor Anderson, from Murdoch Children’s Research Institute.
“If they’ve got really rotten headaches or their balance is terrible, or if they’re light sensitive or noise sensitive, it’s a disaster to send them back too early,” she said. “But if they’re symptom free, then yes, they should go back to school.”
Professor Anderson said returning to school within three days of a concussion was quite early, but a lot of children may go back that soon for many reasons, such as parents needing to work or adolescents being concerned about missing school.
The study also found that on average, younger children returned to school after concussion earlier than older children.
Professor Anderson said this could be because older children had more demands placed on them.
“Adolescents having to study at school will struggle more with symptoms than will a pre-schooler or a primary school kid. The more demanding it is for them, the more they notice the effects of their symptoms.”
Professor Anderson’s own research of children admitted to emergency departments with concussion found that about 70% had completely recovered within 10 days, while around 30% had problems for about four weeks.
Professor Anderson said concussion guidelines to be released this year by the Concussion in Sport Group and the American Congress of Rehabilitation Medicine will emphasise that recovery should be managed on an individual level, based on the child’s or adult’s symptoms.
“The symptoms are really the best measure of whether a child should go back to school, and they will be different on different days for different kids,” she said.
Authors of the JAMA Network Open article said returning to school early could have therapeutic benefits through increased socialisation, reduced stress from not missing too much school, as well as returning to a normal sleep routine and level of physical activity sooner.
“Prolonged activity restriction after concussion is postulated to increase the risk for anxiety and depression and to have deleterious effects on overall physical health and symptom burden,” they said.
“School absence may also increase screen time, which a recent randomised control trial of teenagers with concussion identified as possibly being deleterious to recovery in the initial 48 hours.”
Lead author Dr Christopher Vaughan said absence from school could be detrimental to children in many ways and for many reasons.
“The results of this study found that, in general, an earlier return to school after a concussion was associated with better outcomes,” the neuropsychologist at Children’s National Hospital in Washington DC said in a statement.
“This helps us feel reassured that returning to some normal activities after a concussion – like going to school – is ultimately beneficial.
“Clinicians can now confidently inform families that missing at least some school after a concussion is common, often between two and five days, with older kids typically missing more school,” Dr Vaughan said.
“But the earlier a child can return to school with good symptom management strategies and with appropriate academic supports, the better that we think that their recovery will be.”
