Updated guidelines for concussion in children

Children recover from concussion more slowly than adults, but prolonged rest is now no longer advised

---

Children recover from concussion more slowly than adults, but prolonged rest is now no longer advised as part of the recovery treatment, updated guidelines say.

The guidelines, recently published in the British Journal of Sports Medicine, were accepted by international experts at a concussion conference in Berlin last year.

They are the result of a review by Australian, US and Canadian researchers into the evidence regarding the management of sports-related concussion in children.

Children were expected to take around a month to recover from concussion, which was two weeks longer than adults, according to the guidelines.

“There is a fair proportion of children who will have ongoing problems beyond three months,” Professor Franz Babl, a review author and a paediatric emergency physician at the Murdoch Childrens Research Institute in Melbourne, said.

In the past, complete rest was recommended for children with concussion, but that thinking had recently changed.

“There was a time when some people thought there should be complete rest, meaning don’t touch anything: don’t touch your social media tablet, your computer, your phone,” he said.

But there was very scant evidence that complete rest was necessary or helpful. As well, disrupting schooling, sport and social routines could have negative consequences for children.

The guidelines shifted the emphasis towards rapid introduction of low-level physical and mental activities. Only a few days of rest was recommended following a concussion.

In the early stage of recovery, children should gradually resume daily activities, followed by aerobic exercise such as walking and cycling, and then running, Professor Babl said.

Each of these steps should take around one or two days and progression should depend on the absence of symptoms. However, children with concussion should not return to contact sports until they had successfully returned to school. “So, overall, from the first return to activity until game-play, it would be a minimum of about seven days,” Professor Babl said.

But not everyone concurs with the updated advice.

Dr Adam Castricum, a sport and exercise physician at the Olympic Park Sports Medicine Centre in Melbourne, said two weeks rest still might better than one, in some instances of concussion.

“If you progress them too quickly, they may go backwards,” he said.

Dr Castricum was hoping the Berlin conference would have produced more rigid guidelines around the care of children with concussion.

“But there is still a lot of research to be done,” he said. “It is very difficult with children, because a child that is five is different to a child that is 12.”

Another new recommendation from the review was that baseline computerised neurophysiological testing was not appropriate in children with concussion.

Children developed too quickly for baseline testing to be clinically useful, unless conducted frequently, the review said.

British Journal of Sports Medicine 2017, online