October 28, 2013
News Review From Harvard Medical School -- Going Back to School after a Concussion
Children with concussions should rest their brains and return to schoolwork only gradually, a doctors' group says. The new guidelines come from the American Academy of Pediatrics. The doctors admit there's limited evidence about the best way to recover from concussions. So each child will be different. But they say it's important for kids to have "cognitive rest" as they recover. This means restrictions on not just schoolwork but also video games, texting, TV and reading. Such brain activity may increase symptoms such as headaches or vision problems. If symptoms last more than a few weeks, the child may need to see a specialist. Kids can try returning to school when they can handle 30 to 45 minutes of school work or other stimulation without symptoms. The return may be part-time at first. Parents, the child's doctor and the school should work together on a plan for gradual return to a normal school day. Academic work should be back to normal before sports or other activities resume. The journal Pediatrics published the guidelines. MedPage Today and the New York Times wrote about them October 28.
By Claire McCarthy, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Thanks to new research, we now have some idea of how to decide when an athlete can go back to play after a concussion.
But deciding when people with concussions can go back to school, and what should happen when they do go back, is a different story. That's why the American Academy of Pediatrics came out with a clinical report to help doctors, families and schools figure out what to do.
We don't know anywhere near enough about how the brain reacts and heals after a concussion. However, it's clear that "cognitive activities" can worsen symptoms and possibly lengthen recovery times. Cognitive activities include:
- Taking tests
- Watching TV
Thinking and concentrating also can worsen symptoms. Being exposed to the stimulation of noise and activity can also have an effect.
Symptoms of a concussion include:
- Visual problems
- Sensitivity to noise
- Trouble concentrating or remembering
- Sleep disturbances
Of course, all of these symptoms can make it hard for someone to go to school or do schoolwork.
The advice in the clinical report is all a bit vague. That’s partly because we need to do more research in this area. But it’s also important to know that each child is different, and each concussion is, too. The report gives general guidelines that doctors, families and schools can use as they find the best way to help each student.
What Changes Can I Make Now?
If you have a concussion, or think you may have one, you should get medical attention. It’s important to get examined, and have a thorough neurological exam, to rule out more serious injuries. The exam also helps to make the best plan for moving forward.
Any time there's more than just a mild headache after an injury, go to your doctor's office or an emergency room right away. Also get immediate care if there's any dizziness, changes in vision, trouble concentrating or remembering, or any of the other symptoms of a concussion.
The report says that children should stay out of school until they feel much better and can manage 30 to 45 minutes of cognitive activity or stimulation without symptoms. Usually that's within a week or so of the injury, but it may take more time.
Ultimately, parents need to decide when their child is ready. But the doctor can help make that decision -- and let the school know about the need for absence or shortened days.
Once your child is back at school, the amount of work and stimulation should be slowly increased as the child tolerates it. Communication is important here, too. The family, the doctor and the school need to work as a team. Most concussions get better within 3 to 4 weeks. That means they shouldn't require any long-term changes in a child's school program.
If symptoms last longer than the usual time, it's a good idea to see a concussion specialist. Your child may need more formal changes at school, such as a "504" plan. These programs allow for things like longer times to take tests or turn in assignments. Your child also may be able to take tests in a quieter place.
Students should be back to their academic baseline before they take on anything extra, such as:
- Full physical activity (some mild activity is okay)
- Other after-school activities
It's very important that everyone involved with the student be educated about concussions, their symptoms and the need for a gradual return to activities. Many people who have had concussions look and act normal. It's natural for people who don't know better to think that they should be doing more -- but doing more can be a bad idea.
What Can I Expect Looking to the Future?
We need more research to understand concussions and how we can prevent them and help people recover from them. This is especially important for our youth, who have their lives ahead of them. We don't want concussions to change those lives forever.