A head injury can happen to anyone — from a slip on the ice or car crash. Head injuries caused by falls are especially common in children who are learning about the world, to walk, or ride a bike.
Most injuries are minor, resulting in bumps or bruises. A mild brain injury that causes a concussion is more serious and can temporarily affect the way the brain processes information and controls the body. For children who have young developing brains and small necks, this is especially true. Thankfully, severe traumatic brain injuries that render a person unconscious for hours and days are rare.
As a physician who treats children and youth with traumatic brain injuries of all severities, I can’t stress enough how important it is to recognize a concussion and realize that every child’s concussion experience is unique.
Evaluating a child’s recovery from concussion must be personalized. We can best assess recovery if we have good information about them before the concussion.
Baseline Testing: Evidence in adult concussion care has proven the effectiveness of using baseline testing in ensuring that high-performance athletes return to competition safely. Up until now, there has been little research into its effectiveness in pediatrics practice.
The most current guidelines from the Fourth International Consensus Conference on Concussion from Zurich in 2012 suggest baseline testing be done for elite athletes. When we need to accurately assess full recovery, we must know how they were functioning mentally and physically before they had the injury.
To offer the best care possible, many health care and sports programs now offer baseline testing to their athletes at the beginning of each season. This ensures there is data on hand that can be used by their doctor to assess their recovery if they experience a concussion.
The variety and quality of these tests are now being evaluated. Tests of balance, co-ordination, reaction time and basic grip strength are done along with tests looking at aspects of a person’s memory, attention, problem solving and visual processing.
These tests must be done in a supervised and controlled manner and be reliable.
People who give these baseline tests must ensure the results are an accurate reflection of the athlete’s skills and not fudged, so that if they have an injury during the season it would be easy for them to pass the repeat test to get back to play sooner than advisable.
In the case of children especially, testers must have age-appropriate guidelines to use.
Do all children need to have baseline testing? Absolutely not.
For those who are at high risk of sustaining a concussion in competition, baseline testing makes a compelling argument, and the investment of time and money can be helpful in guiding clinical “return to learn and play” decisions.
Seek immediate medical attention if your child has experienced a significant injury.
If a concussion is diagnosed, then manage the symptoms as directed by your health-care professional.
Return to school, work and play gradually after approval is given. Share information about the injury with your teacher, school administrator and coaches. School boards in Ontario have each developed a concussion recovery protocol to help students properly return to learn and to play.
Once the initial phase of recovery has been completed, gradually increase activity levels to improve strength, endurance and confidence.
Recovery times can vary from days to weeks, and sometimes months. Allowing your child to do too much too soon can prolong this time.
To guide parents and kids in managing a concussion, Holland Bloorview Kids Rehabilitation Hospital recently developed a concussion handbook offering practical advice.