November 12, 2018
2 min read

AAP updates guidance on sport-related concussions in youth

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Photo of Mark Halstead
Mark E. Halstead

Up to 1.9 million children are estimated to have concussions in the United States each year, and these injuries may be underreported among young athletes, according to a clinical report published in Pediatrics.

“While more families, physicians and coaches are aware of the health risks of a blow to the head — and more concussions are being reported — we remain concerned about players who try to tough it out without seeking help,” Mark E. Halstead, MD, FAAP, an associate professor of orthopedic surgery and pediatrics, and the director of the Sports Concussion Program at Washington University School of Medicine in St. Louis, Missouri, said in a press release. “We know from surveys that many high school athletes will continue to play after a head injury out of fear they won’t be allowed back on the field.”

Halstead and members of the AAP Council on Sports Medicine and Fitness wrote an update of a 2010 clinical report for health care providers on guidance for the diagnosis and management of pediatric and adolescent sport-related concussions (SRCs).

The update comes shortly after the CDC issued guidelines to assist physicians in diagnosing, treating and estimating the prognosis of mild traumatic brain injury (mTBI) in children.

The authors of the AAP report noted there is currently no universally accepted definition of SRCs.

“Debate still exists as to whether the term concussion or mTBI should be used to describe the injury,” they wrote. “Often, concussion is considered to be a subset of mTBI.”

They wrote that a recent study estimated that between 1.1 million and 1.9 million recreational concussions and SRCs occur annually in U.S. children aged 18 years or younger. They added that in most cases, SRC is not a visible injury, so underreporting of concussions in athletes remains a concern.

The AAP recommends that no athletes should be allowed to return to play on the same day as the injury, and athletes should not be allowed to return to contact, collision or high-risk activities until symptoms of the concussion have resolved

The authors of the report noted that the athlete and his or her family should be educated about concussions and expectations for recovery.

They concluded that each concussion is unique, so individualized management is appropriate. The authors also noted that initial reductions in physical and cognitive activity might benefit recovery, but prolonged restrictions from physical activity or removal from school can have negative effects. A stepwise program can help with a full return to sports while evaluating for any return of symptoms, they wrote.

“Over the last several years, research has suggested that a more active approach to treating concussions may benefit young athletes more than a watch-and-wait approach,” Halstead, a former executive committee member of the AAP Council on Sports Medicine and Fitness, told Infectious Diseases in Children. “This may include reintroducing some light physical activity earlier in the recovery such as some brisk walking on a daily basis, getting back into school sooner with adjustments to their workload and potentially, physical therapy for certain issues that can accompany a concussion, such as a neck muscle strain.” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.