New Guidance for Concussions in Student-Athletes

Orlando—In the diagnosis and management of concussion school-age children, “‘Student’ comes first in ‘student athlete,’ said Mark E. Halstead, MD, FAAP, a lead author of a new American Academy of Pediatrics report released at the AAP’s National Conference and Exhibition.

Halstead delivered a presentation, “Are You Ready to Return to Play—Concussion,” at the conference’s plenary session on Sunday, Oct. 27. In his address, Halstead reviewed the epidemiology, diagnosis, and treatment of concussions in children and adolescents and noted that while much attention has been focused on when student-athletes can return to the playing field, less attention has been given to when a concussed student can return to the classroom — and under which conditions.

“Students appear physically normal after a concussion, so it may be difficult for teachers and administrators to understand the extent of the child’s injuries and recognize the potential need for academic adjustments,” said Halstead, a pediatrician and assistant professor of orthopedic surgery at Washington University School of Medicine in St. Louis.

The new clinical report, “Returning to Learning Following a Concussion,” offers guidance to pediatricians caring for children and adolescents who have sustained or have possibly sustained a concussion. (Halstead ME, McAvoy K, Devore CD, Carl R, Lee M, Logan K; Council on Sports Medicine and Fitness and Council on School Health.Clinical report: returning to learning following a concussion. Pediatrics. 2013;132:948-957.)

Among the practical advice Halstead offered pediatricians is using a symptom checklist to evaluate the student’s symptoms and their severity. Sorting through and choosing from among the 30 or more available concussion grading scales, many of which are not evidence-based, might not be the most practical approach, he said, and a symptom checklist can better lead to an individualized approach to the unique needs of each injured student.

“The goal is to minimize disruptions to the student’s life and return the student to school as soon as possible, and as symptoms improve, to increase the student’s social, mental, and physical activities,” Halstead said.

The AAP report notes that common post-concussion symptoms among students that may interfere with academic performance include cognitive difficulties and memory problems; moreover, the bright lights and screens and noisy corridors and cafeterias in the school environment may exacerbate symptoms of a concussion.

The report is designed to provide “a framework for the medical home, the educational home, and the family home to guide the student to a successful and safe return to learning.”

–Michael Gerchufsky, CMPP, ELS