now shows it is best to reduce, but not eliminate, a return to some physical
and cognitive activity after concussion.
An estimated 1.1 million to 1.9 million U.S. children and
teens are treated for a recreational or sport-related concussion every year,
and yet the true number of youth concussions likely remains underreported,
according to a report released by the American Academy of Pediatrics (AAP).
In its first update in
eight years, the AAP cites the latest research into the incidence and treatment
of these injuries in the clinical report,
“Sport-Related Concussion in Children and Adolescents,” published in the December issue of Pediatrics (published
online Nov. 12).
Research shows that sport-related concussion remains common
in nearly all sports at all levels, with boys’ tackle football and girls’
soccer reporting the most incidents, followed by other high-contact sports.
“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,” said Mark E. Halstead, MD, FAAP, lead author of the clinical
report. “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.”
Over the past few years, guidance on treatment and recovery
of injured players has evolved. The AAP report reflects the latest research on
recommendations, which now call for reducing – but not eliminating – a return
to some physical and cognitive activity in the days following a concussion.
Effective management of the injury can shorten recovery time
and potentially reduce the risk of long-term symptoms and complications that
interfere with school, social life, family relationships and emotional
“Athletes absolutely need to take an immediate break from
play after a concussion, but we find that, during the recovery process, it is
best to encourage a reasonable amount of activity, such as brisk walking,” said
Dr. Halstead, an associate professor of pediatrics and of orthopedics at
Washington University School of Medicine in St. Louis.
“Students shouldn’t need to take a prolonged amount of time
away from school, though they should work with teachers on lessening the
academic workload. These are individual decisions that families should discuss
and evaluate with their child’s physician.”
There is also no research that shows that a youth’s use of
electronics, such as computers, television, video games or texting, is harmful
after concussion. In fact, complete elimination of electronics may lead to a
child’s feeling of social isolation, anxiety or depression, the report states.
Even as a national focus on health risks of concussions and
mild traumatic brain injury has increased awareness and led to state
legislation, much remains unknown, according to the AAP. For instance, recent
research has shown that middle school tackle football has the highest
concussion rate – at 2.6 to 2.9 out of 1,000 athletic exposures. Yet, most
research has focused on treatment of high school athletes, according to the
report, which states that football, lacrosse, ice hockey and wrestling carry
the highest concussion risks for boys.
In girls’ sports, soccer, followed by lacrosse, field hockey
and basketball, carry the highest risks, according to the report. Concussions
also are more likely to occur in competition than during practice for male and
female athletes, except for cheerleading.
The AAP report also concludes:
Further research is
needed on sport-related concussions, especially in middle school and
Each concussion is
unique and has a spectrum of severity and types of symptoms, which may
overlap with other medical conditions.
Most pediatric athletes
will recover from symptoms within four weeks of their injury.
The long-term effects of
a single concussion or multiple concussions has not been determined.
More specific recommendations on methods of diagnosis and
treatment are included in the report.
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds