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Concussion Guidelines Evolve as More is Learned

Oct 30, 2017 09:06AM ● Published by Digital Media Director

Much more than a bump to the head, a concussion is a traumatic brain injury that causes one or more serious symptoms. As more is learned about the human brain and the effect concussions have on it, especially a child’s developing brain, medical guidelines are adjusted to reflect the latest knowledge and research.

“Years ago, the initial treatment concept called for total rest,” says Kody Moffatt, MD, medical director of the Sports Medicine clinic at Children’s Hospital & Medical Center in Omaha and an associate professor of Pediatrics at Creighton University School of Medicine. “In some cases, that was taken to the extreme, to the point of keeping the child in a darkened room with no cell phone, television or books; almost like solitary confinement.”

Dr. Moffat says that was an especially difficult prescription for adolescents whose lives revolve around social media. “Rather than relax the child, we created a bunch of anxious and depressed teenagers,” he says.

The most recent guidelines call for early recognition of symptoms and rest, especially during the first two days following the injury.

“Taking two days out of school seems to be the optimal length of time to allow for initial brain rest,” says Dr. Moffatt. “After those two days, it is now deemed important to get kids back into school, even for partial school days.”

Moffat says recommendations regarding the resumption of physical activity after a concussion also have evolved. “The new practice patterns call for a couple of days of rest, then the resumption of light cardiovascular activities, as long as those activities don’t significantly worsen any lingering symptoms. It’s almost as if the exercise becomes the child’s medicine,” Dr. Moffat says.

However, a child who has suffered a concussion, whether the injury is sports-related or not, should recover enough to resume full curricular activities before resuming extracurricular activities. “Despite any pressure to do otherwise, a child who can’t go back to school shouldn’t be playing football,” Dr. Moffat says.


At Children’s Sports Medicine Clinic, Dr. Moffatt and his fellow medical professionals implement a two-phase concussion recovery protocol:

Return to Learn is a process of returning to school according to a plan developed specifically for that child. The child moves through the plan at his or her own pace.

The second phase is Return to Play. By law, after suffering a concussion, students will not be allowed to participate in any organized team activities (practice or games) until they have been evaluated by a licensed healthcare professional and have received written, signed clearance and written permission from parents or guardians, and submit that material to the school or team.

The newer concussion guidelines are a more realistic reflection of how children and adolescents respond and recover, Dr. Moffatt says.

“A lot of the kids I see are athletes,” he says. “They’re active all the time, conditioning for their sports for months on end. To order them to completely shut down until every symptom is gone affects them not only physically, but emotionally as well.”

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