For all, the return to activity should be personalized, and family and school and coaches should understand the expectations and the plan. The final recommendation, “counsel patients to return gradually to nonsports activities after no more than two to three days of rest,” Dr. Giza said, should help avoid prolonged rest and isolation, which is not helpful to recovery.
“When I was a kid, people tended to blow off concussions,” Dr. Giza said. Then the pendulum swung the other way, and we began worrying that “any cognitive activity might put your brain at risk,” so injured kids ended up in “cocoon therapy,” in a dark room with no stimulation. But the evidence shows that extending that can be detrimental, he said, with kids developing anxiety symptoms about their schoolwork, or depression from being completely deprived of contact with friends — which may be wrongly attributed to the head trauma.
Parents should ask health care providers for written instructions, Dr. Breiding said, about returning to school and to different levels of activity, and pass those instructions along to the school and to coaches. The C.D.C. has developed materials for parents and a school letter.
And schools need to be sure that information about symptoms the child is experiencing there travel back — usually via the parents — to the child’s doctor. For example, it may become clear in school that a child is having difficulty with memory and concentration, or there may be behavioral changes that are less evident at home.
What can parents do, looking forward, to help prevent head injuries? Start with gates at the top of the stairs for toddlers, move on to bike helmets, car seats and seatbelts, all used appropriately and fitted appropriately to a child’s size, and to protective equipment, including helmets, for other activities and sports.
When a child does play a sport, Dr. Giza said, parents should know the concussion policies in their league or school, should inform themselves about training for the students and the athletic staff, and scope out the coaches and their reputations. Protective equipment, again, should be properly maintained, not worn out, and properly fitted. Many head injuries come from not following the rules: “It’s often the unexpected blow that causes the concussion, the blindside blow,” he said.
Parents should encourage their children to report a suspected concussion, Dr. Breiding said, to be honest about having had injuries, and to speak up if they experience symptoms such as headaches, dizziness, nausea and trouble remembering or concentrating.