Children are resilient. They can often laugh off traumatic injuries that would send most otherwise healthy adults to the ER. For most of elementary school, there was more of my skin in tatters on the playground than on my knees or elbows, the result of daily high-speed bike crashes and padless tackle football games on the blacktop. (You might be wondering where my parents were during all this. Thank you, I appreciate your concern. They were usually at the doctor’s office with one of my brothers tending to an equally gory abrasion). These days, if I stub my toe in the middle of the night on the coffee table, it’ll take a handful of Advil and a firm deadline to get me in to work the next day.
Yet depite their ungodly pain tolerance, children need time to recover after injuries just like anyone else. Unfortunately, it can be difficult to tell when a child is ready to return to activity after a traumatic event. Children are bursting with energy, oftentimes even when they are sick or injured, and they tend to have a hard time explaining what they are feeling. But sending a child back to school or the field before they are completely healed can be lead to future developmental issues.
These problems are particulary threatening for children who have sustained a brain injury. In the past, parents were advised to give children a few weeks rest before letting them resume normal activity. However, new research suggests that a safe “return to play” might be much later in the future than previously believed.
Linda Ewing-Cobbs, a professor of pediatrics at the University of Texas Health Science Center Medical School in Houston, says that nearly one third of children still show signs of a concussion one year after their initial injury. Her team examined 350 children between the ages of 4 and 15 who had sustained either a concussion or a non-cerebral orthopedic injury. Using a standard post-concussion evaluation scale, the researchers found that as many as 31 percent of the children were still experiencing symptoms like inattention and fatigue a full 12 months after their inital injury.
The researchers also found noticeable differences between the recovery process in boys and girls. The female subjects with pre-concussion mood problems were the most vulnerable to persistent symptoms. Girls in general also took nearly twice as long to return to full cognitive health.
Regardless of gender, kids from poor or troubled backgrounds were more vulnerable to post-concussion symptoms than those from economically and socially stable families.
The study noted that family dynamics are critical to the recovery process. “Children from families that are supportive, communicative, and have access to a community network of supports tend to do better in a variety of areas, including recovering from a concussion, than children who do not have these assets,” Ewing-Cobbs said in an interview with WebMD.
Regardless of their family situation, there are ways to help all children recover after a traumatic brain injury. In August, the Centers for Disease Control and Prevention released a groundbreaking Pediatric mTBI Guideline which advises clinicians and families on proper care for concussed children.
Interestingly, the guideline overturned the long-standing practice of prescribing children “time alone in dark room” until their symptoms subsided. Instead, the CDC now recommends that kids return to school as soon as possible, and that moderate activities such as walking and reading should be introduced as the child is able to handle them. In an interview with the New York Times, Dr. Christopher C. Giza, professor of pediatric neurology and neurosurgery at the University of California, Los Angeles, said that “cocoon therapy” and isolation can put kids at risk for developing anxiety problems or depression from lack of social interaction. Instead, he supports an “active recovery process,” where parents and doctors listen to the child and work collaboratively to reintroduce schoolwork and extracurriculars.
In the past few years, much of the conventional wisdom on concussion diagnosis and treatment has been overturned. It has become evident that people of different ages, genders, and backgrounds have vastly different recovery timelines and often need specialized medical care.
However, this new knowledge makes it even more difficult to tailor a treatment protocol. How long should a child stay in bed? How soon should they resume normal activity? When will they be back to their normal, happy, rambunctuous self? Is this brain fog they’re experiencing a lingering symptom or just a bad case of the Mondays?
We had all of these questions in mind while we were developing the Brain Gauge. Through consistent testing, parents can work with clinicians to easily identify which recovery treatments are beneficial to their children. They’ll also see quantitative, objective evidence that their child’s symptoms are subsiding and their brain health is improving, even if they test on a dreary Monday morning. Finally, there is significant evidence that moderately difficult cognitive tasks - like memory quizzes, video games, word puzzles, or Brain Gauge tests - can help speed the recovery process. In any case, that sounds much better than lying alone in a dark room.