New concussion guidelines for doctors, parents, advise less rest, more activity during recovery

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Parents and even doctors can have difficulty keeping up with rapidly changing research on how to treat a child with a concussion. A new guideline written by Canadian and international pediatric concussion experts aims to change it.

The Ontario Neurotrauma Foundation, based in Toronto, has published the Living guidelines for the diagnosis and management of pediatric concussion (found on braininjuryguidelines.org), an online document that its authors claim will be updated regularly with the latest research on brain injury in children. Although intended primarily for doctors, the guide also has sections for parents and youth sports coaches. Replaces the previous guide of the Foundation, published in 2014.

Dr. Nick Reed, associate professor in the department of occupational sciences and occupational therapy at the University of Toronto who, together with Dr. Roger Zemek, senior scientist at the CHEO Research Institute in Ottawa led the panel that created the guide, says his team will work to ensure that the guidelines are never obsolete by adding new research at least once every two months.

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"We want to make sure that if we are directing healthcare professionals and families to use and rely on this guideline, we ensure that the information it contains is the latest and best research available," said Reed.

Children account for over 40% of all concussion patients in Ontario, with children under five with the highest incidence of injury. More than 60,000 doctor visits a year in the province are for pediatric concussions, but Dr. Reed states that these numbers do not reflect the ubiquity of the condition, since many concussion sufferers do not seek medical attention.

It took three years and over 40 experts from all over North America to complete the guide. The panel summarized 383 scientific articles in 22 suggested action courses, which they call tools, for the management of concussion and a series of recommendations for clinicians.

Dr. Reed states that the most significant change made to the 2014 guidelines is what he calls the "no more bedroom" concept. Previously, children with concussion were advised to rest – and not interact with screens, social life, sports or school – until their symptoms had dissipated. For some, this could take months or even years. Dr. Reed states that in prolonged cases it is likely that more rest will hurt the child.

"We have to consider that blocking people away from their lives and all the things that make them smile can cause some secondary damage," he added, adding that these long periods of rest can potentially lead to mental health problems and muscle atrophy.

The new guideline recommends only 24 to 48 hours of rest. Subsequently, children are encouraged to gradually reintroduce the activity into their life (with the guidance of the doctor).

The new guidelines have attracted praise from others in the industry.

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Dr. Kevin Chan, chair of the Canadian Pediatric Society's acute care committee, praised the new guide, calling it a step forward in the management of concussion.

Dr. Adrienne Davis, pediatrician working in emergency medicine at SickKids, said she would advise the site to her patients and colleagues. "One criticism of the guidelines is that as soon as they are published they are obsolete. The fact that they are committed to updating it is fantastic."

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