Prolonged absences from school and other life activities after an acute concussion may be damaging to recovery for children and youths, a recent study has found.
The study, published on Jan. 20 in JAMA Network Open, analyzed data from 1,630 children and youths aged five to 18 years old conducted between August 2013 and June 2015 in nine pediatric emergency departments within the Pediatric Emergency Research Canada network.
The current guidance recommends patients get 24 to 48 hours of rest after a concussion. Then they should be eased into carrying out physical and cognitive activities, followed by a gradual return to school with support and accommodations.
Although there is evidence showing that early return to physical activity is beneficial for concussion recovery, there is a lack of research looking at the associations between return-to-school timing and symptom recovery, the study stated.
The new study has confirmed that an early return to school is important for children’s recovery after a concussion, according to Dr. Roger Zemek, the study’s senior author and a pediatric emergency physician at the Children’s Hospital of Eastern Ontario.
“In the past, we used to think that more rest was better,” Zemek told Global News in an interview.
“This new study has confirmed that getting kids back to the things that they want and love and need to do, including school, not only is important for getting them back to their lives but also may help them with their recovery.”
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Prolonged symptoms in children after a concussion can sometimes be caused by mental health problems due to social isolation, said Zemek. When kids are absent from school, he explained, they may fear that they’re not going to get better, or that they are missing out.
“Our thought is by getting kids back to school sooner, this may prevent that negative feedback loop or that vicious cycle that sometimes occurs for kids who rest too long,” he said, adding that it is important for kids to go back or be part of the learning process again even when they are having symptoms.
Dr. Chris Vaughan, the study’s lead author and a pediatric neuropsychologist at Children’s National Hospital in Washington, D.C., told Global News it’s important to look specifically at how concussion recovery relates to school attendance, as school is a big part of children’s lives.
“The developing (of) brains (for) kids is very important,” said Dr. Vaughan. “And so, any time you have an injury that can affect that, we really need to understand what are those risks.”
He said that going to school helps with development as it provides children with an environment to learn, socialize and be active.
“We need to be careful to learn as much as we can and balance our avoidance of risks with acknowledging the benefits of that activity and exercise for overall health and development.”
According to the study, older youth missed more days of school, on average, than younger youth. However, an early return to school was associated with a lower symptom burden at 14 days post-injury for patients aged 8 to 12 years than for those between 13 to 18 years old.
This implied that the youngest patients actually did pretty well after concussion, and most of them recovered well by two weeks, said Zemek.
“So in the big picture, everyone benefits,” he said. “The ones who are older benefit even more.”
The study also said that “the age difference suggests that what may be clinically considered early return to school for an adolescent may not be early return to school for a younger child.”
Vaughan said parents and caregivers should ultimately listen to the recommendations of the medical providers that are treating the child, because a lot of times the suggestions are going to be based on the child’s symptoms and recovery status.
“While some kids may need to be very limited in what schoolwork they’re doing when they go back, others may be much more capable to do almost typical workloads, but that’s going to vary,” he said.
Zemek said he hopes this study can help develop new guidelines based on the information and ultimately help children get back to school sooner.
“We’re not saying they necessarily need to take exams. We’re not saying that we need to have them do a lot of full days at the initial time point,” he said. “But beginning that social integration earlier will hopefully prevent those children from having symptoms for months and months.”
— with files from Global’s Katherine Ward
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