When young children report symptoms of sport-related concussions, their responses tend to correlate strongly with those given by their parents on a standard questionnaire, a study in JNS Pediatrics has shown.
The recent study contributes to a glaring lack of research into sport-related concussions and is a positive finding in light of the limited language abilities of young children, according to Christopher Bonfield, M.D., a co-author and an associate professor of neurological surgery at Vanderbilt.
Most research into sport-related concussions has been focused on high school and college athletes rather than those of middle school, elementary and younger ages.
“Looking at the literature, there is almost nothing out there,” Bonfield said.
Gaps in concussion research involving young children prompted the study by Bonfield, Vanderbilt Sports Concussion Center co-directors Scott Zuckerman, M.D., and Douglas Terry, Ph.D., and Haley Vance, D.N.P, an associate in the department of neurological surgery also with the Center.
“Historically, evaluations for concussion have been more reliable in these older patients; it’s easier to discuss these injuries with a teenager than a 6-year-old,” Bonfield said. “Much of concussion diagnosis and return-to-activity is based on symptom reporting, and there were concerns over how well the young kids could do this – or if the parents’ reports were truly accurate.”
Learning about Concussion in Young Athletes
Questions remain over how young children with concussions present in terms of symptoms and how they long they need to wait to return to school – and play, Bonfield said.
“Are they different than the older athletes?” is a central theme.
“Studies like ours highlight things to look out for, because of the younger ages involved and overall differences between stages of development.”
“Studies like ours show that we can treat them with similar protocols to the way we treat older kids. They also highlight things to look out for, because of the younger ages involved and overall differences between stages of development.”
Amassing Foundational Data
In a cohort of 47 children seen at Vanderbilt with a sport-related concussion, the researchers described the demographics, facts about their initial presentation, and their recovery.
The young athletes ranged in age from 8 to 12 years. The majority were male (72.3 percent), white (80.9 percent), and non-Hispanic/Latino (100 percent). The main sports played by the boys were football (44.1 percent) and soccer (30.8 percent). The main sports played by girls were soccer (30.8 percent) and cheerleading (30.8 percent).
Among the 47 children with a sport-related concussion, 40.4 percent visited an emergency department. For 77 percent of the children, it was their first such injury. Return to school took a mean of approximately 9 to 11 days and a total of between 27 and 38 days elapsed prior to symptom resolution. Return to sports was measured at 35 to 42 days.
Greater Awareness Needed
The CDC reported that in 2020, 54.1 percent of children aged 6–17 years participated in sports during the previous year.
“Parents, schools and trainers need to recognize that kids can have sports concussions at a young age, and also that there is a stepwise protocol for these kids as well as for older children and teens,” Bonfield said.
“Parents, schools and trainers need to recognize that kids can have sports concussions at a young age, and also that there is a stepwise protocol for these kids.”
Treatment protocols for sport-related concussion have been evolving and will continue to evolve, Bonfield explained.
“It used to be putting a person with a concussion in a dark room for a week to rest. But total rest was not good. There is much less rest now,” Bonfield said.
Both researchers emphasized that concussion recovery is now more focused on active recovery.
“It’s important for the patient to rest for 48 to 72 hours after the injury. Then children should progress in their activity levels in a stepwise fashion,” Vance said. “Monitoring for symptom development serves as a guide for how quickly or slowly we can get children back to their normal activities and sports.
“This is also a call to doctors and advanced practice providers to come together for recommendations for this age group.”
