By Kathryn Doyle
NEW YORK (Reuters Health) - After a concussion, it can be difficult for children to learn new things or remember old things. Parents, pediatricians and school staff need to be able to make adjustments to suit the child for a few weeks or sometimes longer, a new statement from the American Academy of Pediatrics (AAP) says.
Concussions are a relatively new concern. Most regulations and guidelines have focused on athletes returning to play, since that has been the most high-profile issue, Dr. Cynthia Devore said. Fewer have addressed kids returning to learning.
Devore is one of the lead authors of the new clinical report, which offers guidance for pediatricians on getting kids back to school after a concussion but is not an absolute mandate. It is published in Pediatrics.
"Pediatricians can help families and kids understand their symptoms following concussion and guide them in limiting activities," said Devore, a pediatrician from Rochester, New York.
School nurses, psychologists and counselors can also help children make a gradual return to academics, she told Reuters Health.
Physical, mental and emotional rest are key for concussion recovery, Devore said.
After a concussion, kids should avoid bright lights, computer screens and noisy environments, according to the report.
If they are having trouble concentrating for 30 minutes straight, they should stay home from school and limit computer and videogame time and text messaging. Parents should coordinate with schools to make sure learning adjustments are made when the child returns.
Concussions can make learning tough, and trying to learn with a concussed brain can make recovery time longer, the statement says.
The AAP councils involved in the report recommend a team-based strategy for adults who manage the child.
Pediatricians should be in charge of managing the child's recovery and return to school as part of a medical team. That team should work with the family team and two school teams, one that is in charge of academics and one for physical activity, the report says.
For that to work, team members like teachers, sports coaches and school nurses will need to be aware that the child may have special learning needs post-injury.
"Many schools already have teams in place that can address the concussed student's needs," Devore said.
But one specialist not involved in the report said pediatricians aren't necessarily trained and ready to manage a student's return to school after a concussion.
"The article seems to communicate to pediatricians that they should be able to create and orchestrate academic accommodations for students," Rosemarie Scolaro Moser told Reuters Health.
"I believe this is too much to ask pediatricians in all that they do and this is not their area of expertise, so it is important that they refer to and consult with the cognitive specialists, like the neuropsychologist, whose role unfortunately seems to be underplayed in this article."
Moser is a neuropsychologist herself and director of the Sports Concussion Center of New Jersey in Lawrenceville.
The statement recommends having neuropsychologists on the medical team. But they should have a more central role, especially if children continue to struggle with learning more than three weeks after hitting their heads, Moser said.
Joanna Boyd, public education coordinator at the Brain Injury Alliance of New Jersey in North Brunswick, agreed.
"Neuropsychologists specialize in understanding which parts of the brain are functioning best, weeding through cognitive symptoms to provide a much better guide for school accommodations," Boyd told Reuters Health. She also wasn't involved in writing the new report.
There hasn't been much research on a large scale of what happens to the brain after a sports injury, and every injury and every child is unique, she said. That makes it tough to offer blanket rules for when kids should return to school and which kind of learning works best.
That's why specialists often play an important role in concussion recovery, Boyd said.
SOURCE: http://bit.ly/16Glx1X Pediatrics, online October 28, 2013.