New guidelines for treating mild brain injury in children

Mild concussions in children occur frequently, and sometimes parents unknowingly mismanage their care. Often fear and parental anxiety influence concussion assessments rather than hard data, leading to unnecessary investigations. On the other hand, parental wishes can also lead to a child returning to the classroom or the sports team too quickly.

This year, the Centers for Disease Control and Prevention drafted wide-ranging recommendations (a staggering 46!) on how to best care for children who experience mild traumatic head injury.

First, what is a mild traumatic head injury? This is a head injury followed by symptoms like confusion, disorientation, loss of consciousness for less than 30 minutes, loss of memory for less than 24 hours and transient neurologic symptoms, including seizures.

As a parent, any of these symptoms, let alone a combination of them, would worry me greatly. Many of us would probably feel that "more" is better under these circumstances. But "more" can also be harmful, exposing children unnecessarily to radiation and blood work. However, I would insist on a comprehensive assessment to make sure that nothing serious underlies the symptoms.

Of the new CDC recommendations, 11 pertain to diagnosis, 12 relate to prognosis and 23 focus on treatment. The recommendations not only include specific guidelines on when to perform a CT scan, but which validated age-appropriate cognitive testing should be performed during the initial visit and later as the child is recovering. They also suggest there is no need for an MRI, skull radiographs or a PET scan.

The recommendations outline how much physical and cognitive rest is recommended, the importance of managing reintegration into school and how to manage posttraumatic headaches. Above all, the recommendations outline the importance of effective communication, Parents can find many helpful resources in the "head's up" section of the CDC website.

Dealing with a knowledgeable and compassionate provider is key to making the right choices. We are very fortunate in Reno to have expanded our pediatric emergency department at Renown Children's Hospital with two additional board-certified pediatric emergency physicians. If you are unable to visit a pediatric emergency department, ask your provider if they know the CDC's guidelines. If not, seek somebody who does. Our children deserve the best care.

(Editor's note: Max J. Coppes, M.D., PhD, MBA, is professor and Nell J. Redfield chair of pediatrics at the University of Nevada, Reno School of Medicine. He is also physician-in-chief at Renown Children's Hospital.)