The question of when it is safe for your child to return to the playing field after suffering a concussion is one that continues to vex team doctors, athletic trainers, and other sports medicine practitioners.
Consider the following scenarios:
Scenario 1: Your football-playing son tells you he blacked out briefly during a game after making a hard tackle. He sits out practice for the next couple of days during which he has headaches and can't remember what happened either before the game or after. Is it okay for him to play in the next game?
Scenario 2: Your son has his "bell rung" but doesn't lose consciousness and yet an hour after the game is still somewhat disoriented, but has no symptoms for a full week before the next game. Is it safe for him to play?
Scenario 3: Your son takes a blow to the head in the last minute of the first half of a football game and is woozy as he comes off the field but symptom-free within 15 minutes. He is allowed to return to the field in the second half and is hit in the head a second time. He blacks out and doesn't regain consciousness for two minutes. He sits out the remainder of the game, but on the drive home is still disoriented, is mildly dizzy, has ringing in his ears, and can't remember what happened. He is appears fine the next day. The biggest game of the season is the following week. His coach wants him to play. Should you let him?
The return-to-play (RTP) decision will vary.
Because the science of concussion is evolving, management and return to play decisions remain a matter of clinical judgment on an individualized basis1 which takes into account a number of so-called "modifying factors" [4]:
The severity of the current injury (especially loss of consciousness longer than 1 minute [3])
How long the symptoms persist (including persistent symptoms with exertion)
Whether there has been prolonged cognitive impairment (e.g. memory, concentration problems)
Whether the athlete has learning disabilities (ADD, ADHD etc.)
Whether the athlete has suffered repeated concussions over time, and if so, the number, severity, proximity in time to current injury. An athlete with a previous concussion during the season is at 3 to 4 time's greater risk for suffering a second concussion. The risk of concussion increases further after each subsequent concussion.
The sport the athlete is playing. An athlete participating in a non-contact, low-risk sport can, in all likelihood, be returned to play sooner than an athlete returning to a high-risk, collision sport, such as football or wrestling.
Whether repeated concussions are occurring with progressively less impact force
The athlete's age (a child's developing brain is believed to react differently to trauma than a mature brain.
Input from an athlete's parents and teachers should be sought.
In general, a more conservative return to play approach should be followed for children and teens.
While concussion management is largely a matter of clinical judgment, several hard and fast rules have emerged:
A player with a diagnosed concussion should not be allowed to return to play on the day of injury, even if an athlete athlete and even if a high level of medical care is available on the sports sideline;
Children should not be allowed to return to practice or play until completely symptom-free.
Updated and revised July 20, 2009
Links:
[1] https://momsteam.com/node/128
[2] https://momsteam.com/node/149
[3] https://momsteam.com/node/150
[4] https://momsteam.com/node/2695
[5] http://bjsm.bmj.com/cgi/content/abstract/39/4/196
[6] https://momsteam.com/users/robert-cantu
[7] https://momsteam.com/health-safety/concussion-evaluation-management-return-to-play-decision-involves-many-factors
[8] https://momsteam.com/health-safety/concussion-safety/recognition-evaluation/determining-concussion-severity-a-new-approac
[9] https://momsteam.com/health and safety/loss-of-consciousness-not-required-for-concussion-finding
[10] https://momsteam.com/health-safety/post-traumatic-amnesia-retrograde-anterograde-factor-concussion-recovery-severity