The Centers for Disease Control and Prevention recently released guidelines on the diagnosis and management of Mild Traumatic Brain Injury (mTBI), otherwise known as a concussion, among children. Pediatric concussions have long been a concern, with more than 800,000 children visiting emergency rooms annually for TBI-related symptoms. Yet, until this report, there was no "evidence-based guideline" in place for the treatment for such injuries, as noted by Deb Houry, director of CDC's National Center for Injury Prevention and Control.

The nature of concussions has made establishing evidence for guidelines very challenging. The often vague, nonspecific symptoms result in many concussions going undiagnosed or concussion diagnoses when there is another cause of the child's symptoms. Additionally, there is very limited quantifiable data to support how to treat concussions. Since the diagnosis is difficult to make and recovery is hard to measure, concussion research remains in its infancy.

However, this report marks an important first step in universalizing the treatment and management of mTBI for pediatric patients, which can be applied across several different practice areas that may care for such patients, such as emergency medicine and neurology. While sports medicine doctors have increasingly become the go-to for the treatment of concussions, there is a need to implement appropriate protocol that can be followed by all health-care professionals to ensure the safety of patients.

The report, which outlines 19 sets of recommendations for physicians on the diagnosis, prognosis and management of pediatric mTBI, represents current best practices that should be followed across the medical community. The key takeaways for health-care providers that the general public would be also interested in are:

  • Routine CT scans are not recommended to diagnose mTBI. While relatively common, a CT scan is not a benign procedure and has long-term risk associated with it. In addition, CT scans cannot show whether a patient has a concussion or not, because concussion affects how the brain functions and does not change the structure of the brain.
  • Assessment of preexisting conditions is important. A child's underlying neurologic or psychologic conditions and social situation could lead to a protracted recovery. It's important for providers to be aware of and address these stressors.
  • Recovery should start with aggressive brief rest, followed by gradual increased amounts of stimulation as tolerated. After the first few days of restrictions, providers should recommend that the child gradually engage in activities that stimulate the brain. It's important to toe the line between stimulation and over stimulation that can exacerbate symptoms. While this has been shown to help with healing, the timing of recovery varies from child to child and depends on the injury.
  • Exercise therapy can be beneficial for rehabilitation. Previously, when a child had a concussion, all physical activity was off-limits. However, protracted aerobic therapy, vestibular physical therapy, and noncontact skill work can be beneficial as long as the activity doesn't present additional risk for repeat head injury or worsen symptoms. This allows the child to recover slowly based on their symptoms, but close monitoring is still recommended.
  • Adequate sleep is shown to facilitate improvement in symptoms. The report notes that inadequate sleep adversely affects the symptoms related to mTBI. Providers should recommend sleep management habits and methods as it is crucial to a smooth recovery.

For health-care providers, these guidelines serve as the go-to resource for the treatment of pediatric mTBI. The CDC also references that parents and caregivers – including babysitters, teachers and coaches – can use these guidelines to keep children safe. This is especially relevant now that school is back in session, opening more opportunities for injuries on playgrounds or during fall sports. Parents, caregivers and teachers can also check out the CDC's HEADS UP page as a resource.

Michael Wolf, MD, is an attending sports medicine physician at St. Christopher's Hospital for Children in Philadelphia.