Kids with concussions: recovery in just two days

MINNEAPOLIS - Most children who suffer concussions don't need strict, prolonged rest to fully recover, according to a study that suggests extra down time beyond the typical standard of care may lead patients to focus more intently on their symptoms.

While the Centers for Disease Control and Prevention recommends one to two days of complete rest before resuming regular activities, some doctors lengthen the time of enforced inactivity and others encourage "cocooning" the child in a darkened room for several days. Those efforts may be counterproductive, said Danny Thomas, the lead researcher.

The study published Monday in the journal Pediatrics is one of the first to look for an optimal recovery period after a concussion. The researchers found five days of strict rest, including staying home from school, didn't improve balance or mental function compared with the usual 24 hours to 48 hours at home and a slow return to activity. Those assigned to longer periods of rest reported more symptoms and slower recoveries.

"Telling them to rest for five days didn't help them get better faster and it actually increased their symptom reporting," Thomas, an assistant professor of pediatric emergency medicine at Children's Hospital of Wisconsin in Milwaukee, said in a telephone interview. "I don't think it made their injury worse, it just made them more focused on it," he said, much like a toothache that hurts more at night when there are no distractions.

Concussions are getting increased attention as research shows they are more common and their damage is more widespread than realized, particularly in youth sports. Emergency room visits for traumatic brain injury stemming from sports have increased 60 percent in the past decade, the researchers said. Seventy percent of the concussions in the study were caused by sports, mainly football.

The major risk after a concussion is a second injury to the brain, which can have catastrophic results. Overdoing mental activity, like watching television, texting or attending classes, may prolong the time it takes to recover, though it's unlikely to do lasting harm, Thomas said.

"You should never push through your symptoms," he said. "Kids should listen to their bodies and respect their symptoms, but there is no evidence that stopping activities like watching movies or talking to friends will have a benefit."

There are almost two dozen symptoms linked to having a concussion, including headache, loss of consciousness, confusion, amnesia and sensitivity to sound or light. Patients may have nausea, lingering fatigue, irritability, trouble sleeping and depression. For as many as 90 percent of people, all evidence of the damage disappears in a week to 10 days.

The major difference between the two groups in the study of 88 children was the amount of time they spent in school. Parents in both groups limited physical activity after visits to the emergency room led to a concussion diagnosis, Thomas said. Children assigned to five days of rest spent significantly less time in class and at after-school activities.

"Kids after a concussion should get back to school," Thomas said. "That's their job and what they should be doing. They might not make it through the whole day and they may need support, but they need to get back to their routine."