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Should we get imaging if they’ve suffered from a concussion?
Dr. Sirak: This is the first question most parents ask during an initial visit for concussion. Following a thorough neurological examination, reassurance can be provided to the family that there is no signs of a bleed, infarction, increased intracranial pressure and that monitoring is all that is needed.

Should I keep my child awake all night?
Dr. Sirak: No! Sleep is one of the most important treatments we have for a concussion. It is recommended that the child should be allowed to sleep. If the injury occurs close to bedtime and the family is concerned, recommend checking in on the child periodically but try not to wake them.

Is the concussion going to cause permanent damage?
Dr. Sirak: Most children when properly managed and allowed to fully recover from their concussion have full resolution of symptoms and return to academics and activities.

What can they do while they are home recovering?
Dr. Sirak: For the first 48 – 72 hours following a concussion rest is most important. After that, encourage gradual return to daily tasks and activity as tolerated with the exception of physical activities that could increase risk of re-injury. Introduce new activity for 15 – 20 minutes at a time with breaks in between. If the child is symptom free then they can return to the activity, if the newly introduced activity worsened symptoms then refrain for a few days and try again. Common first activities that a child with a concussion can try include listening to light music, board/card games with the family, arts/craft projects or supervised baking.

Is screen time bad?
Dr. Sirak: Only if it worsens the child’s symptoms. Screens are not inherently evil when it comes to concussion recovery. However many patients with concussions have light sensitivity and eye fatigue. Therefore screens are often deterred as they can exacerbate symptoms. Gradual reintroduction as tolerated is recommended.

My child is sleeping during the day but cannot fall asleep at night, what should we do?
Dr. Sirak: This is a good sign! When a child is first recovering from a concussion they often can sleep day and night. As the brain is healing they need less sleep and the daytime napping starts to interfere with night time sleeping. Recommend decreasing naps until falling asleep at night is not an issue.

When can they go back to school and what can they do at school?
Dr. Sirak: Early return to school is recommended but with accommodations and stress taken off of the child. Even if the child is not symptom free, return to school for partial or full day with no requirement to complete assignments and no tests can assist with concussion recovery. As the child begins to feel better, work can be added back into their day until they are back to full academics.

What should we do if they get/have a headache?
Dr. Sirak:Headaches are a common concussion symptom. Rest and removal of anything that is irritating/causing the headache is the first line of treatment. If headache persists, over the counter options such as ibuprofen or acetaminophen can be safely given. However strongly encourage rest and removal of headache causing agent first. Also it is not recommended to take medication in order to be able to tolerate an activity such as school, going out with friends, the movies, etc.

They were better over the weekend but worse with school on Monday, did we make it worse?
Dr. Sirak: As the child gets better, minor set backs are common. As the child recovers they may accidentally over do it and worsen their symptoms. Provide reassurance that no long term damage nor major setback is caused by this. Advise to scale back activity until back to below symptom level and then increase activity as tolerated again in a few days.

When can they return to sport/Should they return to sport?
Dr. Sirak: Most commonly asked by the eager child themselves, the simple answer is that the child needs to be 7 days symptoms free and back in school full day without needing academic accommodations. The child should then complete the return to play protocol with their school athletic trainer or a physical therapist before clearance to return to sport is provided.

 

Dr. Michelle Sirak is a Goryeb Children’s Hospital pediatric physiatrist focused on physical medicine, rehabilitation, restoration of function, and a return to a high quality of life. Dr. Sirak works with patients, pediatricians, and specialists to create individualized treatment plans, including home exercise programs, for children with muscle, bone, soft tissue or nervous system injuries and diseases.

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