Caring for Your Child with a Concussion Ages 4 Years and Younger

Caring for your child with a concussion Ages 4 years and younger

What is a concussion? What are common symptoms A concussion: of a concussion • Is a type of traumatic brain injury (TBI) caused by a blow to Symptoms of a concussion can occur right away or up the head or another part of the body. to two days after the injury. They may include: • Affects how the brain functions and processes information Physical at the neurochemical level. • Headache • Is not a structural injury to the brain, so imaging tests like • Sensitivity to noise and light a CT scan or MRI will most often look normal. • Loss of balance • Trouble walking • Being really tired or drowsy • Nausea or vomiting • Vision changes

Thinking and remembering • Trouble thinking clearly • Trouble remembering • Feeling slowerhanges

Social and emotional • Being irritable or fussier than normal • Feeling more emotional • Feeling sad or nervous • Being aggressive The blow causes the head to quickly move back and forth • Hard to consolenges or turn from side to side. The movement inside the skull can cause a direct, back and Sleep forth, or rotating force to the brain. • Sleeping less than normal This can stretch and damage cells, sometimes causing • Sleeping more than normal chemical changes in the brain. • Trouble falling asleep

Concussions are rarely life-threatening. Despite sometimes being referred to as a “mild” TBI, a concussion is still a TBI and can have serious effects, especially if not recognized and ©2019 Children’s Healthcare of Atlanta Inc. All rights reserved. These materials are reprinted with permission from Children’s Healthcare of Atlanta, Inc. NUR.978634.rb.10/19 Healthcare Children’s with permission from reprinted These materials are of Atlanta Inc. All rights reserved. Healthcare ©2019 Children’s treated. Multiple concussions are especially dangerous.

Page A.2 In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Caring for your child with a concussion Ages 4 years and younger (continued)

What to watch for after your young Important tips child’s concussion 1. Make an appointment with your child’s primary care 1. Symptoms may worsen or new ones may appear over the doctor as soon as possible. Keep the appointment even if first 48 hours. your child starts to feel better. Your child’s doctor will track their recovery and advise you on their safe return to school 2. Your child may not know they have symptoms until they try and sports or play activities. to do their normal activities. 2. Avoid waking up your child at night to check on them. 3. Most children feel better within about two weeks. If your Your child’s brain needs to rest and get as much sleep as child does not, they may need to see a specialist. possible in the first few days after a concussion. What to do in the first few days 3. Have your child eat a healthy diet and drink more clear 1. Have your child take it easy in a quiet environment. When fluids, such as water, than normal. Even though your child symptoms are more severe: may not feel like eating, offer small amounts of food and fluids every three to four hours and before bed. • Limit cognitive (thinking or remembering) and physical activities to allow the brain to heal. 4. Give acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) for pain if advised by your child’s doctor. • Avoid excessive screen time, such as watching TV or looking at a cellphone or computer screen. Find relaxing activities at home like drawing and playing with toys. Helping your child safely return to • Slowly resume normal activity, as long as symptoms do not day care or school worsen. Your child may:

2. Your child may slowly return to regular (non-strenuous) • Need to take a short time off from day care or school right activities as they start to feel better. During this time, after the concussion, but it is not necessary for a child to be encourage them to: 100% symptom-free before returning to school. Multiple absences from school and prolonged inactivity after a • Spend time outside participating in activities like taking concussion are discouraged. short walks. • Return to day care or school with accommodations even if • Get as much sleep as possible at night. they still have symptoms. Accommodations are changes to • Take fewer daytime naps or return to their daytime nap your child’s normal schedule and activities that are supported schedule (as appropriate for their age). by the school. For most children, only short-term changes are 3. As symptoms improve, you may: needed. • Encourage outside time. Note: Returning to day care or school does not mean returning to play. Your child should not return to play outside or go to PE • Return your child to their regular schedule. class or recess until their doctor says it is OK. • Have your child take breaks if their symptoms worsen.

If you notice any changes, call your child’s doctor. of Atlanta, Inc. NUR.978634.rb.10/19 Healthcare Children’s with permission from reprinted These materials are of Atlanta Inc. All rights reserved. Healthcare ©2019 Children’s

Page A.3 In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Caring for your child with a concussion Ages 4 years and younger (continued)

See the separate return to play instructions for more information. move like normal • Cannot recognize people or places • Has convulsions or seizures • Passes out

Have questions? Call the Children’s Concussion Program nurse Speak with our Concussion Program nurse for advice and help if you cannot reach your doctor. Our nurses can also help you schedule an appointment if your child needs to see a Children’s concussion specialist. 1. Call 404-785-KIDS (5437) Monday through Friday from 8 a.m. to 4 p.m. 2. Visit choa.org/concussion for more education and return to learn and play instructions. 3. You can also find information at cdc.gov/headsup (Centers for Disease Control and Prevention).

In case of an urgent concern or emergency, call 911. ©2019 Children’s Healthcare of Atlanta Inc. All rights reserved. These materials are reprinted with permission from Children’s Healthcare of Atlanta, Inc. NUR.978634.rb.10/19 Healthcare Children’s with permission from reprinted These materials are of Atlanta Inc. All rights reserved. Healthcare ©2019 Children’s

Page A.4 In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Caring for your child with a concussion Ages 5 to 21 years

Thinking and remembering • Trouble thinking clearly • Trouble remembering • Feeling slowerhanges

Social and emotional • Being irritable or fussier • than normal • Feeling more emotional • Feeling sad or nervous The blow causes the head to quickly move back and forth • Being aggressive or turn from side to side. • Hard to consolenges The movement inside the skull can cause a direct, back and forth, or rotating force to the brain. Sleep This can stretch and damage cells, sometimes causing • Sleeping less than chemical changes in the brain. • normal • Sleeping more than Concussions are rarely life-threatening. Despite sometimes being referred to as a “mild” TBI, a concussion is still a TBI • normal and can have serious effects, especially if not recognized and • Trouble falling asleep ©2019 Children’s Healthcare of Atlanta Inc. All rights reserved. These materials are reprinted with permission from Children’s Healthcare of Atlanta, Inc. NUR.978634.rb.10/19 Healthcare Children’s with permission from reprinted These materials are of Atlanta Inc. All rights reserved. Healthcare ©2019 Children’s treated. Multiple concussions are especially dangerous.

Page A.5 In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Caring for your child with a concussion Ages 5 to 21 years (continued)

What to watch for after your 3. As symptoms improve, you may: child’s concussion • Encourage outside time. • Return your child to their regular schedule. 1. Symptoms may worsen or new ones may appear over the • Have your child take breaks if their symptoms worsen. first 48 hours. If you notice any changes, call your child’s doctor. 2. Your child may not know they have symptoms until they try to do their normal activities. 3. Most children feel better within about two weeks. If your Important tips child does not, they may need to see a specialist. 1. Make an appointment with your child’s primary care doctor as soon as possible. Keep the appointment even if What to do in the first few days your child starts to feel better. Your child’s doctor will track 1. Take it easy in a quiet environment. When symptoms their recovery and advise you on their safe return to school are more severe: and sports or play activities. • Limit cognitive (thinking or remembering) and physical 2. Avoid waking up your child at night to check on them. activities to allow the brain to heal. Your child’s brain needs to rest and get as much sleep as possible in the first few days after a concussion. • Avoid excessive screen time, such as watching TV or looking 3. Have your child eat a healthy diet and drink more clear at a cellphone or computer screen. Find relaxing activities at fluids, such as water, than normal. Even though your child home like drawing and playing with toys. may not feel like eating, offer small amounts of food and

• Slowly resume normal activity, as long as symptoms do not fluids every three to four hours and before bed. worsen. 4. Give acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) for pain if advised by your child’s doctor. 2. Your child may slowly return to regular (nonstrenuous) activities as they start to feel better. During this time, Helping your child safely return to school encourage them to: Your child may: • Spend time outside participating in activities like taking short walks. • Need to take a short time off from school right after the concussion, but it is not necessary for a child to be 100% • Get as much sleep as possible at night. symptom-free before returning to school. Multiple absences from school and prolonged inactivity after a concussion are • Take fewer daytime naps or return to their daytime nap discouraged. schedule (as appropriate for their age). • Return to school with accommodations even if they still have • Do homework for 10 to 15 minutes at a time, as long as symptoms. Accommodations are changes to your child’s symptoms do not get worse. normal schedule and activities. Most schools require written accommodations from your child’s doctor. For most children,

At this point, your child may check their cell phone, watch TV, only short-term changes are needed. of Atlanta, Inc. NUR.978634.rb.10/19 Healthcare Children’s with permission from reprinted These materials are of Atlanta Inc. All rights reserved. Healthcare ©2019 Children’s play video games and visit with friends for short periods of time, as long as symptoms do not get worse. Note: Returning to school does not mean returning to sports and play. Your child should not return to PE class, recess, sports or workouts until their doctor says it is OK. .

Page A.6 In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Caring for your child with a concussion Ages 5 to 21 years (continued)

Helping your child safely return to sports When to seek help right away and play If you cannot reach your doctor right away, return to the 1. Your child should not return to sports and play on the same emergency department if your child: day of the injury. • Has more headaches or neck pain 2. Your child must return to normal schoolwork and studies • Is hard to wake up before returning to game play. • Vomits more than two times in 24 hours 3. Your child’s doctor will let you know when it is OK for your • Has unusual behavior, or seems confused, restless or agitated child to return to sports. • Cannot think clearly or remember things 4. The Children’s Healthcare of Atlanta Sports Medicine team • Has slurred speech, weakness or numbness, or does not has return to play instructions for 11 sports on choa.org. move like normal The stages vary depending on the sport. • Cannot recognize people or places 5. If your child is a student athlete, it is very important that • Has convulsions or seizures their school is aware of their concussion. Returning to • Passes out sports too early may slow healing and increase risk of a second concussion, which has serious effects (e.g., second impact syndrome)..

See the separate return to learn and return to play instructions for more information.

Page A.7 In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. page A.8 Return-to-Learn Guidelines Mild head injury and concussion problems. and symptoms still hasmany Your child Stage 1– healing Stage of problems. and symptoms still hassome Your child Stage 2– full activities. may return to Your child Stage 5– to normal. seems back Your child Stage 4– away. have gone problems and symptoms Your child’s Stage 3– In caseof anurgent concern oremergency, call 911 orgotothenearest emergency department rightaway. Home activity • • • • • • • • • • • • • • • • • • • symptoms school interactionswithfivedays ofno Your childmayreturn tonormalhomeand social interactions Your childmayhavenear-normal homeand and carbohydrates,asinStage1 Continue withfluids,smallfreqent meals Allow familyinteractionsagain games andtexting Slowly return towatchingTV, playingvideo falling behind adding homeworkinshortsittingstoavoid As yourchildhaslesssymptoms,begin and carbohydrates,asinStage1 Continue withfluids,smallfrequent meals schoolwork Help yourchildnottostress overmissed followed byaone-hourbrainbreak he mighthave20minutesofbrainwork — texting, tweetingandemailforashorttime Allow yourchildtouseTV, videogames, Allow forenoughsleep—atleasteighthours and remembering) as symptomsimprove Slowly increase cognitive activity(thinking cereals, pastaandrice to eat,,suchaswholegrainbreads and Give yourchildplentyofcarbohydrates and atbedtime Feed small,frequent mealsduringtheday Give yourchildplentyoffluidstodrink from yourchild’s room Remove anyactivityplannersandto-dolists from yourchild’s room Remove anyelectronics andcomputers focus, reason orremember Limit thingsthatrequire your childtothink, Allow asmuchsleeppossible Limited orminimalstimulation less than two hours a day; for example, less thantwohoursaday;forexample, School activity • • • • • • • • • • • • • • • for 24to48hoursandmonitorifsymptomsimprove Your childmaynotgotoschool.Itistypicalrest restrictions without theneedforextraaccommodations or Your childmayreturn tonormalschoolfunction and becomecaughtup Your childmaybegintocompletepastassignments problems return Tell theschoolnurseorteacherif anysymptomsor as needed,tocomplete He maytakeonetestorquizadaywithextratime, quizzes He mayneedtoschedulemake-upwork,testsand Your childmaygraduallyreturn toafulldayofclasses cafeterias, atPEandrecess Avoid veryloud noiseslikemusicandnoisein create aplan academic accommodationsfrom yourdoctorand Talk withtheschoolnurseorteacherabout minutes atatimewithrest breaks inbetween Complete shorthomeworkassignments—work20 Use pre-printed classnotes Your childmaynottaketestsorquizzes needed Rest inthenurse’s officebetweenclasses,as time Attend core classes onlyorhaveshortenedclass Return toschoolforhalfdays activity activity Physical chart 1 innext See Stage chart 7 innext See Stage next chart and 6in Stages 5 See chart 2-4 innext Stages See next chart 2-3 in Stages See

©2019 Children’s Healthcare of Atlanta Inc. All rights reserved. These materials are reprinted with permission from Children’s Healthcare of Atlanta, Inc. NUR.978634.rb.10/19 Mild head injury and concussion

Return-to-Play and Sports Guidelines

Stage of Activity allowed Examples of sports Examples of other activities Goal healing • No activity • Complete physical rest • Quiet time with rest • Brain rest and • Complete • Avoid groups, videos, reading, healing 1 cognitive and computers, video games, • BE FREE OF physical rest cellphones, noisy places SYMPTOMS • Light aerobic • 10 to 15 minutes of walking or • Walk in park or neighborhood • Increase heart activity stationary bike • Avoid group activities 2 rate to 30-40% at • Light sweat on the brow most • Slight increase in breathing rate • Moderate aerobic • 20 to 30 minutes of jogging or • Supervised play • Increase heart activity stationary bike • Low risk activities, such as rate to 40-60% at • Light resistance • Arm curls, shoulder raises, or dribbling a ball, playing catch, most 3 training leg lifts with weights that can be changing directions, jumping, • Add resistance comfortably lifted side-to-side slides, chasing a ball • Use eyes to track • One set of 10 repetitions for each or catching a ball on the run objects activity • Intense aerobic • 40 to 60 minutes of running or • Supervised play • Increase heart activity stationary bike • Moderate risk activities, such rate to 60-80% at • Moderate • Same resistance exercises with as balance and agility drills most resistance training weight for three sets of 10 reps • No head contact activities • Increase • Sport-specific • Pre-competition warm-ups, such 4 • Can sweat and breathe heavy resistance exercise as passing a soccer ball, throwing • Mimic the sport a football or doing ladder drills

• Controlled-contact • 60 to 90 minutes of time on the • Free play • Mimic the sport training drills field, court or mat for specific drills • Run and jump as able or free play • Take part in normal practice • Full return to PE without the risk of head injury session • Recheck for symptoms or 5 • Contact that is normally part of the problems often sport—only use items that do not hit back,, such as a sled in football • Recheck for symptoms or problems often • Full-contact • After OK from the doctor, may • With parent or adult supervision, • Build confidence 6 practice take part in normal training may take part in normal activities • Assess skills activities • Return to play • Normal game play • Normal playtime and activities • No restrictions

Page A.9 In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Mild head injury and concussion

Where can I get more information? You can get more information on mild head injury and concussion from the following websites: • American Academy of Neurology: aan.com • American Academy of Pediatrics: aap.org • American College of Sports Medicine: acsm.org

• Centers for Disease Control and Prevention: cdc.gov

Children’s Healthcare of Atlanta has not reviewed all of the sites listed as resources and does not make any representations regarding their content or accuracy. Children’s Healthcare of Atlanta does not recommend or endorse any particular products, services or the content or use of any third party websites, or make any determination that such products, services or websites are necessary or appropriate for you or for the use in rendering care to patients. Children’s Healthcare of Atlanta is not responsible for the content of any of the above-referenced sites or any sites linked to these Sites. Use of the links provided on this or other sites is at your sole risk. ©2019 Children’s Healthcare of Atlanta Inc. All rights reserved. These materials are reprinted with permission from Children’s Healthcare of Atlanta, Inc. NUR.978634.rb.10/19 Healthcare Children’s with permission from reprinted These materials are of Atlanta Inc. All rights reserved. Healthcare ©2019 Children’s

Page A.10 In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away.