What is the Football Association's (FA) management of concussion in a 12-year-old?

From the Guidelines

The Football Association (FA) recommends a conservative approach to managing concussion in 12-year-olds, with immediate removal from play being the first step, and a graduated return-to-play protocol should be followed, as outlined in the concussion rehabilitation guidelines 1. The management of concussion in a 12-year-old should prioritize complete physical and cognitive rest for the first 24-48 hours, followed by a gradual reintroduction of activities that don't provoke symptoms.

Key Considerations

• The return-to-play protocol should last at least 5 days, with each stage lasting a minimum of 24 hours, as recommended by the American Academy of Pediatrics 1.
• Medical clearance from a healthcare professional is required before returning to contact training or matches.
• No medications are specifically recommended for concussion treatment in children, though acetaminophen (paracetamol) may be used for headache management at age-appropriate doses.
• Parents and coaches should monitor for worsening symptoms like increased headache, repeated vomiting, seizures, weakness in limbs, or confusion, which require immediate medical attention, as emphasized in the clinical report by the American Academy of Pediatrics 1.

Rehabilitation Protocol

The rehabilitation protocol should include the following stages:

• No activity, with complete physical and cognitive rest
• Light aerobic activity, such as walking, swimming, or stationary cycling at 70% maximum heart rate
• Sport-specific exercise, without head impact
• Noncontact training drills, with gradual introduction of resistance exercises
• Full-contact practice, after medical clearance
• Return to play, with normal game participation It is essential to note that if symptoms recur during the rehabilitation program, the athlete should stop immediately and resume at the previous asymptomatic level after at least 24 hours, as recommended by the American Academy of Pediatrics 1.

From the Research

Management of Concussion in a 12-year-old

The Football Association's (FA) management of concussion in a 12-year-old is guided by various studies and guidelines.

• The management of concussion includes rapid removal from play, symptomatic treatment, and return to learn/play recommendations 2.
• A six-step process is recommended for return to play (RTP) after a concussion, which includes gradual participation in increasingly difficult physical activities 3.
• Sport-specific RTP guidelines have been proposed to take into account the variability that occurs within different sports, including football 3.
• The final RTP determination should occur with documented medical clearance from a licensed healthcare provider who has been trained in the evaluation and management of concussions 3.
• Individualized management is appropriate for concussion, as every concussion has its own unique spectrum and severity of symptoms 4.
• The reduction, not necessarily elimination, of physical and cognitive activity is the mainstay of treatment, and a full return to activity and/or sport is accomplished by using a stepwise program while evaluating for a return of symptoms 4.

Guidelines for Concussion Management

• The American Academy of Pediatrics has published guidelines for the diagnosis and management of concussion in children and adolescents, which include recommendations for removal from play, symptomatic treatment, and return to learn/play 5, 4.
• The guidelines emphasize the importance of individualized management and the need for a multidisciplinary approach to concussion care 6.
• Policy changes related to sport-concussions have been implemented to improve long-term outcomes, including requirements for medical clearance before returning to sport 6.