What are the discharge instructions for a 13-year-old diagnosed with a concussion?

Concussion Discharge Instructions for a 13-Year-Old

Health care providers should inform the family about warning signs of more serious injury, expected course of symptoms and recovery, how to monitor postconcussive symptoms, prevention of further injury, management of cognitive and physical activity/rest, instructions for return to play/recreation and school, and clear follow-up instructions. 1

Initial Rest Period and Symptom Monitoring

• Recommend a period of relative rest for 24 to 48 hours immediately following acute concussion 1, 2
• Activities of daily living, including walking and other symptom-limited physical and cognitive activities, are permitted as tolerated during this period 1
• Monitor for warning signs requiring immediate medical attention:
  • Worsening headache
  • Repeated vomiting
  • Increased confusion
  • Seizures
  • Difficulty waking up
  • Slurred speech
  • Weakness or numbness in arms/legs
  • Unusual behavior changes

Return to School (RTS) Protocol

1. No school attendance - Complete cognitive rest for 24-48 hours
2. Partial day with accommodations - Start with half-days or limited class attendance with breaks as needed
3. Full day with accommodations - Gradually increase academic activities with continued accommodations
4. Full return to school - Normal academic activities without accommodations

Note: Children/youth typically return to school faster than they return to physical activities 3, but full contact sports should be delayed until successful reintegration to school has been achieved 2, 3

Return to Activity/Play (RTA) Protocol

The American Academy of Pediatrics recommends a minimum of 24 hours for each step, requiring at least 5 days after becoming asymptomatic 2:

1. No activity - Complete physical rest until asymptomatic for 24 hours
2. Light aerobic exercise - Walking, swimming, stationary cycling at <70% maximum heart rate
3. Sport-specific exercise - Running drills, no head impact activities
4. Non-contact training drills - More complex training, progressive resistance training
5. Full-contact practice - Only after medical clearance
6. Return to competition - Only after completing all previous steps without symptoms

Important: If any symptoms return during any stage, the athlete must return to the previous asymptomatic stage and wait at least 24 hours before attempting to progress again 1, 2

School Accommodations

Common accommodations to consider:

• Reduced workload and extended time for assignments/tests
• Frequent breaks during the school day
• Avoiding loud environments (cafeteria, assemblies)
• Limited screen time
• Postponement of high-stakes testing
• Excused absence from physical education classes

Medication Guidelines

• Do not use medications that mask concussion symptoms when beginning the return-to-play protocol 2
• Avoid medications containing aspirin or NSAIDs initially (may increase bleeding risk)
• Acetaminophen may be used for headache management if necessary

Follow-Up Care

• Medical clearance from a licensed healthcare provider trained in concussion management is mandatory before returning to contact sports 2
• If symptoms persist beyond 10 days, management in a multidisciplinary fashion is recommended 1
• Consider referral to a concussion specialist if:
  • Symptoms worsen or fail to improve
  • History of multiple concussions
  • Pre-existing learning disabilities or ADHD
  • Persistent school difficulties despite accommodations

Common Pitfalls to Avoid

1. Returning to activities too soon - This can prolong recovery and increase risk of further injury
2. Ignoring cognitive rest - Mental exertion can exacerbate symptoms just as physical exertion can
3. Inconsistent monitoring - Regular assessment of symptoms is essential for proper management
4. Inadequate school communication - Ensure teachers and school staff are aware of accommodations needed
5. Allowing return to full contact sports before complete symptom resolution - Medical clearance is required

Remember that recovery time varies significantly among individuals, with younger athletes typically requiring longer recovery periods compared to older athletes 2. Regular communication with healthcare providers is essential throughout the recovery process.