Treatment of Concussion in an 11-Year-Old Football Player
The appropriate treatment for an 11-year-old with a concussion from playing football requires complete physical and cognitive rest until symptoms resolve, followed by a gradual 5-day minimum stepwise return-to-play protocol under medical supervision. 1
Immediate Management
- Remove the athlete from play immediately and do not allow same-day return to play under any circumstances, even if symptoms appear to resolve 1
- Evaluate the child by a healthcare professional with experience in concussion management before considering any return to physical activity 1
- Rule out more severe injuries requiring emergency care, particularly if loss of consciousness lasted longer than 30 seconds 1, 2
Rest Phase (Until Asymptomatic)
Physical Rest
- Complete physical rest from all sports and physical exertion until the athlete is completely asymptomatic at rest 1
- Avoid any activity that increases energy demand on the brain as this may exacerbate symptoms and potentially prolong recovery 1
- Young athletes typically require longer recovery periods (7-10 days or more) compared to college or professional athletes 1, 2
Cognitive Rest
- Implement "cognitive rest" to prevent symptom exacerbation 1
- This may include:
- Temporary leave of absence from school if symptoms are severe 1
- Shortened school days 1
- Reduced academic workload and extended time for assignments 1
- Avoidance of activities requiring concentration including video games, computer use, and television 1
- Avoidance of loud music if phonophobia is present 1
- Use of sunglasses if photophobia is significant 1
Medication Considerations
- There is currently no evidence-based research supporting medication use in pediatric concussion treatment 1
- NSAIDs and acetaminophen have not been proven to shorten concussion recovery 1
- If medications are used to manage prolonged symptoms, they must be discontinued before return to play, and the athlete must remain symptom-free off medication 1
Return to Play Protocol
Once the athlete is completely asymptomatic at rest, implement the following stepwise return-to-play protocol 1:
- No activity: Complete physical and cognitive rest until asymptomatic 1
- Light aerobic activity: Walking, swimming, or stationary cycling at 70% maximum heart rate; no resistance exercises 1
- Sport-specific exercise: Sport-related drills without head impact 1
- Noncontact training drills: More complex drills, may start light resistance training 1
- Full-contact practice: After medical clearance, participate in normal training 1
- Return to play: Normal game play 1
Important Protocol Guidelines
- Each step must last a minimum of 24 hours 1
- The entire protocol requires a minimum of 5 days to complete 1
- If symptoms return during any step, the athlete must stop immediately 1
- Once asymptomatic again for 24 hours, the athlete should return to the previous asymptomatic level 1
- Medical clearance from a licensed healthcare provider trained in concussion management is required before full-contact practice 1, 2
Special Considerations for Pediatric Athletes
- Younger athletes generally have longer recovery times than adults and require a more conservative approach 1, 2
- Neuropsychological testing can provide objective data but should be just one tool in the complete management of concussion 1
- Sport-specific return-to-play guidelines may be beneficial to simulate movements particular to football 3
- For athletes with multiple concussions or prolonged symptoms, consider a longer rehabilitation program or potential retirement from contact sports 1, 2
School Reintegration
- Educate teachers, counselors, and school administrators about the cognitive effects of concussion 1
- Allow adequate time for make-up assignments and reduce the overall volume of work 1
- Gradually increase academic demands as symptoms improve 1