The Centers for Disease Control and Prevention (CDC) released a major new guideline on diagnosing and managing head injuries in children. The guideline, which is the first from the CDC that is specific to mild brain injury in children, advises against the long recovery period, isolated in a dark, quiet room, that has sometimes been used in treatment. Having a truly evidence-based guideline should help clinicians personalize the care that children receive and the ways they gradually reintegrate into activities and sports rather than applying rigid rules — and should generally encourage an earlier return to non-risky activity.
The key recommendations from the guideline help explain what will — and should — happen when a child suffers a head injury. First, the guideline tells medical providers that imaging studies — CT scans and X-rays — are not necessary for diagnosing mild traumatic brain injury, and avoiding these tests helps minimize children’s exposure to radiation. There is also no blood test for mild traumatic brain injury; the diagnosis is made by clinical examination and observation. Doctors are directed to validated, age-appropriate symptom scales, which are also very useful in tracking recovery. Doctors should assess some of the risk factors that can make a child’s recovery longer and trickier, from prior injury or preinjury headaches to baseline psychiatric issues, learning disabilities or lower cognitive ability. The return to activity should be personalized, and family and school and coaches should understand the expectations and the plan. The final recommendation, “counsel patients to return gradually to nonsports activities after no more than two to three days of rest,” should help avoid prolonged rest and isolation, which is not helpful to recovery.