Elementary-Aged Students

Scenario:
Your child’s school nurse calls to tell you that your child hit his head in the school yard during recess…

What is different about managing concussion for young children as compared to teens?

Younger children do not lose consciousness as easily as teens and older children. [1] They also may not have the language to accurately describe concussion symptoms they might be experiencing. Instead, they may be more likely to complain of physical symptoms or act out behaviorally in response to their symptoms, often complaining that they just “don’t feel good.” Adults need to be diligent in observing any changes in typical behavior. Parents know their children better than anyone and will be the first to recognize when things are not going well. If your child is diagnosed with a concussion, it is very important to follow the physician’s recommendations and monitor your child for worsening symptoms in the immediate hours and days that follow.

Recent preliminary research findings suggest that young children may need to take longer periods of rest following concussion than older children or adults do. It is commonly recommended that they take at least an additional 7 day rest/recovery period after they are symptom-free.


Do the New Jersey Concussion Law and/or the Department of Education’s Model Policy for Concussion provide any mandates to protect elementary-aged children?

Generally, the law applies to all public and nonpublic schools in New Jersey and applies to student-athletes in grades 8 – 12 who play interscholastic sports. The law does not provide any mandates applying to elementary-aged children unless they are playing interscholastic sports.

The model policy expands this to include grades K-12 and provides some statements that specifically address return-to-play protocols following a concussion. In addition, any youth sports team organization [2] that operates on school grounds must also sign a statement of compliance with that school district or nonpublic school’s policies for the management of concussions and other head injuries.

The key points in the model policy pertinent to elementary-aged children are as follows:

  • The model policy states that in the absence of daily testing by “knowledgeable school district staff to clear a student-athlete to begin the graduated return-to-play protocol, the student-athlete should observe a 7 day rest/recovery period before commencing the protocol.”
  • The policy states that “Younger students (K-8) should observe the 7 day rest/recovery period (after they are symptom free at rest) prior to initiating the graduated return-to-play protocol.”
  • The policy also states that the return-to-play protocol should be monitored by a physician trained in the evaluation and management of concussion as well as the parents/guardians of the student-athlete.
  • School nurses may serve as advocates for communicating signs and symptoms to physicians and parents/guardians. Any time there is a re-emergence of symptoms, a student-athlete is to be returned to the school/team physician or primary care physician.

What is different about a concussion from playing sports and a concussion from something else?

A concussion is a brain injury, and ALL brain injuries are serious. Concussions result from many types of incidents, but unique issues arise from sports-related concussions because decisions need to be made about safe return to practice and competition after a period of recovery.

The New Jersey Concussion Law or the Department of Education’s Model Policy does not address non-sports-related concussions. However, concussions in all children need to be taken just as seriously as those in student-athletes.

Sports concussion experts and researchers have provided insight that is relevant for all pediatricians, physicians, and clinicians who treat concussions, as well as the general public.

School districts can choose to provide guidelines for elementary and middle schools to follow in the event that a student sustains a concussion outside of interscholastic sports. Schools may also provide physical education teachers with interscholastic head injury training because of the contact sports they facilitate daily and the risk of students sustaining concussions during gym activities. In addition, because of the risk of contact sports and the dangers of sustaining a second concussion before the first has resolved, many students with concussion return to school with gym restrictions, making it imperative for physical education teachers to be on the same page as other staff. Including a requirement for teachers to attend concussion trainings will reinforce the relationship between concussion and cognition, academic accommodations, and the physical activity restrictions that are typically necessary following a concussion.