Draft Supplement: Concussion in early childhood
Contributors: Miriam Beauchamp, Cindy Beaudoin, Isabelle Gagnon, Marie-Gabrielle Delisle, Hugo Paquin, Jocelyn Gravel, Jennifer Dawson, Nikoleta Odorico, Nick Reed
Introduction/Background
Concussions sustained in early childhood are associated with different individual and environmental characteristics than those in older, school-age children and adolescents. This results in unique patterns of signs, symptoms, outcomes and recovery. This supplement to the Living Guidelines for Pediatric Concussion aims to provide healthcare professionals with an overview of the unique characteristics that need to be considered. The supplement includes references to theoretical and empirical work, as well as links to suggested tools to assist in decision-making regarding concussion recognition, initial medical assessment and management, return to daily activities/physical activities/play/childcare, and management of prolonged symptoms when accidental concussion is sustained during early childhood (i.e., infants, toddlers, preschoolers, and young children before the age of 8 years). Empirical evidence is generally less comprehensive for the early childhood period than for other developmental periods. As a result, the information and recommendations that follow are likely to evolve and expand rapidly over the coming years. This supplement does not cover the specificities of concussion, traumatic brain injury or head and neck trauma associated with suspicion of maltreatment or non-accidental traumatic brain injury. Furthermore, it does not replace the recommendations for children and adolescents shared in the Living Guideline, but instead should be used as a complementary resource, highlighting the differences and specific recommendations and tools to address concussion in young children.
A narrative review provides background information on the specificities of early childhood concussion and guidance in the choice of the following suggestions/recommendations (Beauchamp et al., 2024). We invite the reader to consult this article for a thorough review of specific considerations on early childhood concussion. The following considerations are drawn from this work and are of particular importance:
- Developmental considerations: Early childhood developmental stages present unique characteristics that should be considered when addressing concussion detection, assessment, monitoring of post-concussive symptoms, and recommendations for recovery.
- Language and environmental considerations: Early childhood is characterized by emerging and limited cognitive and language abilities, as well as different daily activities and environments.
- Sleep: Infants, toddlers and preschoolers also show vastly different sleep patterns compared to older individuals, including more unconsolidated sleep that includes daytime naps.
- Symptoms: Young children display different patterns of post-concussive symptoms than older children and adults, including unique symptoms such as elevated comfort seeking behaviors, irritability/tantrums, and regressions, that are best evaluated using observational or behavioural-anchored approaches.
- Diagnostic uncertainty: Diagnostic uncertainty tends to be more frequent in this population, leading to an increased risk of unspecified diagnosis and less precise recommendations.
- Role of parents and caregivers: Young children are entirely dependent on their parents/caregivers and other significant adults. Parental stress can be a challenge after early childhood concussion, probably in part because parents may struggle to identify post-concussive symptoms and concussion sequalae. It is known that parental emotional state and parenting behaviours influence a child’s recovery. Supporting parents through education and guidance, and early identification and treatment of parental stress is an important consideration.
Link to word document of the draft (left in a google doc to allow for comments)