What are the most appropriate return-to-play guidelines for concussed child athletes?

Objective: To examine concussion literature for specific guidelines regarding return to play (RTP) following sport-related concussion in child athletes. To make recommendations regarding the most appropriate RTP guidelines for child athletes following sport-related concussion. Design: A literature review of concussion literature. Intervention: A literature search was conducted using Medline and Embase databases from 1998 to 2008. More than 60 articles and two websites were reviewed. Results: There is a paucity of research on sport-related concussion in child athletes, particularly younger children (age 5-12 years). In particular, there is no research on RTP guidelines for child athletes following sport-related concussion. Child athletes take longer to recover from concussions than adults. Concussion symptoms may resolve before cognitive function has completely recovered. Concussion assessment and management in children can be confounded by their growth and development, as well as the lack of trained medical personnel involved with youth sports. There are no child-specific assessment tools for concussion. Conclusions: RTP decisions in children should be made cautiously and should be individualised. No concussed child athlete should be allowed to RTP the same day. Physical and cognitive rest is very important to allow for the resolution of concussion symptoms. Child athletes should remain symptom free for several days before starting a medically supervised stepwise exertion protocol. Further research is needed to elucidate the effects of concussion in children and to determine the most appropriate RTP guidelines. Child-specific concussion assessment tools need to be developed to improve concussion assessment and management in children.