A study shows that many states are missing standards for children returning to school after concussions. Some doctors aren’t sure if standards will help

Every state has laws that govern when student athletes can return to sports activity after a concussion.

However, few have protocol on when a student should return to class.

A study in the latest issues of Pediatrics found that eight states have Return to Learn (RTL) laws. About half of the laws only deal with student athletes, which excludes those who incur concussions through nonsports activities.

About 75 percent of the laws made schools responsible for RTL management, but noted that RTL education for school staff members was only in one quarter of the laws.

Illinois was the only state to specify an evidence-based standard that aligned with the Centers for Disease Control and Prevention (CDC) guidelines for RTL protocol development. None of the laws specified managing students with persistent post-concussive symptoms or specified timing when accommodations should end.

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Steven Cuff, a physician and co-director of Nationwide Children’s Hospital Sports Concussion Program, told Healthline that concussions can cause headaches, which are often worsened by exposure to bright lights, loud noises, and prolonged concentration.

They can also cause impaired focus, fatigue, vision changes, and difficulty remembering information.

These are all things that can make academic work more taxing on a child and require the need for a formal follow-up practice such as the Reduce Educate Accommodate Pace (REAP), which is commonly used.

Cuff said it depends on these types of symptoms as to when a child should return to school after a concussion.

“Some kids may return to school right away and others may benefit from a few days of rest,” he said.

Typically, if a child can tolerate 30 minutes of cognitive activity without symptoms getting worse, they are probably ready to return to school.

Cuff said students should be given academic accommodations to ease the transition back to school and be frequently re-evaluated by academic personnel and medical providers.

Adjustments should be made as needed.

Cuff added that it is OK for a student to return to school while they still have concussion symptoms, but they may benefit from academic accommodations such as shortened school days, regular breaks, a reduced workload, or more time to complete assignments.

Allowing the child extra time to complete tests or delaying tests is also common, as is being allowed to wear sunglasses or avoid noisy settings.

As a rule of thumb, children can return to school while symptoms are still present but are improving, John Leddy, director of the Concussion Clinic at the University of Buffalo in New York, told Healthline.

“REAP would not suggest, however, that a student or athlete return to school if symptoms are severe,” Leddy said.

Severe symptoms include nausea, vomiting, and dizziness. Those symptoms usually pass on the first day or two following a concussion.

Rarely would a student need to miss more than a few days of school due to a concussion, Leddy noted.

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“Promotion of RTL laws, which often do not have any significant consequences if not followed, may be futile,” Mark E. Halstead, a pediatric sports medicine doctor at St. Louis Children’s Hospital in St. Louis, Missouri, said in an accompanying editorial to the Pediatrics study.

“Although it is true that legislation comes with an increase in public awareness, for RTL, it may be more appropriate to use time and funding to enhance existing educational resources,” Halstead wrote.

Cuff said the efficacy of RTL laws would depend how they are structured.

“What’s most important is increasing awareness about the difficulties concussed students may face when returning to school, and educating teachers and administrators about how to help concussed students re-integrate into the classroom,” Cuff said.

Elizabeth Matzkin, chief of women’s sports medicine at Harvard Medical School in Boston, told Healthline that the laws could give children who need more time that assistance, but with the rise in minor concussions the laws may be abused.

“It will be very difficult to have a set of standard guidelines for the vast variety of concussions that can occur,” she noted.

Matzkin said the medical community still has a lot to learn about diagnosing, treating, and managing concussions, as well as the long-term effects. That must be done before guidelines and laws can be introduced, she said.