Pediatricians are being warned not to stick their necks out too far in protecting the heads of their young patients. And to put on their own helmets. A recent article in the AAP News, the official news magazine of the American Academy of Pediatrics, the major professional organization of US pediatricians, is cautioning providers about the long reach of new legislation around concussions into the private lives and lifestyles of parents and patients.
Specifically, at least forty of the fifty US states have passed legislation which mandates medical clearance following a sports related head injury before a child may return to school sponsored physical education and sports. By giving this authority to physicians, says the author, William McDonnell, a physician and lawyer who is the chair of the AAP committee on medical liability and risk management, the law also hands over responsibility for the consequences of lifestyle choices which the physician may actually have little control over.
Let’s imagine for instance that a family decides on its own to allow their recuperating child to play in a recreational soccer league even though the physician only has purview to recommend that the child be barred from play at school according to the school’s policy. Parents need a great deal of education to understand that any subsequent head injury may require a longer recuperation period than the first one. Just how long a student is vulnerable is a currently hotly debated and researched question.
Dr McDonnell has the following tips for practicing pediatricians in order to reduce their liability:
- Follow a defined concussion protocol
- Follow a clear Return to Play (RTP)clearance policy
- Give clear discharge instructions
- Document that RTP clearance is a relative issue, is not a guarantee and can change
- Resist pressure to give RTP before a student is really ready
- Follow up is critical
- Facilitate follow-up with specialists if symptoms do not clear as early as expected
What Dr McDonnell does not emphasize in his AAPNews article is that Return to Learning is equally important and that many concussions occur outside of the sports world. Much of the morbidity of concussions is seen in the classroom and emerges as absenteeism, and presents as psychological, emotional, cognitive, and academic symptomatology. It is these more “silent” issues that must be attended to in the athlete and non-athlete alike. Not every state mandate is addressing these. But these, too remain the responsibility of every good pediatrician.