Research In Action

With summertime in full swing, many of our school aged patients are away at camp. What to do if a patient sustains a concussion while at camp? I recently spoke with my colleague, Ms. Roni Robinson, MSN, CRNP, a nurse practitioner in CHOP's Concussion Care for Kids program, about some of the unique aspects of caring for campers who sustain a concussion.

Are there any differences in the types or severity of concussions sustained during typical summer camp compared to other daily activities during the rest of the year?

Ms. Robinson: There are no specific "types" of concussions, as the medical world no longer grades concussions on severity.  Grading systems in the medical world were created to determine outcome; however, severity of concussion is very difficult to assess immediately after one sustains a head injury. We determine the severity of a concussion based on how long the symptoms last.  In the pediatric and adolescent age group, it can take up to 3- 4 weeks for spontaneous recovery from a concussion; this would be considered a relatively typical concussion recovery. If concussion symptoms last longer than this time period, we would consider this to be a more severe injury and would recommend that child be evaluated by a concussion specialist.

What kind of challenges might there be in assessing symptoms and managing a child's concussion when their parents are not there (e.g., sleep away camp)?

Ms. Robinson: In my experience, there is no difference in initial concussion symptom assessment, whether parents are there or not. However, the camp staff would need to realize that the camper will be recovering without parents present. Parents typically help monitor symptoms over time and support the prescribed recovery plan. This places a little extra responsibility on the camp staff to make sure the camper understands and can follow the instructions regarding concussion management and then monitors the camper closely. In a camp environment, where there may be multiple activities scheduled throughout the day and pressure to join their peers, it may be harder for a young camper to agree to take it easy. That may be one aspect of camp that may make it more challenging to manage concussions.

Ms. Robinson recommends these guidelines for managing concussions at camp for camp-based clinicians and the camper's designated counselor:

• In the immediate period after a concussion occurs, the camper should take a break from busy, crowded, or noisy camp activities. Other low-cognitive demands (drawing, playing cards) may be a better option. They should also avoid contact activity and ball sports.
• As the camper feels better, he can try higher levels of social activities in short intervals with frequent breaks as tolerated. They may be able to try moderate non-contact cardio activity as well.
• Once the camper is able to participate in regular daily activities with the camp group, they might be able to try more cognitively demanding activities, such as video games and reading. They may also be able to advance to heavy aerobic activity as tolerated. However, they should continue to avoid collision sports.
• Finally, after the camper has recovered, they may follow the Return to Play Protocol for sport activity. If asymptomatic with the protocol, the camper may be cleared by a healthcare provider experienced in concussion management.

Do you have any tips regarding communicating with parents if their children become injured and are recovering while away at camp?

Ms. Robinson: I think it is very important to keep the line of communication open between parents and camp staff in regards to the health of the camper. Providing parents with accurate information about concussions and concussion management is very important; this, along with frequent and routine updates on their child's status can provide comfort for parents who are far away from their child. Communication with the camper’s primary care provider may also be helpful so the progression of the concussion can be followed closely and to ensure the camper is able to transition back to school after summer camp is over. Educational handouts (click here and here), can be provided to the parents of campers who sustained a concussion at camp.

Click here for more tips on managing concussions while children are at camp.