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Symptom spikes after concussion not believed to be a recovery setback

August 01, 2016

MILWAUKEE - A new study published today by a Children’s Hospital of Wisconsin doctor in JAMA Pediatrics found that families should not be worried if a child’s concussion symptoms return once resuming day-to-day activities.

“Activity-Related Symptom Exacerbations After Pediatric Concussion” was co-authored by Danny Thomas, M.D., M.P.H., a pediatric emergency medicine physician at Children’s Hospital of Wisconsin and an associate professor of pediatric emergency medicine at the Medical College of Wisconsin.

This study supports research Thomas published last year that concluded that limiting the amount of rest an adolescent has after concussion may help them return to normal activities sooner.

His newest paper found that an increased risk for a symptom spike after a mild concussion was associated with an abrupt increase in mental activity, such as returning to school and extracurricular activities, from one day to the next. Most spikes, however, were not preceded by mental or physical exertion.

 “The key implications for clinicians is that modest physical and mental activity did not worsen symptoms and that returning to school may cause an increase in symptoms, but this should not be seen as a setback in recovery,” Thomas said. “When a family calls concerned that their child’s symptoms got worse that first day back to school, clinicians can reassure them that spikes in symptoms are pretty common, get better with time, and do not seem to change your recovery time.”

That said, Thomas advises that high-risk activities like football and tree climbing should wait until after children have recovered from concussion.

The analysis of clinical trial data included 63 children who were asked to complete a post-concussion symptom scale and to record their activities in diaries for 10 days. The children – most were boys – were an average age of almost 14.

About JAMA Pediatrics

JAMA Pediatrics is an international peer-reviewed journal and the oldest continuously published pediatric journal in the United States, dating back to 1911. JAMA Pediatrics is a member of The JAMA Network family of journals, which includes JAMA and 11 specialty journals.

About Children’s Hospital of Wisconsin

Children’s Hospital of Wisconsin is the region’s only independent health care system dedicated solely to the health and well-being of children. The hospital, with locations in Milwaukee and Neenah, Wisconsin, is recognized as one of the leading pediatric health care centers in the United States. It is ranked in all 10 specialty areas in U.S. News & World Report’s 2016-17 Best Children’s Hospitals report. Children’s provides primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. In 2014, Children’s invested more than $102 million in the community to improve the health status of children through medical care, advocacy, education and pediatric medical research. Children’s achieves its mission in part through donations from individuals, corporations and foundations and is proud to be a member of Children’s Miracle Network Hospitals. For more information, visit the website at

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