Children may find it difficult to return to play or school after a concussion; Pediatricians can help identify if some will need special learning accommodations or additional referral for treatment
Most children and teens who report blurry vision, difficulty focusing and other vision disorders after concussion will recover on their own by four weeks, but up to one-third may need to be referred to a specialist for further assessment and treatment.
The American Academy of Pediatrics has co-authored a policy statement to help inform pediatricians on identifying visual symptoms of concussion and their severity, called, “Vision and Concussion: Symptoms, Signs, Evaluation, and Treatment.” The policy statement, and an accompanying clinical report, “Evaluation of the Visual System by the Primary Care Provider Following Concussion,” will be published in the August 2022 Pediatrics (published online July 18).
The AAP Section on Ophthalmology, the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, and the American Association of Certified Orthoptists joined to write the policy statement and clinical report.
Concussion is a common injury in childhood affecting an estimated 1.4 million children and adolescents annually in the United States. Most pediatric concussions occur in sports or recreational settings, and can result in difficulty reading, blurred vision, difficulty focusing, and eye fatigue.
“While vision problems following a concussion typically resolve over time, they can have a substantial impact on children in their school and extra-curricular activities,” said Christina L. Master, MD, FAAP, CAQSM, FACSM, FAMSSM, lead author of the statement and clinical report. “Pediatricians play a significant role in learning to identify kids who will need school accommodations and management of the injury throughout recovery, or even extra care from a specialist.”
Specialists with experience in comprehensive concussion management – such as those in sports medicine, neurology, neuropsychology, physiatry and ophthalmology – can help with further assessment and treatment when necessary, according to the statement.
Children may find it challenging to return to school or activities, and a pediatrician can recommend academic accommodations such as larger font, preprinted notes, and temporary use of books on tape. Early identification and appropriate management of visual symptoms may help lessen the negative effects of concussion on children and adolescents and their quality of life while they recover from a concussion.
The AAP describes vision disorders associated with concussion, health equity implications, and special health care needs that need to be taken into consideration.
“Children are not always able to describe their symptoms clearly, and so these screening and diagnostic tools will help guide physicians when evaluating patients with concussions,” Master said. “It’s important that we identify any problems with vision. They can have an enormous impact on a child or teen’s daily routines and quality of life.”
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.